AVASCULAR NECROSIS OF HIP
Avascular necrosis is a localized bone decay of top one –third part of head of femur as a result of trauma or other cause like drug side effects. Necrosis of joint result pain in joint, groin and front of thigh and reduce motion.
It is also called aseptic necrosis or osteonecrosis.
Blood supply of head of femur:
Early damaged with any femoral neck fracture or occluded with small embolic matter like lipids (fat emboli)
AVN occur where bone has single terminal supply such as hip-femoral head.
• Trauma- fracture neck femur
• Chronic corticoid steroid therapy (taking steroid for some other disease for longer time)
• Hyper lipidemics –increase level of lipids
• Trauma and some drug reactions are causative factor for AVN. Therefore drug should be used very carefully to avoid this very unpleasant side effect
• Early diagnosis very help full to control disease
• Optimal treatment is key for success.
• AVN of Hip prognosis depend upon underline cause-
• Larger area of bone necrosis often can’t be repair and ultimately joint replacement become necessary.
AVN of hip diagnosis is done through physical examination of hip joint, medical history and radiology process like X-ray, MRI and bone scanning
X-ray generally does not reveal any abnormality
• Plan radiography- normal or minor osteopenia
• MRI- edema
• Bone scan- increased uptake
• Clinical significance: Pain in groin
• A standard radiography show only the shadow of the mineralized portion of bone
The following conditions are excluded before reaching to correct diagnosis
• Haematopoelic marrow
• Pitt’s pit
• Fovea centralis
• Idiopathic transient osteoporosis of hip (Absence of focal lesion in MRI strongly suggestive of ITOH) Non weight bearing for some weeks reduced pain
• Pitts pit:
Refer to round latency in anterioposterior aspect of femoral neck
It is synovial herniation pit and has no clinical significance.
AVN HIP MANAGEMENT
Treatment depends upon causative factors.
If AVN of Hip diagnosis has been established general Principal is to avoid injury to affected joint by reducing weight bearing. In case of AVN hip crutches are used to reduce weight bearing on hip joint and joint mobility is maintained to delay joint replacement especially in young patients.
• Core decompression at very initial stage -Dead bone is removed
• Local bone grafting or
• Total hip replacement
• Result of core decompression is doubtful.
WHAT WE DO
We do Conservative treatment:
• Vikalp Physiotherapy clinic therapy help to optimize hip joint range of motion and pain reduction
• To control pain we use pulse magnetic therapy PEMF, special program of electrotherapy, shockwave therapy, exercises, modified activity of daily living & mobilization are helpful physiotherapy procedures.