Dead Hip Avascular Necrosis
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Dead hip, osteonecrosis, or avascular necrosis are all common names describing a debilitating condition that develops in the hip joint. This problem starts when there is a decrease or disruption of the blood supply that nourishes the femoral head (top of the thigh bone) in the hip joint.
This disruption results in a progressive destruction of the bone and eventually causes the hip joint to degenerate. It is accompanied by hip pain and as the disease process continues it becomes very difficult to walk or perform day to day activities.
Anatomy of the Hip
The hip joint is considered a ball and socket joint. At the top of the thigh bone there is a rounded surface known as the femoral head. It articulates with a concave surface formed on the side of the pelvis known as the acetabulum.
The bone surfaces that form this joint are covered by a smooth material called articular cartilage. This slippery surface allows for friction-free movement of the thigh bone when we walk, run, or climb.
With the destruction of this surface that accompanies avascular necrosis, walking becomes very painful as the exposed bone no longer has a covering that helps disperse body weight.
Image of the hip joint
Symptoms of Dead Hip
As one can imagine, avascular necrosis or dead hip can be very painful. In the early phases of this disease process there usually is no pain. As destruction of the bone progresses pain will be noticed with weightbearing activities but will go away at rest. Eventually the hip will remain painful even at rest.
Causes of Dead Hip
With dead hip there are several different reasons why blood flow to the hip has been compromised. The most common causes are:
1) Trauma or injury to the hip joint
2) Prolonged use of corticosteroids
3) Excessive use of alcohol
Risk Factors for AVN in the Hip
Avascular necrosis can be seen in individuals with hip dislocations or fractures that damage the blood supply to the femoral head.
It is also is seen with people that suffer from Crohn’s disease, asthma, inflammatory arthritis, severe allergies or any other conditions that require long term use of corticosteroids.
It is seen with other medical conditions such as Caisson disease, Sickle Cell disease, systemic lupus, and Gaucher’s disease. It is also related for unknown reasons to individuals who consume excessive amounts of alcohol.
Diagnosis of Dead Hip
Without a recent history of hip trauma an early diagnosis can be missed. Typically this condition can be diagnosed with a thorough subjective history by a health care provider, accompanied by a physical examine to evaluate hip movements and limitations. An X-ray can be useful to look at the shape of the femoral head and also it’s alignment/spacing in regards to the acetabulum. MRI’s are useful in determining how much bone destruction has already occurred.
Treatment of AVN in the Hip
1) Physical Therapy
With early detection of avascular necrosis patients are often instructed in joint protection techniques to decrease the strain to the hip. If the hip is symptomatic with walking it may be beneficial to use crutches or a walker for ambulation.
Sometimes physical therapy can be of benefit as the therapist can instruct in stretches and strength exercises to decrease the strain to the hip. They can also teach better methods for walking, squatting, stair climbing and other activities that become increasingly difficult.
2) Surgical Intervention
There are several options to address the disease process that has occurred in hips with avascular necrosis. With early detection of this condition a procedure called Core Decompression can be performed.
This procedure involves drilling holes in the femoral head to alleviate pressure in the bone and to allow blood vessels to nourish the dying bone.
This can help prevent the destruction of the femoral bone and decrease the development of arthritis in the hip joint. Vascularized Tibial Bone Grafting is another procedure used to try to re-establish blood supply to the dying bone.
With this procedure a small portion of bone is harvested from the lower leg and placed in the affected area in the hip where a tunnel has been drilled. Along with harvesting the bone, the small blood vessels that are attached to the bone are also taken as well.
These blood vessels are grafted to blood vessels around the hip joint to allow for nourishment of the diseased region of the hip.
Image of Total Hip Replacement from JOI
For some individuals the disease process advances to the point that the hip joint becomes severely arthritic. In these cases Total Hip Arthroplasty Surgery is required to remove the diseased bone.
With this procedure the head of the femur and often times the acetabulum will be removed and prosthetic components are put in to mimic the hip structure. By doing this, the painful arthritic joint surfaces are removed decreasing the pain that comes with this condition.
If you feel like you may have issues related to your hip consider calling JOI for answers and solutions to improve your condition. If you want to learn more about hip pain, go to hip pain. Learn more in this article about Hip Exercises That You Can Do at Home or Direct Access to JOI Rehab Physical Therapy.
Several Approaches To Treating Hip Pain With JOI Physical Therapy
Despite hip pain being a common complaint amongst all people, there are a few easy forms of physical therapy which can help. Exercises for core strength and stability are used to treat and prevent pain in the hips. Ergonomic education is instrumental in treating hip pain, as the source of most of the pain comes from how people sit and/or stand for long periods of time. Lastly and perhaps most importantly is keeping up with your health. Weight loss and a healthy BMI are always recommended in the treatment of hip pain.
To schedule physical therapy at one of the 12 JOI Rehab Centers, please call 904-858-7045.
To schedule an appointment with a JOI Hip Specialist, call 904-JOI-2000, schedule online, or click the link below.