Osteonecrosis of the Hip PDF Print E-mail
Wednesday, 09 November 2011 08:47

hip_necroOsteonecrosis of the hip is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately lead to destruction of the hip joint and arthritis.

Osteonecrosis is also called avascular necrosis or aseptic necrosis. Although it can occur in any bone, osteonecrosis most often affects the hip. More than 20,000 people each year enter hospitals for treatment of osteonecrosis of the hip. In many cases, both hips are affected by the disease. Although osteonecrosis affects people of all ages, it most commonly occurs between the ages of 40 and 65. Men develop osteonecrosis more often than women.

Cause

Osteonecrosis of the hip develops when the blood supply to the femoral head is disrupted. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis.

hip_injury

Although it is not always known what causes the lack of blood supply, there are a number of risk factors that can make it more likely for someone to develop the disease:

              • Injury — Hip dislocations, hip fractures, and other injuries can damage the blood vessels and impair circulation to the femoral head
              • Alcoholism
              • Corticosteroid medicines — Many diseases, such as asthma, rheumatoid arthritis, and systemic lupus erythematosus, are treated with steroid medications. Although it is not known exactly why these medications can lead to osteonecrosis, research shows that there is a connection between the disease and long-term steroid use.
              • Other medical conditions — Osteonecrosis is associated with other diseases, including Caisson disease (diver's disease or "the bends"), sickle cell disease, myeloproliferative disorders, Gaucher's disease, systemic lupus erythematosus, Crohn's disease, arterial embolism, thombosis, and vasculitis

Treatment

Although nonsurgical treatment options like medications or using crutches can relieve pain and slow the progression of the disease, the most successful treatment options are surgical. Patients with osteonecrosis that is caught in the very early stages (prior to femoral head collapse) are good candidates for hip preserving procedures.

Core Decompression

This procedure involves drilling one larger hole or several smaller holes into the femoral head to relieve pressure in the bone and create channels for new blood vessels to nourish the affected areas of the hip.

When osteonecrosis of the hip is diagnosed early, core decompression is often successful in preventing collapse of the femoral head and the development of arthritis.

Core decompression is often combined with bone grafting to help regenerate healthy bone and support cartilage at the hip joint. A bone graft is healthy bone tissue that is transplanted to an area of the body where it is needed.

Many bone graft options are available today. The standard technique is to take extra bone from one part of your body (harvest) and move (graft) it to another part of your body. This type of graft is called an autograft.

Many surgeons use bone that is harvested from a donor or cadaver. This type of graft is typically

scalpel

acquired through a bone bank. Like other organs, bone can be donated upon death.

There are also several synthetic bone grafts available today.

Vascularized Fibula Graft

Another surgical option is a vascularized fibula graft. This is a more involved procedure in which a segment of bone is taken from the small bone in your leg (fibula) along with its blood supply (an artery and vein). This graft is transplanted into a hole created in the femoral neck and head, and the artery and vein are reattached to help heal the area of osteonecrosis.

Total Hip Replacement

If osteonecrosis has advanced to femoral head collapse, the most successful treatment is total hip replacement. This procedure involves replacing the damaged cartilage and bone with artificial implants.

Total hip replacement is successful in relieving pain and restoring function in 90 to 95 percent of patients. It is considered one of the most successful operations in all of medicine.


Article courtesy of  AAOS





 

 

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