Avascular Necrosis: Treatment Without Joint Replacement

The diagnosis of “avascular necrosis” (osteonecrosis) sounds like a death sentence: most patients are told that the only option is joint replacement. But in early stages, regenerative therapy can preserve the native joint.

What Is Avascular Necrosis

Avascular necrosis (AVN) is death of bone tissue due to disrupted blood supply. Most commonly affects the femoral head (70%), less often — femoral condyles, talus, humeral head. ICD-10: M87.

Causes

• Corticosteroids (30% of all cases) — even a short course of prednisolone
• Alcohol (20%)
• Trauma (femoral neck fracture, dislocation)
• Systemic lupus erythematosus, sickle cell anaemia
• Idiopathic (20–30% — cause unknown)

ARCO Stages

Stage	MRI	Prognosis without treatment	Regenerative treatment chances
1 (reversible)	Bone marrow oedema	Progresses to stage 2 in 6–12 months	85–90%
2 (necrosis without collapse)	Necrotic zone, contour preserved	Collapse in 12–24 months	70–80%
3 (early collapse)	Subchondral fracture, crescent sign	Rapid progression	40–50%
4 (arthrosis)	Secondary coxarthrosis	Arthroplasty	Palliative effect

Regenerative treatment Protocol for Avascular Necrosis

1. BMAC (bone marrow) — main component: 2–5 million MSCs with high osteogenic potential
2. CGF — fibrin scaffold + growth factors (BMP-2, VEGF) for neovascularisation
3. Core decompression (micro) — drainage of the necrotic zone through a 3 mm puncture
4. Navigation — CT control for precise targeting of the necrotic zone

Key difference from standard core decompression: we don’t just relieve pressure, we fill the necrotic zone with regenerative material.

Results

Based on published series of avascular necrosis treated with cell-based methods:

• Stage 1: 90% joint preservation at 5 years
• Stage 2: 75% joint preservation at 5 years
• Stage 3: pain reduction is possible

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