<P> The intravertebral vacuum cleft sign (at white arrow) is a sign of avascular necrosis . Avascular necrosis of a vertebral body after a vertebral compression fracture is called Kümmel's disease . </P> <P> A variety of methods may be used to treat the most common being the total hip replacement (THR). However, THRs have a number of downsides including long recovery times and short life spans (of the hip joints). THRs are an effective means of treatment in the older population; however, in younger people they may wear out before the end of a person's life . </P> <P> Other techniques such as metal on metal resurfacing may not be suitable in all cases of avascular necrosis; its suitability depends on how much damage has occurred to the femoral head . Bisphosphonates which reduces the rate of bone breakdown may prevent collapse (specifically of the hip) due to AVN . </P> <P> Other treatments include core decompression, where internal bone pressure is relieved by drilling a hole into the bone, and a living bone chip and an electrical device to stimulate new vascular growth are implanted; and the free vascular fibular graft (FVFG), in which a portion of the fibula, along with its blood supply, is removed and transplanted into the femoral head . A 2012 Cochrane systematic review noted that no clear improvement can be found between people who have had hip core decompression and participate in physical therapy, versus physical therapy alone . More research is need to look into the effectiveness of hip core decompression for people with sickle cell disease . </P>

Icd10 code for avascular necrosis of right hip