Avascular necrosis or Osteonecrosis is a term that is used to denote the death of a bone due to a decrease in its blood supply. As bones also have small blood vessels in them that nourishes them and keeps their structure and strength intact. However, when this blood supply is disrupted due to any trauma or any pathology, the bone starts to weaken and necrosis occurs in the absence of blood and oxygen supply. As a result the bone breaks and collapses in the later stages of the disease. The avascular necrosis is more common in long bone ends and most common in hip bone (femoral head). This article explains the causes, symptoms, diagnosis and treatment of avascular necrosis of hip. 

Causes of Avascular Necrosis of Hip

• Excessive or regular Alcohol Intake 
• Long term Steroid Use
• Trauma or injury to the bone
• Cancer Treatment Radiotherapy
• High Cholesterol Levels 
• Blood flow diseases  
• Diabetics are also prone to avascular necrosis especially the ones who suffer from poor control over blood sugar levels.

Symptoms of Avascular Necrosis

• Pain while standing or walking during the early stages
• Pain in thighs and hip
• Pain at rest in the chronic or advanced stages 
• Limited activity of joint such as pain while getting up in case of osteonecrosis of the hip

How the Diagnosis of Avascular Necrosis is made?

• Examination – the orthopedic doctor examines the range of motion of the hip joint and pain areas as well as the tender points. This gives a fair idea to an experienced orthopedic surgeon about the disease. 
• X-ray Imaging – X-ray shows high-density areas in case of the presence of avascular necrosis.
• CT scan & MRI – These tests are performed in order to access the condition of the hip bone in detail so that the proper treatment protocol can be decided.
• Bone Scan – the bone scan may or may not be required depending upon the condition of the patient. 

Avascular Necrosis Treatment in Noida 

• Medicines – Different types of medicines are prescribed such as NSAIDs (Non-steroidal Anti-inflammatory Drugs), medicines to induce calcium formation in bones, anti-cholesterol medicines, and disease-specific medicines if required. 
• Physiotherapy Treatments – The physiotherapy treatments such as exercises, electrical stimulation, and other non-weight bearing treatments are given to allow faster healing in the joint/bone.
• Rest – Rest is an important factor in the treatment of osteonecrosis of the hip as it avoids any further damages to the joint and allows time for healing as well. 
• Walking with assistive devices – Walking with a cane or crutches to take the load off the bone is advised till the recovery. 

• Surgical Options 

• As the avascular necrosis of the hip remains asymptomatic in the initial stages, it is diagnosed in the middle or chronic stages in most cases. Which is why surgery is often required to prevent or treat the collapse of bone –

• Core decompression– a part of the inner layer of bone is removed by drilling some holes in the head of the femur (hip bone) thereby relieving the pressure. It is best performed if the osteonecrosis is in the early stages. As it gets time to heal itself and prevent the collapse. This procedure is not effective in the later stages of the disease. 
• Joint Replacement – This option is best for collapsed or damaged joints. In the hip joint replacement surgery, a metal implant is placed and the diseased bone is removed. The patient becomes pain-free and the quality of life is improved to a great extent. 
• Bone Reshaping/Osteotomy – Bone is shaped in such a way that it takes the load off the diseased bone. It buys some time for the patient till the joint replacement surgery.
• Bone Graft – if only a part of the bone is dead, then the bone graft is placed instead of the dead bone, and healing is allowed.

Having any such symptoms? Don’t ignore them and meet the best orthopedic doctor in Noida, Dr. Sumit Badhwar. You can book an appointment with him here.