Avascular necrosis, or osteonecrosis, of the hip refers to the progressive death of the bone under the articular cartilage of a joint, most commonly the femoral head of the hip. It usually results from the loss of the blood supply to the bone in this region. It can occur after a traumatic event, such as a hip dislocation or subluxation, but it can result from alcohol use, steroids, and medical issues. In the hip, it often presents as groin pain. Severity can range from mild pain and no articular cartilage breakdown to collapse of the bone and cartilage with degeneration of the involved joint.
Causes of avascular necrosis of the hip
Avascular necrosis can often develop after a traumatic injury that disrupts the blood vessels supplying the femoral head. A displaced femoral neck fracture or a hip dislocation can lead to later AVN.
This condition can also occur without a traumatic event. Some of the risk factors associated with osteonecrosis include long-term use of steroid medications, chronic alcohol use, and many medical conditions, such as sickle cell disease.
Signs and symptoms of osteonecrosis
A patient with avascular necrosis will often notice hip and groin pain. Certain motions and walking can make this pain worse. Over time as the condition worsens, the patient might lose range of motion in the affected hip.
Diagnosis of avascular necrosis
An orthopedic surgeon will check the patient’s hip range of motion and look for other areas of tenderness. X-rays of the hips can demonstrate the collapse of the femoral head, if it’s present. An MRI can be useful, especially in the early stages of the condition, when x-ray changes are not as noticeable. An MRI might also show changes in the opposite femoral head, even before a patient starts having pain on that side.
Generally nonsurgical treatments for avascular necrosis can decrease pain, but they do little to slow the progression of the disease process. Using crutches to decrease weight on the hip can lessen pain.
Options for surgery
Surgery to try to restore blood supply and preserve the femoral head can be a reasonable option, especially in the earlier stages of this condition. One option for some patients involves core decompression, where the surgeon drills holes in the femoral neck to decrease pressure and increase blood flow to the femoral head. Another option is to add bone graft to the drill holes to try to support the bone of the femoral head. Transferring a part of the fibula (long bone on the outside of the leg) with its blood supply to the femoral neck and head can be an option as well.
If the disease process is advanced, and the femoral head has already started to collapse, a patient with avascular necrosis might be limited to a hip replacement. In this procedure, the surgeon removes the diseased femoral head and replaces the worn out bone and cartilage with metal and plastic implants.
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