No fractures? no steroid use you did not want to tell the doc about?
Here is some stolen info on what they can use surgery for in your instance:
Surgical Intervention
Surgical treatment of AVN can be broadly categorized as either prophylactic measures (to retard progression) or reconstruction procedures (after femoral head collapse). Small asymptomatic lesions do not warrant surgical intervention and are closely monitored with serial examination. If symptoms ensue, repeat imaging and surgical treatment are indicated.
Prophylactic measures
The most commonly performed prophylactic surgical intervention is core decompression, whereby one or more cores of necrotic femoral head bone is removed in order to stimulate repair.8 Core decompression is often supplemented with bone grafting (cancellous autograft or structural allograft) to enhance mechanical support and augment healing. Biologic augmentation of core decompression includes the addition of demineralized bone matrix, bone morphogenic proteins, or electric/electromagnetic stimulation.9 These agents are purported to either enhance bone formation or decrease bone resorption in the hope of maintaining the structural integrity of the femoral head. Biologic augmentation of core decompression alone offers therapeutic benefit—if it is instituted before subchondral collapse (Steinberg stage III).9
The addition of a vascularized fibular graft to core decompression offers promise in cases with more advanced lesions, but this procedure involves considerable morbidity. One study indicated that vascularized fibular grafts were more effective in preventing femoral head collapse than nonvascularized fibular autografts.10
The results of prophylactic measures for femoral head AVN have considerable variation, but certain generalizations can safely be stated. Namely, the clinical results of core decompression alone deteriorate with more advanced lesions.9 The addition of cancellous bone grafting appears to slightly enhance clinical outcomes if subchondral fracture is present.10 The addition of demineralized bone matrix to core decompression confers little (if any) clinical response, and the effects of bone morphogenic protein remain uncertain.
The supplemental implementation of electrical stimulation with core decompression has provided disappointing results.9 Low-frequency pulsed electric and magnetic fields may offer more promise, but clinical results thus far are inconclusive. The placement of a structural graft through a core tract into the femoral head generally yields disappointing results. However, grafts placed into the femoral neck or directly into the femoral head are more promising. Free vascularized fibular grafting significantly alters disease progression in precollapse lesions and is even useful in modifying disease in mildly collapsed and early arthritic hips.10
Osteotomies are performed in attempt to move necrotic bone away from primary weight-bearing areas in the hip joint. Osteotomies can be angular or rotational, with the latter proving to be much more technically difficult. These techniques may delay arthroplasty, but they are best suited for small precollapse or early postcollapse of the femoral head in patients who don't have an ongoing cause of AVN. However, osteotomies make subsequent arthroplasty more challenging and, unfortunately, these procedures are associated with an appreciable risk of nonunion.
The role of arthroscopy to better stage the extent of disease has emerged. Arthroscopic evaluation of the joint can help better define the extent of chondral flaps, joint degeneration and even joint collapse and may help with the temporary relief of synovitis.11 Arthroscopic-assisted reduction of the head collapse is experimental at this time.
Thank you medscape.com the explainerer of oh so many conditions.
