Hip pain is one of the most common types of pain in the world. It is caused due to various problems with hip muscles, ligaments, tendons and other soft tissues surrounding the hip. Avascular Necrosis (AVN) is commonly occurs in the Hip. Bone is a living tissue hence it requires blood. In Avascular Necrosis (AVN), bone tissue dies due to a lack of blood supply. If this problem is not treated on time then it can lead to tiny breaks in the bone and finally causes bone to collapse. Avascular Necrosis (AVN) is also known as Osteonecrosis, Aseptic Necrosis or Ischemic Bone Necrosis. People between the age group of 30-50 are mostly affected by Avascular Necrosis disease.
Causes- Avascular Necrosis of Hip:
Avascular Necrosis (AVN) mainly occurs when the blood flow to a bone is get interrupted or reduced.
This insufficient blood supply is caused by various factors such as:·
1. Joint or Bone Trauma
Road accidents can cause severe hip injury like Hip dislocations, severe hip fractures and other injuries to the hip which can damage the functions of blood vessels. These damaged blood vessels are unable to supply sufficient amount of blood to the femoral head.
2. Excessive Alcohol Intake
Excessive alcohol intake can cause fatty substances to deposit in the blood vessels so that the blood supply to the bones decreases.
3. Corticosteroids Medicines
Steroid medicines are used to treat many diseases such as Asthma, Rheumatoid Arthritis and Systemic Lupus Erythematosus. This reason is still unknown but research shows that the high dose of Corticosteroids can increase lipid levels in the blood reducing blood flow to bones
4. Medical Treatments
Certain medical treatments such as radiation in cancer treatment can weaken the bone. Organ transplantation especially Kidney transplant also causes Avascular Necrosis of Hip.
5. Other Medical Diseases
Avascular Necrosis of Hip is also associated with other diseases such as Caisson disease (diver's disease or the bends), Sickle cell disease, Myeloproliferative disorders, Gaucher's disease, Systemic lupus erythematosus, Crohn's disease, arterial embolism, thrombosis and vasculitis.
Symptoms-Avascular Necrosis of Hip:
At early stage,many patients do not show any specific symptoms. But as the condition becomes worse the affected joint starts hurting and patient can feel extreme pain in the
1. Hip: Patient starts experiencing pain gradually. Pain can be mild or severe depending on the level of bone damage. Patient suffering from the Avascular Necrosis of the hip can feel pain mainly in the groin, thigh or buttock area. But sometimes pain can be spread to shoulder, knee, hand and foot areas.
2. Diagnosis- Avascular Necrosis of Hip: Orthopedic doctor or Hip Surgeon performs physical examination of patient like pressing joints and checking tenderness. Doctor also ask patient to move joints in various positions to observe the range of motion. Many times doctor does not find exact location of pain.
In such situation, doctor asks for imaging tests such as:·
3. X rays: In the initial stage, X rays appears normal but in the later stages X rays show changes in the bone.
4. CT or MRI Scan: These tests produce detailed images which show early changes in bone. This test reports are used to indicate Avascular Necrosis.
5. Bone Scan: In Bone Scan test, a small amount of radioactive material is injected into the vein. This tracer travels to the parts of bones that are injured or healing and shows up as bright spots on the imaging plate.
Treatment- Avascular Necrosis of Hip:
The Avascular Necrosis treatment is mainly depending on the level of bone damage. The main goal of treatment is to prevent further bone loss. The treatment of Avascular Necrosis of Hip is divided into two types’ medications or physical therapy and surgical procedures. Medications and Therapies In the early stage of Avascular Necrosis of Hip, doctor prescribes effective medicines to cure symptoms. A doctor recommends various medicines and therapies such as ·
1. Non steroidal Anti-Inflammatory Drugs: These medicines help to relieve the pain in the Avascular Necrosis of Hip. Osteoporosis Drugs: These drugs are used to slower the progression of Avascular Necrosis.
2. Cholesterol-Lowering Drugs: These drugs are used to reduce the amount of cholesterol and fat inblood to prevent the vessel blockages that can cause Avascular Necrosis.
3. Blood thinners: Doctor recommended Blood Thinners to prevent blood clots in the vessels.
4. Rest: Rest is very important to cure Avascular Necrosis of hip. Patient should reduce the weight and stress on affected bone as well as should avoid heavy physical activity.
5. Exercises: Physiotherapist teaches suitable exercises to patient for marinating or improving the range of motion in hip joint.
Surgical Treatment If medicines failed to cure Avascular Necrosis of Hip then doctor decides surgical treatment option. Today, hip surgery is performed by Minimally Invasive Technique.
Various surgical options are:· Core Decompression Surgery: In this surgery, Surgeon removes part of the inner layer of bone. This surgery not only reduces the pain but also stimulates production of healthy bone tissues and new blood vessels.
Bone Transplant (Graft): This surgery is helpful to strengthen the area of bone affected by Avascular Necrosis. The graft is a section of healthy bone taken from another part of body.
Bone Reshaping (Osteotomy): In Osteotomy procedure, a wedge of bone is removed above or below a weight-bearing joint to help shift weight from damaged bone.
Bone reshaping postpones joint replacement surgery.
Joint Replacement Surgery: This surgery is performed to replace the damaged parts of joint with plastic or metal parts.
Regenerative Medicine Treatment: Bone Marrow aspirate and concentration is a newer procedure which is used for early stage Avascular Necrosis of the hip. In this surgery, Stem cells are harvested from patient’s bone marrow. During surgery a core of dead hip bone is removed and stem cells inserted in its place which allows for growth of new bone. More research is going on to get best results.If Avascular Necrosis of the hip is diagnosed after collapse of the bone and core decompression surgery failed to prevent further collapse. In this situation,the patient is best treated with a total hip replacement surgery which is very effective in relieving pain and restoring motion. Today, Hip Replacement Surgery is performed by minimally invasive technique over traditional technique. Minimally Invasive surgery has lots of benefits such as less pain,minimal blood loss, faster recovery and no scarring.