Diagnosis and Treatment of Osteonecrosis of the Hip in Wake County

What is Osteonecrosis of the Hip?

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, resulting in reduced blood supply to the bone cells. This can lead to the cellular death of the bone cells in the femoral head, resulting in the collapse of the femoral head. In turn, this causes the 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 that have a unique blood supply that makes them susceptible to this problem, and the femoral head is one of those areas.

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Causes of Osteonecrosis of the Hip

The cause of reduced blood supply to the hip in cases of osteonecrosis is not always clear. However, those in the medical community have identified a number of risk factors that can make someone more likely to develop this condition. Risk factors for osteonecrosis of the hip include:

  • Being between the ages of 40 and 65
  • Being a man, as 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
  • Having other diseases that can cause osteonecrosis, including sickle cell and Crohn’s disease

Symptoms of Osteonecrosis of the Hip

Osteonecrosis develops in stages. Hip pain is typically the first symptom and may involve 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, which can be sudden and severe when the femoral head collapses
  • Stiffness
  • Limp

How is Osteonecrosis of the Hip Diagnosed?

When diagnosing osteonecrosis, a doctor will begin by conducting a physical examination. They will look for tender areas by pressing on the joints and check the patient’s range of motion by moving the joints into different positions. If necessary, your healthcare provider may order imaging tests to diagnose osteonecrosis. X-rays can show changes to the bones in the later stages of osteonecrosis but are not as effective in the early stage. MRI and CT scans are better at displaying early-stage osteonecrosis. A bone scan can also be used to highlight parts of the bones that are injured or in the healing process.

Treatment Options for Osteonecrosis of the Hip at Raleigh Orthopaedic

Nonsurgical Treatment

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There are several nonsurgical treatment options to relieve pain and slow the progression of osteonecrosis, including anti-inflammatory medications, activity changes, or using a cane or crutches. However, surgery is the most successful treatment option, especially when the condition is caught in the early stages.

Surgical Treatment Options

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There are several different surgical procedures used to treat osteonecrosis of the hip:

  • Core decompression: In the early stages, drilling into the femoral head is performed to encourage the development of new blood supply, prevent a 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 incorporate a new hip prosthesis. Total hip replacement is successful in relieving pain and restoring function in the majority of patients with osteonecrosis.

Recovering from Surgery for Osteonecrosis of the Hip

After surgery to correct osteonecrosis, you will remain in the hospital for several days. Your doctors or pain management team will work to keep you comfortable during your hospital stay by prescribing the right medication. You may also work on range of motion and learn how to use crutches or a walker with a physical therapist. After two weeks, you will return to have your stitches removed. Walking aids such as crutches or a cane are required for at least six weeks after surgery. When you work with our team at Raleigh Orthopaedic, we will make sure your recovery instructions are clear and that you understand the steps needed for a successful recovery.

Can Osteonecrosis of the Hip Be Prevented?

Osteonecrosis has no known cause, which makes prevention very difficult. There are, however, some ways you can reduce your risk of osteonecrosis. Avoid or limit drinking excessive amounts of alcohol, as heavy drinking is one of the top risk factors for the development of osteonecrosis. If possible, avoid high doses and long-term use of steroids, as they can worsen bone damage. Finally, it is important to limit smoking, as it can narrow blood vessels and reduce blood flow.

Leading Hip Care at Raleigh Orthopaedic

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Your well-being is important to us. Raleigh Orthopaedic is Wake County’s oldest and most experienced orthopedic practice, serving the Triangle and surrounding regions of central North Carolina since 1919. Our orthopedic surgeons specialize in a wide range of orthopedic injuries and conditions, from back pain to osteonecrosis of the hip. To learn more about the care we provide or to schedule an appointment at a Raleigh Orthopaedic clinic location near you, please give us a call or book online today. We look forward to helping you live and move more comfortably!