(Osteonecrosis; Avascular Necrosis; Ischemic Necrosis; Osteochondritis Dissecans)
Definition
Definition
Aseptic necrosis of the hip is the death of bone tissue in the head of the femur (thigh bone) due to an inadequate blood supply.
There is a specific type of aseptic necrosis of the hip called Legg-Calvé-Perthes disease. It affects the growth plate at the upper end of the femur in children. It most commonly affects boys aged 5-10 years old.
The Hip JointCopyright © Nucleus Medical Media, Inc.
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Causes
Causes
Aseptic necrosis of the hip is caused by any event or condition that damages the arteries that feed the head of the femur . The most common events are fractures in the upper femur and dislocations of the hip, especially developmental dysplasia of the hip. Other causes reduce the blood supply by closing off or compressing the blood vessels.
Risk Factors
Risk Factors
Factors that increase your chance of developing aseptic necrosis of the hip include:
- Femoral neck fractures
- Hip trauma
- Dislocation of the hip
- Radiation therapy
- Prolonged or repeated use of cortisone-like drugs
- Decompression sickness
- Sickle cell disease
- Gaucher disease
- Cushing disease
- Smoking
- Excessive alcohol use
- Systemic lupus erythematosus (SLE)—especially if SLE is being treated with corticosteroids
- Chronic renal failure or renal transplantation
- HIV infection
Symptoms
Symptoms
Symptoms may include:
- Groin pain, especially with weight-bearing actions
- Hip pain or limited hip motion
- Buttock, thigh, and knee pain
- Limping
Diagnosis
Diagnosis
You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to an orthopedic surgeon.
Images may need to be taken of your internal structures, especially your bones. This can be done with:
Treatment
Treatment
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Physical Therapy
Your doctor or physical therapist may advise non-weight-bearing exercises to minimize disease progression.
Medications
The following medications may be prescribed:
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen, to relieve pain
- Bisphosphonates to prevent the loss of bone mass
- Iloprost to relax blood vessels
- Enoxaparin to prevent blood clots
Surgery
There are several surgical procedures used to treat aseptic necrosis of the hip. The choice depends on the extent of disease and the age and health status of the patient. Bone grafts, decompression of the inside of the bone, realignment of the bone, femoral head resurfacing, and prosthetic hip replacement are some options.
Prevention
Prevention
To help reduce your chances of getting aseptic necrosis of the hip, take the following steps:
- Minimize the dose and duration of cortisone-like drugs.
- Avoid decompression disease when diving underwater.
- Reduce or stop smoking.
- Avoid excessive alcohol.
RESOURCES:
OrthoInfo—American Academy of Orthopaedic Surgeons http://orthoinfo.aaos.org
CANADIAN RESOURCES:
References:
Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology (Oxford). 2005;44:352.
Osteonecrosis of the hip in adults. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated July 15, 2014. Accessed March 10, 2015.
Martin K, Lawson-Ayayi S, Miremont-Salame G, et al. Symptomatic bone disorders in HIV-infected patients: incidence in the Aquitaine cohort (1999-2002). HIV Med. 2004;5:421.
Matsuo K, Hirohata T, Sugioka Y, et al. Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop. 1988;234:115.
Metselaar HJ, van Steenberge EJ, Bijnen AB. Incidence of osteonecrosis after renal transplantation. Acta Orthop Scand. 1985;56:413.
Last Updated: 2/10/2014