AVASCULAR NECROSIS(AVN) OF THE HIP

INTRODUCTION:

              Avascular Necrosis is otherwise called as Osteonecrosis or Aseptic Necrosis of the hip. AVN of the hip is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, AVN can ultimately lead to destruction of the hip joint and arthritis.  Although it can occur in any bone AVN most often affects the hip. Many people each year enter hospitals for the treatment of AVN of the hip. In many cases, both the hips are affected by the disease.

ANATOMY:

            The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone). A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, low friction surface that helps the bones glide easily across each other.

CAUSES:

Ø  RISK FACTORS:

                                         Although it is not always known what causes the lack of blood supply, there are a number of risk factors that can make it more likely for someone to develop the disease:

·         Injury — Hip dislocations, hip fractures, and other injuries can damage the blood vessels and impair circulation to the femoral head

·         Alcoholism

·         Corticosteroid medicines — Many diseases, such as asthma, rheumatoid arthritis, and systemic lupus erythematous, are treated with steroid medications. Although it is not known exactly why these medications can lead to osteonecrosis, research shows that there is a connection between the disease and long-term steroid use.

·         Other medical conditions — Osteonecrosis is associated with other diseases, including Caisson disease (diver's disease or "the bends"), sickle cell disease, myeloproliferative disorders, Gaucher's disease, systemic lupus erythematous, Crohn's disease, arterial embolism, thrombosis, and vasculitis

Ø  Although AVN affects people of all ages. It most commonly occurs between the ages of 40-65.Men develop AVN more often than women.

SYMPTOMS:

                  Aseptic necrosis develops in stages. Hip pain is typically the first symptom. This may lead to a dull ache or throbbing pain in the groin or buttock area. As the disease progresses, it will become more difficult to stand and put weight on the affected hip, and moving the hip joint will be painful. It takes for the disease to progress through these stages varies from several months to over a year. It is important to diagnose this disease early, because some studies show that early treatment is associated with better outcomes.

EXAMINATION AND TEST:

    Increased pain during certain movements may be a sign of Avascular Necrosis.

IMAGING STUDY:

Ø  X-rays: These scans create pictures of dense structures, like bone. X-rays are used to determine whether the bone in the femoral head has collapsed and to what degree.

 

Ø  MRI:  Early changes in the bone that may not show up in an x-ray can be detected with an MRI scan. These scans are used to evaluate how much of the bone is has been affected by the disease. An MRI may show early osteonecrosis that has yet to cause symptoms (for example, whether osteonecrosis is developing in the opposite hip joint).

TREATMENT:

                     Although nonsurgical treatment options like medications or using crutches can relieve pain and slow the progression of the disease, the most successful treatment options are surgical. Patients with osteonecrosis that is caught in the very early stages (prior to femoral head collapse) are good candidates for hip preserving procedures.

Ø  Total Hip Replacement.

 

Ø  Vascularized Bone Graft.

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