What It Is

Osteonecrosis, also known as Avascular Necrosis (AVN), is a condition that occurs when the blood supply to a bone is interrupted or reduced, causing the bone tissue to die. In the knee, AVN most commonly affects the femur (thighbone) near the joint, leading to the collapse of the bone and subsequent arthritis if left untreated. Osteonecrosis can develop after an injury or due to underlying health conditions, such as prolonged steroid use or excessive alcohol consumption, which impact blood flow to the bone.

Signs & Symptoms

• Gradual onset of pain in the knee, often worsened with activity and relieved by rest
• Swelling and tenderness in the knee joint
• Limited range of motion and stiffness
• Pain that increases over time, eventually becoming constant, even at rest
• A feeling of instability or weakness in the knee

Diagnosis

Dr. Romanelli will conduct a physical examination to assess the knee’s function and identify any pain or movement limitations. Imaging tests such as X-rays, MRI, or bone scans are typically used to confirm the diagnosis of osteonecrosis and determine the stage of the condition. These tests can show bone damage, collapse, or early signs of AVN that are not yet visible on X-rays.

Treatment

Treatment for osteonecrosis focuses on stopping the progression of bone damage, relieving pain, and maintaining joint function. Early detection is crucial, as treatment options vary depending on the stage of the disease.

Non-Surgical Treatment

For early-stage osteonecrosis, non-surgical treatments may help reduce symptoms and slow the progression of the disease. These include:

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage pain and inflammation.
• Activity Modification: Limiting activities that place stress on the knee joint, such as weight-bearing exercises, can help prevent further damage.
• Assistive Devices: Using crutches or a cane to take pressure off the affected knee may be recommended in early stages.
• Core Decompression: A minimally invasive procedure that relieves pressure inside the bone and stimulates new blood flow to promote healing.

Surgical Procedure

Surgery is often necessary for advanced cases of osteonecrosis when non-surgical treatments are no longer effective. Surgical options include:

• Bone Grafting: This procedure involves transplanting healthy bone tissue into the affected area to promote healing and restore blood flow.
• Osteotomy: A bone-cutting procedure that realigns the knee joint to shift weight away from the damaged area and delay further joint collapse.
• Knee Replacement: In severe cases where the bone has collapsed and significant arthritis has developed, partial or total knee replacement surgery may be required to restore joint function and relieve pain.

Physical Therapy

Physical therapy is a critical part of recovery, both after surgical and non-surgical treatments for osteonecrosis. Rehabilitation focuses on strengthening the muscles around the knee, improving range of motion, and supporting the joint to prevent further damage. Dr. Romanelli works with physical therapists to design individualized rehabilitation plans that help patients regain mobility and return to their daily activities with reduced pain and improved function.