Hip Avascular Necrosis ( Femur Head Aseptic Necrosis)?
Bones are living tissues, and like all living tissue, they rely on blood-bringing blood vessels to keep them alive. Most living tissues have blood vessels that come into the tissue from many directions. If a blood vessel is damaged, it may not be a problem, as there may be a backup blood supply coming from a different direction. But some joints of the body have only a few blood vessels that bring blood. One of these joints is the hip.
The hip joint is one of the body’s true ball-and-socket joints. The hip socket is called the acetabulum and forms a deep socket surrounding the ball of the upper thigh bone. The thigh bone itself is called the femur , and the ball at the end is the femoral head. The thick muscles of the hip at the back and the thick muscles of the thigh at the front surround the hip.
surface of the femoral head and the inside of the acetabulum are covered with articular cartilage. This cartilage is about 2-2.5 mm thick in most large joints. Articular cartilage is a hard, slippery material that allows surfaces to glide without damaging each other.
femur , a thinner area of bone that connects the ball to the thighbone, to the ball that forms the hip joint. If this blood supply is damaged, there is no backup. Damage to the blood supply can cause the death of the bone that forms the ball of the femur . When this occurs, the bone can no longer protect itself.
Living bone always renews itself. To maintain a bone’s strength, bone cells continually repair the wear and tear that affects bone tissue. If this process stops, the bone may begin to weaken. Just as rust affects the metal structure of a bridge, and eventually the bone structure begins to collapse, like a rusty bridge.
avascular necrosis occurs in the hip joint , the top of the femoral head (ball part) collapses and begins to flatten. This occurs because this is where most of the weight is concentrated. Flattening creates a situation where the ball no longer fits properly into the slot. Like two parts of a mismatched piece of machinery, the joint begins to wear itself out. This leads to calcification of the hip joint and pain.
Hip Avascular Necrosis ( Femur Head Aseptic Necrosis) Develop?
Avascular necrosis has many causes. Anything that damages the hip blood supply can cause AVN .
Injuring the hip itself can damage blood vessels. Fractures of the neck of the femur (the area that connects the ball of the hip joint), dislocation of the hip joint can damage blood vessels. Avascular necrosis usually takes several months to appear and can become a problem for up to two years after such injury.
Some drugs are known to cause avascular necrosis. Cortisone is the most common drug known to cause avascular necrosis. This is usually only a problem in patients who need to take cortisone every day because of other diseases such as advanced rheumatism or to avoid rejection of an organ transplant. Sometimes there is no other option and cortisone must be prescribed to treat a condition, fully knowing that avascular necrosis may occur. Short-term cortisone therapy, such as one or two injections into the joints for the treatment of arthritis or bursitis , has not been proven to cause avascular necrosis.
There is a clear link between avascular necrosis and alcoholism. Excessive alcohol intake somehow damages blood vessels and leads to avascular necrosis. Deep-sea divers and miners operating under great atmospheric pressures are also at risk of damaging their blood vessels. The pressure causes small bubbles in the blood stream to form, which can block the blood vessels leading to the hip, which can damage the blood circulation.
What are the Symptoms of Hip Avascular Necrosis ( Femur Head Aseptic Necrosis)?
avascular necrosis is pain when weight is placed on the hip. Pain can be felt in the groin area, hip area, and anterior thigh. As the problem progresses, symptoms include limping when walking and stiffness in the hip joint. Eventually, the pain persists at rest and even during sleep.
Hip Avascular Necrosis (Hip AVN)?
hip avascular necrosis begins with the history and physical examination. Your doctor will want to ask about your occupation, any other medical problems you have, and your medication use. You will be asked if you drink alcohol. A physical examination will be done to determine how much stiffness you have in your hip and whether you have a limp. Once this is done, he or she will most likely order an X-ray.
avascular necrosis if the disease has been present long enough . Even if you have pain in the very early stages, it may not show up on X-rays. In advanced stages, the hip joint will be very calcified and it may be difficult to tell whether the real problem is avascular necrosis or advanced hip calcification. In both cases , treatment is basically total hip replacement surgery.
MRI scan is probably the most common test used to look for avascular necrosis of the hip. The MRI scanner uses magnetic waves instead of radiation. Multiple photos of the hip bones are taken by the MRI scanner. The images look like bone slices. An MRI scan is very sensitive and can show small areas of damage to the hip’s blood supply even just hours after the damage has occurred.
Hip Avascular Necrosis Include?
avascular necrosis occurs, treatment options are based on how advanced the problem is and your symptoms. While symptoms can be reduced with pain medications and anti- inflammatory drugs, no medical treatment can restore blood flow to the femoral head and reverse avascular necrosis.
What are the Non-Surgical Treatment Options?
avascular necrosis is caught early, a walker or crutches can help keep the weight of the aching foot off while standing and walking. The idea is to allow healing and prevent further damage to the hip. Stretching movements can be shown to patients in order not to lose the range of motion in the hip. Anti – inflammatory drugs are often used to relieve pain. In some cases, surgeons may recommend an electrical stimulator or hyperbaric oxygen therapy to allow the bone to heal. Sometimes these measures can help delay the need for surgery, but they rarely reverse the problem.
What are the Treatment Options with Surgery?
femoral head has not begun to collapse, your surgeon may recommend surgery to try to increase blood flow to the femoral head. Various processes have been designed to do this.
Decompression of the Femoral Head
The simplest operation is to try to reach the area without blood flow by making one or more holes from the femoral neck to the femoral head. The drill pierces a bone plug inside the femoral head. This surgery is thought to do two things: (1) it creates a channel for new blood vessels to rapidly enter the area where there is no blood flow, and (2) it relieves some of the pressure within the femoral head bone. Relieving this pressure seems to help reduce the pain patients experience from avascular necrosis.
This operation is performed with a very small incision on the side of the thigh. The surgeon watches with a fluoroscope as the drill is used . A fluoroscope is a type of X-ray that shows bones on a TV screen. The surgeon uses the fluoroscope to guide the drill where it needs to go . This operation is usually done on an outpatient basis, or you can go home on crutches the next day.
In addition to this procedure, stem cells taken from the patient can be placed through the drilled hole or holes to the damaged area of the femoral head with an injector.
Femoral Head Grafting
A more complex procedure to try to increase blood flow to the head of the femur , vascularized fibular bone grafting is one of the procedures. This is actually a tissue transplant. graft It is taken from the fibula (the thin bone that lies next to the shinbone). The graft is vascular, meaning it has its own blood supply. This graft supports the femoral head.
removes a piece of the small bone in your lower leg ( fibula ) along with the blood vessels leading to the bone. The surgeon then makes a hole in the femoral head from the side of the femur and places the graft . The surgeon connects the blood vessels in the fibula to one of the blood vessels around the hip. This provides instant blood flow to the bone graft and head of the femur . This operation does two things: (1) ensures blood flow to the femoral head through the bone graft , and (2) the fibular bone graft is strong and prevents the femoral head from collapsing as the bone heals on its own . This procedure is an inpatient procedure and will require you to stay in the hospital for several days.
This is a very complex process and not commonly done. The blood supply of the graft is not always successful because it is fragile and may not be fully formed.
Another method is to place the cylindrical cancellous bone taken from the iliac wing with special tools, by compressing it with special tools after the dead bone areas are removed. Along with this bone tissue, the stem cells and mineralized bone matrix present in the bone are also transferred. This graft is expected to revitalize the dead zone and prevent collapse.
However, it should be kept in mind that these methods will not be completely successful.
Total Hip Replacement
avascular necrosis is in advanced stage, the situation is not different from calcification of the hip joint. Your surgeon will likely recommend replacing the hip with an artificial hip joint.
What is done in rehabilitation?
You can work with a physical therapist who will show you ways to safely move and stretch your hip. The goal is to keep your hips mobile and avoid losing range of motion. Your therapist will also instruct you to use a walker or crutches. Keeping the weight off your hips while standing or walking can help the bone heal while preventing further damage to the femur .
Rehabilitation after surgery
After a simple piercing, you’ll likely be using crutches for up to six weeks. The holes made weaken the bone around the hip, making it possible to fracture the hip. Using crutches allows the bone to heal safely and reduces the risk of breaking your hip. Patients who have been grafted bone and blood vessels should limit how much weight they put on their hips for up to six months.
Once you are confident in putting full weight on your leg, your doctor may ask you to work with a physical therapist to help you regain hip range of motion and strength. Patients undergoing artificial hip joint replacement follow a structured physical therapy program that begins shortly after surgery.