Avascular necrosis
Also known as: avascular necrosis, AVN, osteonecrosis, aseptic necrosis, ischaemic bone necrosis, bone infarction, osteonecrosis of the femoral head, hip osteonecrosis, steroid-associated osteonecrosis, alcohol-associated osteonecrosis, post-traumatic osteonecrosis
Avascular necrosis is the death of bone tissue caused by disruption or reduction of its blood supply. It is also called osteonecrosis, aseptic necrosis or ischaemic bone necrosis. The condition most commonly affects the femoral head at the hip but may also involve the knee, shoulder, ankle, wrist, jaw or other bones. Early disease may produce no symptoms. As structural damage develops, patients commonly experience deep joint pain, stiffness, reduced range of motion, limping and pain during weight-bearing. Progression can cause subchondral fracture, collapse of the articular surface and secondary osteoarthritis. Recognised risk factors include previous fracture or joint dislocation, prolonged or high-dose corticosteroid exposure, excessive alcohol consumption, sickle cell disease, systemic lupus erythematosus, organ transplantation, decompression sickness, certain chemotherapy or radiation treatments, pancreatitis, blood-clotting disorders and some metabolic conditions. In some cases, no cause is identified. Diagnosis generally requires clinical assessment and imaging. Plain radiographs may be normal during early disease, while magnetic resonance imaging can identify osteonecrosis before collapse is visible on X-ray. Treatment depends on the affected bone, disease stage, symptoms, age and underlying cause. Options may include activity and weight-bearing modification, walking aids, analgesia, physiotherapy, management of risk factors, core decompression, bone grafting, osteotomy or joint replacement. Conservative treatment may reduce symptoms but does not reliably restore dead bone or prevent collapse in advanced disease. Acupuncture may provide limited adjunctive pain or muscle-tension support in a medically stable patient, but it cannot re-establish the bone's blood supply, reverse necrosis, repair subchondral fracture or replace orthopaedic surgery. Chinese herbal medicine must not be represented as regenerating necrotic bone, and strong Blood-moving herbs require caution around surgery, anticoagulants and bleeding disorders.
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Lifestyle & Diet
- •Attend all orthopaedic and imaging appointments.
- •Follow prescribed weight-bearing restrictions precisely.
- •Use crutches, a walking frame, cane or other mobility aid as instructed.
- •Do not discontinue a mobility aid solely because pain temporarily improves.
- •Use prescribed analgesics and anti-inflammatory medicines according to medical advice.
- •Discuss corticosteroid exposure with the treating doctor but do not stop corticosteroids abruptly.
- •Use the lowest medically appropriate corticosteroid dose only under prescriber supervision.
- •Limit or avoid alcohol because excessive consumption is a recognised risk factor.
- •Do not smoke or vape tobacco or nicotine products.
- •Participate in physiotherapy designed for the affected joint and disease stage.
- •Use low-impact activities such as hydrotherapy, cycling or swimming only when approved.
- •Avoid high-impact exercise, jumping and heavy loading when joint collapse is possible.
- •Maintain muscle strength around the affected joint without exceeding structural restrictions.
- •Use pacing and planned rest to reduce pain flares.
- •Maintain adequate dietary protein and overall nutrition.
- •Ensure calcium and vitamin D needs are assessed when corticosteroid exposure or low bone density is present.
- •Manage diabetes, cholesterol, blood pressure and other cardiovascular risk factors.
- •Seek medical advice before using supplements marketed for bone growth or circulation.
- •Prepare for surgery by following instructions regarding medicines, smoking, alcohol, nutrition and infection prevention.
- •Do not stop anticoagulants or antiplatelets without surgical or medical advice.
- •After surgery, follow wound-care, bathing, driving and rehabilitation instructions.
- •Seek urgent care for fever, wound drainage, calf swelling, chest pain or sudden breathlessness.
- •Use home-safety modifications to reduce falls.
- •Address anxiety, depression, work limitations and sleep disturbance associated with chronic pain.
- •Discuss workplace modifications where prolonged standing, lifting or impact loading worsens symptoms.
- •Maintain follow-up even when symptoms are mild because early disease can progress.
Cautions & Contraindications
- •Do not claim that acupuncture or herbs regenerate necrotic bone or reopen its blood supply.[,]
- •Do not replace MRI, orthopaedic assessment or surgery with acupuncture, herbal therapy or massage.[,,]
- •Do not perform forceful manipulation over a joint affected by osteonecrosis.
- •Do not encourage unrestricted weight-bearing when subchondral fracture or joint collapse is possible.[,]
- •Do not needle through a surgical incision, infection, ulcer or draining wound.
- •Do not needle into or directly over a prosthetic joint or orthopaedic implant without specialist clearance.
- •Do not use strong local treatment immediately after core decompression, osteotomy, grafting or joint replacement.
- •Do not advise abrupt cessation of corticosteroids.[]
- •Do not recommend alcohol-based herbal preparations to patients advised to avoid alcohol.
- •Dān Shēn, Táo Rén, Hóng Huā, Chuān Xiōng, Dāng Guī, Sān Léng, É Zhú and Niú Xī may increase bleeding risk.
- •Strong Blood-moving formulas should generally be avoided before surgery and in patients using anticoagulants or antiplatelets.
- •Fù Zǐ and related aconite herbs can cause fatal cardiac and neurological toxicity.
- •Gān Cǎo may cause hypertension, oedema and hypokalaemia and may interact with corticosteroids or diuretics.
- •Dà Huáng and other purgatives may cause dehydration and electrolyte disturbances.
- •Avoid Aristolochia species and any product containing aristolochic acid.
- •Avoid unregulated products marketed as bone-growth, stem-cell or circulation cures.
- •Screen herbal products for undeclared corticosteroids, non-steroidal anti-inflammatory medicines, heavy metals and pharmaceutical adulterants.
- •Review all herbs for liver disease, kidney disease, pregnancy, transplantation and immunosuppressant interactions.
- •Do not use vigorous cupping, scraping or bloodletting in sickle cell crisis, coagulopathy, thrombocytopenia or perioperative care.
- •Do not interpret increasing pain, loss of motion or inability to bear weight as detoxification or healing.
Frequently Asked Questions
What is avascular necrosis?+
Avascular necrosis is the death of bone tissue caused by interruption or reduction of its blood supply [6].
Which joint is most commonly affected?+
The hip, particularly the femoral head, is most commonly affected, although the knee, shoulder, ankle, wrist and other bones may also be involved [6].
What causes avascular necrosis?+
Causes and risk factors include trauma, corticosteroid exposure, excessive alcohol use, sickle cell disease, lupus, transplantation and some medical treatments [6].
Can early avascular necrosis have no symptoms?+
Yes. Early disease may be asymptomatic and may not be visible on an ordinary X-ray [6].
How is avascular necrosis diagnosed?+
Diagnosis uses clinical assessment and imaging. MRI is particularly useful for identifying early osteonecrosis [6].
What happens if avascular necrosis progresses?+
The affected bone may develop small fractures, collapse and secondary osteoarthritis with increasing pain and loss of movement [6].
How is avascular necrosis treated?+
Treatment may include weight-bearing modification, pain management, physiotherapy, core decompression, bone grafting, osteotomy or joint replacement [6].
Can acupuncture reverse avascular necrosis?+
No. Acupuncture cannot restore dead bone or reliably prevent structural collapse, although it may provide adjunctive pain support [6].
Are Chinese Blood-moving herbs safe before surgery?+
Not necessarily. Many may increase bleeding risk and should be reviewed by the surgeon, doctor and pharmacist [6].
When does joint pain require urgent assessment?+
Urgent assessment is needed after trauma, with inability to bear weight, deformity, fever, joint redness, neurovascular symptoms or sudden major deterioration [6].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases · 2021
Authoritative overview of interrupted bone blood flow, bone death, joint collapse, risk factors, diagnosis and treatment.
- PubMed-indexed clinical review · 2026
Orthopaedic reference covering femoral-head osteonecrosis, symptoms, risk factors, imaging and surgical options.
- Mayo Clinic · 2025
Clinical overview of bone-tissue death, symptoms, complications and major risk factors including trauma, corticosteroids and alcohol.
- Royal National Orthopaedic Hospital NHS Trust · 2025
Specialist patient guidance on disrupted femoral-head blood supply, joint deformation, stiffness and treatment considerations.
- MedlinePlus, United States National Library of Medicine · 2024
Consumer medical summary of reduced bone blood flow, bone breakdown, symptoms and treatment.
- World Health Organization · 2008
Standard acupuncture-point nomenclature and anatomical-location methodology.
- World Health Organization · 2021
International reference for acupuncture competence, clinical procedures, infection control and safety.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.