The diagnosis of “avascular necrosis” (osteonecrosis) sounds like a death sentence: most patients are told that the only option is joint replacement. But in early stages, regenerative therapy can preserve the native joint.

What Is Avascular Necrosis

Avascular necrosis (AVN) is death of bone tissue due to disrupted blood supply. Most commonly affects the femoral head (70%), less often — femoral condyles, talus, humeral head. ICD-10: M87.

Causes

  • Corticosteroids (30% of all cases) — even a short course of prednisolone
  • Alcohol (20%)
  • Trauma (femoral neck fracture, dislocation)
  • Systemic lupus erythematosus, sickle cell anaemia
  • Idiopathic (20–30% — cause unknown)

ARCO Stages

StageMRIPrognosis without treatmentMIBRAR® chances
1 (reversible)Bone marrow oedemaProgresses to stage 2 in 6–12 months85–90%
2 (necrosis without collapse)Necrotic zone, contour preservedCollapse in 12–24 months70–80%
3 (early collapse)Subchondral fracture, crescent signRapid progression40–50%
4 (arthrosis)Secondary coxarthrosisArthroplastyPalliative effect

MIBRAR® Protocol for Avascular Necrosis

  1. BMAC (bone marrow) — main component: 2–5 million MSCs with high osteogenic potential
  2. CGF — fibrin scaffold + growth factors (BMP-2, VEGF) for neovascularisation
  3. Core decompression (micro) — drainage of the necrotic zone through a 3 mm puncture
  4. Navigation — CT control for precise targeting of the necrotic zone

Key difference from standard core decompression: we don’t just relieve pressure, we fill the necrotic zone with regenerative material.

Results

Based on 800+ AVN cases treated at the MIBRAR® clinic:

  • Stage 1: 90% joint preservation at 5 years
  • Stage 2: 75% joint preservation at 5 years
  • Stage 3: 45% joint preservation (delays arthroplasty by 3–5 years)

More about avascular necrosis treatment →