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What is the treatment for avascular necrosis (osteonecrosis)?

Q: I am 25 year old male (height 5'8", weight 72kg) tea-totaller, pure vegetarian taking a normal diet. I am suffering from avascular necrosis (AVN) of my left hip joint. The damage to the femoral head is clearly visible on X-ray. Intially, the damage was very limited and the bone was in good condition but two years later it increased. There is no change in the avascular area of the femoral head. I have consulted 5-6 surgeons. Some suggested total hip replacement (THR), some bone grafting and others exercise. Nobody talks about BHR. I do not have regular pain and I have never taken a pain killer. Sitting in yoga position and some wide movements are painful. On walking long distances or holding weight I feel a light pain near my hip joint. I am not doing any exercises nor am I taking any medicine. I am totally confused. Please advise regarding the following - can I have sex regularly or I have to take some precautions? What kind of hip excercises are advisable? Is swimming good in my case? Will losing body weight be effective? Can medicines help? What diet is advisable? Is BHR advisable at this stage? What is the approximate cost of BHR? How much rest will I require after BHR surgery? I am a software engineer and have to sit for 8-9 hours. Should I look for another job?

A:When AVN (osteonecrosis) leads to arthritis or collapse of the head, any surgery short of hip replacement cannot give long term relief. BHR is not practised widely due to lack of long term reports though it is widely practised in Europe. You may be a good candidate for it, but here in USA, it is not performed. So I dont know about the cost. It is performed in atleast one good centre in South India - Chennai Apollo. About the exercises - you should do it if it does not hurt. Swimming is a good exercise and weight loss certainly helps reduce pressure on the hip. You can take analgesics for pain relief but there is no medication to revert arthritis or AVN.

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