John D. Burrow, DO
Avascular Necrosis is a medical term that means a loss of blood supply causing bone tissue death. While it can happen anywhere in the body there is bone, it is most often seen in the hip. This is because the hip joint blood supply is retrograde (against flow) and is dependent on channels within the bone (Haverson canals). These channels may become blocked with fatty deposits which cut off blood flow, resulting in bone death isolated to the femoral head.
Who’s at risk? While relatively rare for the general population, there are some risk factors to be considered, which are:
- Excessive alcohol use
- Overuse of corticosteroids
- Trauma – hip dislocation or fracture
- Chemotherapy and radiation therapy for cancer
There are certain medical conditions, such as sickle cell anemia, lupus, diabetes and pancreatitis that put individuals at a higher risk for AVN. About 30% of all AVN of the hip cases are idiopathic, which means we don’t know the cause.
In the earliest stages of AVN, the patient will be asymptomatic. When a patient comes to see me, they are usually complaining of hip pain and pain in the groin and buttock. The pain may also radiate down into the knee. They may have trouble walking and putting weight on their hip and it may be difficult for them to sleep at night or get comfortable due to the pain. I’ll do a thorough physical exam, ask the patient to move, bend and walk for me. I’ll order x-rays, which will typically show me more during the later stages of AVN, than during the first stages.
If the patient’s pain is manageable and the x-rays show early-stage disease, I will probably recommend conservative treatment such as NSAIDs, physical therapy, ice/heat, or a steroid injection to relieve pain and inflammation. Based on their examination, I may refer them back to their PCP for help with their cholesterol, smoking, alcohol consumption, diet or other medical issues that we can address with medications or lifestyle changes. Research has shown that conservative treatment can improve symptoms just as well as surgery in the early to moderate stages of disease.
If the patient’s pain is severe and the x-rays are not normal, I will order an MR scan immediately to ascertain the level of damage to the hip joint. In the later stages, the pain and dysfunction will become increasingly noticeable and debilitating. Rest, and the use of crutches may be recommended. Surgery will always be recommended treatment unless the patient’s condition is too poor to withstand it.
For very young and healthy patients, hip replacement is not usually the first surgical option. Core Decompression may be tried, where dead areas of bone are drilled out, hopefully, to be replaced by the body with healthy and vascularized bone tissue. There are also grafting surgeries that can be done, such as a Vascularized Fibula graft, where healthy bone tissue is taken from one area of the body and transplanted to the hip, which is technically difficult with varied response.
However, for most patients with AVN, total hip replacement remains the surgical treatment of choice for End-Stage Grade IV Disease. Hip replacement is a major surgery and has risks and complications, but today’s hip replacement surgery is often done as an outpatient surgery.
Patients with AVN who have had a hip replacement often report a miraculous level of pain relief after surgery and are typically sorry they postponed the decision to move forward.
Make an appointment with Dr. Burrow or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.