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Femoral Head Avascular Necrosis

Aseptic necrosis of the hip is the death of bone tissue in the head of the femur due to an inadequate blood supply.

Certain bones have a fragile blood supply. The head of the femur in the hip joint is the most likely to suffer loss of blood supply. This can cause tissue death.*

Causes

Any event or condition that damages the arteries that feed the head of the femur raises the risk of aseptic necrosis. The most common events are fractures in the upper femur and dislocations of the hip, especially developmental dysplasia of the hip. Other causes reduce the blood supply by closing off or compressing the blood vessels.

There is a specific type of aseptic necrosis of the hip called Legg-Calvé-Perthes disease that affects the growth plate at the upper end of the femur in children. It most commonly affects boys aged 5-10 years old.*

Risk Factors

Factors that increase your chance of developing aseptic necrosis of the hip include:

  • Femoral neck fractures
  • Hip trauma
  • Dislocation of the hip
  • Radiation therapy
  • Prolonged or repeated use of cortisone-like drugs
  • Decompression sickness
  • Sickle cell disease
  • Gaucher disease
  • Cushing disease
  • Excessive alcohol use
  • Systemic lupus erythematosus (SLE) —especially if SLE is being treated with corticosteroids
  • Chronic renal failure or renal transplantation
  • HIV infection*

Symptoms

The few symptoms of aseptic necrosis of the hip are nonspecific and may be caused by other, less serious health conditions. Symptoms include:

  • Groin pain, especially with weight-bearing actions
  • Hip pain or limited hip motion
  • Buttock, thigh, and knee pain
  • Limping

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. If the diagnosis is suspected, you will be referred to an orthopedic surgeon.

Images may need to be taken of your internal structures, especially your bones. This can be done with:

  • X-ray
  • CT scan
  • Radioisotope bone scan
  • MRI Scan

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Conservative Treatment

Taking nonsteroidal and other pain relievers and performing non-weight-bearing exercises may prevent or minimize disease progression.

Surgery

There are several surgical procedures used to treat aseptic necrosis of the hip. The choice depends on the extent of disease and the age and health status of the patient. Bone grafts, decompression of the inside of the bone, realignment of the bone, femoral head resurfacing, and prosthetic hip replacement are all available.

Prevention

To help reduce your chances of getting aseptic necrosis of the hip, take the following steps:

  • Minimize the dose and duration of cortisone-like drugs
  • Avoid decompression disease when diving underwater

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