If the hip pain or discomfort caused by avascular necrosis does not improve with non-operative treatment, or if your doctor is concerned about further collapse of the ball and worsening of your condition, surgery for AVN may be recommended.

Autologous bone-marrow grafting and core decompression

First, the surgeon drills a hole into the bone to relieve the internal bone pressure (core decompression), then injects healthy bone marrow harvested from another part of the patient’s body (autologous bone-marrow grafting) into the diseased hip bone to facilitate healing.

Free vascularized fibular grafting

In mild-to-moderate avascular necrosis, treatment is generally core decompression and bone grafting; in late-stage avascular necrosis, the standard treatment is total hip arthroplasty. Microsurgical free vascularized fibular grafting (FVFG) is an alternative approach to treat certain forms of avascular necrosis.

In a FVFG procedure, dead bone at the hip is replaced with live, structurally sound and vascularized bone from the fibula (lower leg). Blood vessels from the living bone are then attached to those around the hip to provide immediate blood supply. FVFG is offered in cooperation with our orthopedic colleagues at the Hospital of the University of Pennsylvania (HUP).