Hip Avascular Necrosis Treatment

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Avascular Necrosis Of The Hip?

Avascular necrosis of the hip, also known as hip osteonecrosis, is a condition characterised by the disruption of blood flow to the femoral head, the “ball” part of the hip joint. This disruption leads to the death of bone tissue, a process that can result in the eventual collapse of the bone. If untreated the bone can lose its smooth shape, leading to severe arthritis.

While avascular necrosis can affect different bones in the body, such as those in the shoulders, knees, and ankles, it most commonly occurs in the hip.

Causes of Avascular Necrosis

Avascular necrosis of the hip occurs due to a disruption in the blood supply to the femoral head. This disruption can stem from a variety of causes and risk factors:

  • Joint or Bone Trauma to the Hip
    Injuries such as hip dislocations, fractures, or previous hip surgeries can damage blood vessels, impairing circulation to the femoral head and leading to avascular necrosis. This is known as traumatic avascular necrosis.
  • Excessive Stress on the Hip
    Smoking, high cholesterol levels, and activities that put excessive stress on the hips can also contribute to the development of avascular necrosis.
  • Accumulation of Fatty Deposits in the Blood Vessels
    Excessive alcohol use can lead to the accumulation of fatty deposits in the blood vessels, obstructing blood flow. This can result in increased cortisone levels, ultimately reducing blood supply to the bone.
  • Reduced Blood Flow from Steroid Use
    Prolonged use of corticosteroids is a common factor contributing to non-traumatic avascular necrosis. These medications may increase lipid levels in the blood, thereby reducing blood flow.
  • Certain Medical Conditions
    Several medical conditions, such as autoimmune diseases (e.g., systemic lupus erythematosus), blood disorders, blood vessel inflammation (vasculitis), and decompression sickness in divers, are linked to the development of avascular necrosis.

Symptoms and Signs

In the early stages, avascular necrosis of the hip may not exhibit any symptoms. As the condition advances, the following symptoms and signs typically emerge:


  • Pain: Initially, individuals may experience pain in the hip, particularly when weight is placed on it. This might be mild at first but can gradually worsen. The discomfort often centres on the groin, thigh, or buttock area, and may radiate to the knees.
  • Limited Range of Motion: As avascular necrosis progresses, the range of motion in the affected hip may become limited, further impacting daily activities.
  • Development of Avascular Necrosis in Both Sides of the Hip: In some cases, avascular necrosis can occur in both sides of the body, such as in both hips or knees.

Diagnosis

Diagnosing avascular necrosis of the hip involves a combination of medical history review, physical examination, and imaging tests.

  • Medical History and Physical Exam
    The process starts with understanding the patient’s symptoms and medical history. A hip specialist will conduct a physical exam, checking for pain when pressure is applied to the hip and assessing the hip’s range of motion.
  • Imaging Tests
    In the early stages, X-rays may not reveal changes, but they are useful in identifying bone structure alterations in later stages and the progression to hip arthritis. MRI scans are particularly effective in producing detailed images of early changes in bone structure and identifying bone swelling seen in early avascular necrosis.

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Non-Surgical Treatment Options

In the early stages of avascular necrosis of the hip, several non-surgical treatment options can be considered. These aim to relieve pain and may slow the progression of the disease.

Medications

The use of bisphosphonates and anti-inflammatory medications can help manage pain and reduce inflammation.

Lifestyle Changes

Modifications in daily activities and habits, including reducing or eliminating alcohol consumption and smoking, can play a role in managing the condition. Exercise can also help strengthen hip muscles and improve the range of motion.

Using Walking Aids

Hip specialists may suggest using crutches, canes, or walkers to lessen the weight placed on the affected hip, providing relief from pain.

Surgical Treatment Options

Avascular necrosis often requires surgical treatment, especially in its advanced stages. These procedures should be performed promptly, to effectively manage the condition.

  • Core Decompression - This procedure is most effective in the early stages before the femoral head collapses. It involves drilling into the femoral head to relieve pressure and stimulate blood flow. Core decompression can be enhanced with stem cell therapy, where stem cells are injected to promote new bone growth.
  • Bone Grafting - In this technique, a healthy bone from another part of the patient's body or a donor is transplanted into the affected area to stimulate new bone growth. This can help bring blood supply to these areas. It may be combined with core decompression.
  • Total Hip Replacement - In cases where the femoral head has collapsed or there is severe hip arthritis, a total hip replacement may be necessary. This involves replacing the damaged hip joint with artificial components. It is often required in advanced stages of avascular necrosis and can improve the patient's quality of life by reducing pain and disability.
  • Osteotomy - This surgical procedure involves cutting and realigning the femur to redistribute weight to healthier parts of the bone.

Prevention Strategies

While it may not be possible to completely prevent avascular necrosis of the hip, certain strategies can help reduce the risk.


  • Lifestyle Modifications to Reduce Risk of Blocked Blood Vessels: Reduce or avoid alcohol and stop smoking, as heavy drinking and smoking are linked to an increased risk of blocked blood vessels. Keeping cholesterol levels low can also help prevent the formation of fat deposits that can block blood supply to the bones.
  • Monitor Steroid Use to Avoid Bone Damage: Be aware of the past or present use of high-dose steroids, as repeated courses of high-dose steroids can worsen bone damage related to avascular necrosis.
  • Maintaining a Healthy Weight to Reduce Strain on Hips: Maintaining a healthy weight reduces strain on the hip joints and can lower the risk of developing the condition.
  • Prevent Hip Injuries: Avoiding activities that could lead to hip injuries, such as high-impact sports, can help reduce the risk of damage to the blood vessels in the hip area.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    What Happens if Avascular Necrosis of the Hip Goes Untreated?

    Untreated avascular necrosis of the hip can lead to long-term chronic pain and severe arthritis, with the hip bone eventually collapsing. This deterioration can affect mobility, often necessitating hip replacement surgery to remove and replace the damaged joints. Early intervention by hip specialists can help manage the condition and prevent severe complications.

    How Long Is the Recovery Time After Avascular Necrosis of the Hip?

    Recovery time varies depending on the treatment method. For non-surgical treatments or early-stage interventions like core decompression or bone grafting, recovery can take several weeks to a few months. In advanced cases requiring total hip replacement, recovery may take up to 6 months. The individual’s overall health and fitness level influence the recovery duration.

    How Do You Sit with Avascular Necrosis of the Hip?

    When sitting with avascular necrosis of the hip, try to maintain a position that minimises hip stress. Use a chair with good back support and keep the knees at the same level or slightly lower than the hips. Avoid crossing legs or sitting in low chairs that can strain the hip joint. Consulting with our hip specialist can provide more personalised sitting strategies.

    How Fast Does Avascular Necrosis of the Hip Spread?

    The progression rate of avascular necrosis of the hip varies. Typically, it develops over several months to years, depending on the underlying cause and the effectiveness of the treatment. Regular monitoring by a hip specialist can help manage the condition’s progression effectively.

    Can Diet Help Treat Avascular Necrosis of the Hip?

    While diet alone cannot cure avascular necrosis, it can play a supportive role in treatment. A balanced diet rich in nutrients can aid overall bone health. Try to reduce alcohol consumption and maintain healthy cholesterol levels.