How is osteonecrosis (ON) treated?

Treatments for osteonecrosis are based on various factors, including the patient's age, the size of the lesion, its location on the bone that the condition affects, the underlying cause of the problem and the stage of the disease.

Osteonecrosis treatment is meant to ensure bone and joint survival, to prevent additional bone damage and to allow the patient to better use the joint affected. Treatments for ON include:

  • Core decompression: Core decompression is a surgery in which the inner layer of bone is removed, allowing for better blood flow to the area of concern. This surgery is most effective for people in the earliest stages of the disease. It is usually used for small to medium size pre-bone collapse lesions.
  • Osteotomy: This surgery reshapes either the affected bone or surrounding bones in order to decrease stress on the afflicted area. The surgery is most effective for patients with advanced forms of the disease and for when ON affects a small area of bone. Depending on how advanced the disease is and other factors, this surgery can be very effective. However, this procedure is used less often as it can affect future total hip replacement or reconstruction.
  • Bone graft: Bone graft is commonly used for medium to larger-sized lesions. In this surgery, diseased bone is replaced with healthy bone from another part of the body.
  • Joint replacement: This treatment is used in late-stage ON and when the joint cannot be saved. The diseased joint is replaced with artificial parts, to recreate the mechanics of a human joint. This option is most commonly used for patients with collapsed bone.

Other exploratory treatments include medications and combination therapies meant to increase the growth of new bone and blood vessels. Many of these are experimental, but have been proven in studies. Patients need to carefully follow instructions about activity limitations and work with their doctors to make sure that appropriate treatments are used.

Last reviewed by a Cleveland Clinic medical professional on 12/10/2017.


  • American College of Rheumatology. Osteonecrosis. Accessed 6/4/2018.
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteonecrosis. Accessed 6/4/2018
  • Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update. J Bone Joint Surg Am 2015;97:1604–27
  • Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J 2017;99–B:1267–79.

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