Osteonecrosis hip, also called avascular necrosis or AVN, occurs when the blood supply is interrupted to the head of the femur (the ball of the ball and socket joint). When the blood supply is cut, the bone receives fewer nutrients and oxygen, leading to bone death. What causes hip osteonecrosis, and what can we do about it?
Cause of Osteonecrosis Hip
We think that disruption of the blood supply to the head of the femur leads to bone swelling, followed by bone death and collapse.
Most causes of hip avascular necrosis or AVN are unknown. However, cortisone use, alcohol intake, trauma such as a fracture, inflammatory arthritis such as lupus, sickle cell disease, Crohn’s disease, vasculitis, high cholesterol, and HIV infection are all associated risk factors.
Generally, men between 40 and 60 are at the highest risk.
Osteonecrosis Hip Symptoms
When the blood flow is interrupted, the bone dies, leading to collapse. Subsequently, the articular cartilage collapses, producing debilitating arthritis.
Generally, people with avascular necrosis describe the new onset of pain in the hip or groin. As the disease progresses, walking can become difficult. Night pain is also common. Your doctor will examine your hip and groin. Hip movements are often painful, mainly when your doctor rotates your hip.
You must consider other causes of hip and groin pain, such as hip impingement, arthritis, dysplasia, or bone marrow oedema.
Often, we confirm a diagnosis by using imaging.
First, we start with a hip X-ray. In early cases, we can see sclerosis of the dead area of bone. In advanced cases, we see the collapse of the hip ball and arthritis. Sometimes, an X-ray is normal, necessitating an MRI.
Osteonecrosis Hip MRI
MRI imaging is the best diagnostic tool for investigating AVN of the hip. An MRI scan reveals swelling or bone oedema of the femoral head. As the disease progresses, there is destruction of the articular cartilage, leading to the collapse of the head and early osteoarthritis.
Osteonecrosis hip treatment
Treatment of Osteonecrosis of the hip is complex.
If symptoms are detected early, rest with crutches and anti-inflammatory medication can help restore blood flow. Sometimes, we use a unique drug called bisphosphonates, such as alendronate. Some studies show benefits in improving blood flow and preventing bone collapse, but others show no effect.
Surgical options in the early stages, before damage to the cartilage occurs, include hip decompression and surgical bone grafting. Surgical decompression involves drilling one or larger holes in the head of the femur to increase blood flow. Sometimes, we combine decompression with bone grafting from another healthy site to improve blood flow. A recent review found that core decompression combined with bone grafting was better than decompression alone in preventing bone collapse. However, this combined treatment did not reduce the time to total hip replacement.
A total hip replacement is a good option if the osteonecrosis is too advanced and has led to collapse. This procedure gives good pain relief and is a good option for people above the age of 40 with evidence of collapse.
Other Frequently Asked Questions about Osteonecrosis Hip
What is the best exercise for avascular necrosis of the hip?
The best exercises for avascular necrosis of the hip include strengthening and mobility. A strengthening programme should include glute, hamstring, adductor and hip flexor muscle exercises. Core exercises can also help with stability at the hip and pelvis and are helpful to include. The patient should do a strengthening exercise programme two to three times per week.
Do Bisphosphate treatments reduce the risk of osteonecrosis progression?
Bisphosphonate treatment, such as alendronate, is used early to prevent collapse. However, studies show that these drugs do not improve outcomes or avoid bone hip collapse compared to other treatments. More research is needed to determine whether these drugs improve outcomes in early hip AVN.
Final word from Sportdoctorlondon about Hip Osteonecrosis
AVN, or avascular necrosis of the hip, is a rare cause of sudden pain and limited movement in the hip or groin. Early diagnosis with imaging is essential to improving outcomes. You should see a specialised sports doctor who can diagnose and treat you early.
Leave A Comment