Femoral Head Avascular Necrosis Medication

Updated: Oct 20, 2023
  • Author: John D Kelly, IV, MD; Chief Editor: Craig C Young, MD  more...
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Medication Summary

Medical therapy for AVN of the hip is principally indicated for relief of discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs) and, on occasion, narcotics, form the basis of pharmacotherapy. Investigations into vasoactive lipid-lowering agents and anticoagulants are ongoing and hold promise [6, 28, 29] (eg, studies suggest low molecular weight heparin [LMWH] may prevent the progression of idiopathic osteonecrosis of the hip [26] ); however, these medications are not currently recommended. Inhibition of the vascular endothelial growth factor may hold promise in preventing femoral head collapse because revascularization compromises bone structural integrity. Because medical comorbidities are common in patients with AVN, the use of selective cyclooxygenase (COX)–2 inhibitors is appealing.


Cyclooxygenase-2 inhibitors

Class Summary

These agents inhibit primarily COX-2, an isoenzyme that is induced during pain and in response to inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID gastrointestinal (GI) toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased.

Celecoxib (Celebrex)

Selective COX-2 inhibitor with improved GI tolerability over first-generation NSAIDs