Femoral Head Avascular Necrosis

08 July, 2020
Avascular necrosis is the death of bone tissue. Why does it happen? How does it affect the lives of patients? In this article you'll learn everything you need to know.

Avascular necrosis, like all necrosis, is caused by a lack of blood supply to the tissues. In this particular case it affects the bones, which leads to quite serious consequences.

In this article, we’ll describe what femoral head avascular necrosis is, how it affects patients’ quality of life and their treatment options.

As some articles point out, such as Chronic hip pain: femur head necrosis, avascular necrosis isn’t very frequent. But this doesn’t mean that it doesn’t deserve special attention, since the aftermath is very severe and the risks for patients are very high.

What causes avascular necrosis?

The first question that may come to mind is what are the causes of this very serious problem that has serious consequences for patients.

Below, we’ll see some of the reasons why it can appear, as indicated by the article Nontraumatic causes of bilateral avascular necrosis of the femoral head: link between hepatitis C and pegylated interferon:

  • History of trauma: An injury or dislocation in the joints can affect the blood vessels, causing a lack of blood supply.
  • Cancer treatment: Undergoing radiation or chemotherapy treatments weakens the body and bones, and can damage blood vessels.
  • Hypercoagulable state: This predisposes you to thrombosis and the blood clots significantly reduce blood supply.
  • Long-term steroid treatments: An excess of steroids (high doses) can be one of the causes of femoral head avascular necrosis.
An x-ray image of the hip, highlighting the area affected by avascular necrosis.

Symptoms

The symptoms of femoral head avascular necrosis are more or less severe depending on the stage the patient is in. Thus, we can differentiate between a mild stage, a moderate stage, and the last stage, which is severe. Let’s take a look at some of the symptoms that a patient can experience.

The first thing to note is that, in the mild stage, the patient may not have any symptoms. This means that avascular necrosis can go completely unnoticed. However, if it isn’t diagnosed, it will worsen. Thus, you’ll begin to notice the following:

  • Pain in the joint affected by necrosis when you put your weight on it
  • Discomfort when you’re at rest, lying down, or sitting
  • Pain that worsens and radiates to the groin, thighs, buttocks, even the knees

The pain will grow in intensity to the point that it becomes a constant discomfort without relief. This affects the quality of life of the patients, limiting them. Therefore, it’s very important to go to the doctor at the slightest symptom. The reason is that the bone can lose its shape, thus causing arthritis.

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Treatments

Doctor reviewing hip x-ray with patient with avascular necrosis.

When a patient is diagnosed with avascular necrosis, the doctor will take into account their age, the quality of the bones, the stage of the disease, and the damage it has already caused. Below, we’ll present the most conservative treatments and others that involve surgery.

  • External support: Using crutches or canes is an option for the mildest cases. However, it doesn’t achieve entirely satisfactory results.
  • Medications: These tend to have a much more positive effect, some are antihypertensive, lipid-lowering, fibrinolytic and vasoactive drugs.
  • Hyperbaric oxygen therapy: Breathing oxygen at high pressures increases plasma oxygenation. In mild stages, it can have a very positive impact.
  • Electrical stimulation: This promotes bone formation, since avascular necrosis causes bones to become weaker and break easily.

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What happens when avascular necrosis is at a much more advanced stage? Although you can try the aforementioned treatments, doctors often recommend you undergo surgery.

However, even in moderate cases, the doctor may consider this option, since the combined treatment will increase the chances of achieving a positive outcome.

In the event of any discomfort, we recommend going to the doctor immediately. If you don’t have any symptoms, remember that it’s still important to have regular checkups to make sure everything is okay. Many times, the absence of symptoms doesn’t mean that you don’t have a problem.

In this case, for example, an early diagnosis will prevent you from having to undergo surgery.

  • Alvarez López, Alejandro, & García Lorenzo, Yenima. (2005). Clasificación y diagnóstico de la osteonecrosis de cabeza femoral. Revista Cubana de Ortopedia y Traumatología19(2) Recuperado en 08 de marzo de 2019, de http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-215X2005000200013&lng=es&tlng=es.
  • Alvarez López, Alejandro, & García Lorenzo, Yenima. (2006). Tratamiento de la osteonecrosis de cabeza femoral. Revista Cubana de Ortopedia y Traumatología20(1) Recuperado en 08 de marzo de 2019, de http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-215X2006000100010&lng=es&tlng=es.
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