Osteonecrosis (bone death), also called avascular necrosis (AVN) or aseptic necrosis, of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is changed, or significantly diminished and is not providing enough blood to the bone cells. This can lead to the cellular death of the bone cells in the femoral head, resulting in collapse of the femoral head, which also causes cartilage covering the hip bones to collapse.
Bone cells, like all cells, need a steady supply of blood to provide nutrients and oxygen. There are a few bones in the body which have a unique blood supply that makes them susceptible to this problem and the femoral head is one of those areas.
Who is at risk for osteonecrosis of the hip?
- Most common between the ages of 40 and 65
- Men develop osteonecrosis more often than women
- Previous injuries to the hip, such as a hip dislocation or fracture
- Excessive, prolonged alcohol use
- Chronic medical steroid use for conditions such as autoimmune diseases
- Some diseases or medical conditions can cause osteonecrosis such as sickle cell and Crohn’s disease
Osteonecrosis develops in stages. Hip pain is typically the first symptom and may lead to a dull ache or throbbing in the hip area, notably the groin or buttock area. As the disease progresses other symptoms can include:
- Difficulty standing
- Pain-can be sudden and severe when femoral head collapses
There are nonsurgical treatment options to relieve pain and slow progression of osteonecrosis such as anti-inflammatory medications, activity changes or using a cane or crutches; however, surgery is the most successful treatment option.
There are several different surgical procedures used to treat osteonecrosis of the hip:
- Core decompression: In early stages, drilling into the femoral head is performed to encourage the development of new blood supply, prevent collapse of the femoral head and slow the development of arthritis.
- Osteochondral (bone and cartilage) grafting: Regenerates healthy bone and cartilage at the hip joint. This procedure is used in conjunction with core decompression.
- Vascularized fibula graft: A segment of bone is taken from the fibula (smaller bone in the lower leg) and transplanted into the femoral neck and head to heal osteonecrosis.
- Total hip replacement: If the femoral head has already collapsed, a total hip replacement will remove the damaged bone and cartilage and be replaced with a new hip prosthesis. Total hip replacement is successful in relieving pain and restoring function in the majority of patients with osteonecrosis.
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