24/06/2023
Today we'd like to discuss Avascular Necrosis of Hip Joints (AVN).
AVN aka avascular necrosis or aseptic necrosis or osteo necrosis of the hip is a painful condition that occurs when the blood supply to the head of the thighbone (femur) is curtailed. Bone cells need a regular supply of blood to stay healthy. Without adequate nourishment, the bone in the head of the femur dies and gradually collapses. As a result, the articular cartilage covering the hip bones also collapses, leading to disabling arthritis. If untreated, AVN can ultimately lead to destruction of the hip joint.
Demography:
AVN can affect anyone, but is more common in people between the ages of 40 and 65. Men develop AVN of the hip more often than women.
Risk Factors:
It is not always known what causes the lack of blood supply, but doctors have identified a number of risk factors that can make an individual more likely to develop AVN:
• Injury. Hip dislocations, hip fractures, and other injuries to the hip can damage the blood vessels and impair circulation to the femoral head.
• Excessive alcohol use. Over consumption of alcohol can cause fatty deposits to form in the blood vessels resulting in a decreased blood supply to the bone.
• Corticosteroid use. Many diseases, including asthma, rheumatoid arthritis, and systemic lupus erythematosus (SLE), are treated with steroid medications. Although it is not known exactly why these medications can lead to AVN, research shows that there is a connection between the disease and long-term corticosteroid use.
• Medical conditions. AVN is associated with other diseases, including Caisson disease, sickle cell disease, myeloproliferative disorders, Gaucher's disease, SLE, Crohn's disease, arterial embolism, thrombosis, and vasculitis.
• Genetic predisposition. AVN may be associated with a genetic predisposition especially if it is shown up in the patients in their 30s.
Symptoms:
AVN develops in stages. Hip pain is always associated with the initial symptoms. There may be a dull ache or throbbing pain in the groin or back area. As the disease progresses, it becomes more difficult to stand up and put weight on the affected hip. It may take from several months to over a year for the disease to progress.
Diagnosis:
Doctor Examination After analysing the pain symptoms and medical history, a doctor will examine the hip to discover which specific motions cause pain. He may advise further scans.
X-rays. X-rays are used to determine whether the bone in the femoral head has collapsed and to what degree.
MRI scans. Early changes in the bone that may not show up on an x-ray can be detected with an MRI scan. These scans are used to evaluate how much of the bone is affected by the disease. An MRI may also show early AVN that has yet to cause symptoms.
Treatment:
Although nonsurgical treatment options, such as anti-inflammatory medications, activity changes, and using crutches, can help relieve pain, the most successful treatment options are surgical. Patients with AVN that is caught in the very early stages (before the femoral head collapses) are potential candidates for hip-preserving procedures.
Core Decompression and Grafting
This procedure involves drilling one large hole or several smaller holes into the femoral head to relieve pressure in the bone and create channels for new blood vessels to nourish the affected areas of the hip.
Total Hip Replacement
Where the femoral head has already collapsed, the most successful treatment is total hip replacement. In this procedure, doctors remove the damaged bone and cartilage, and then positions new metal joint to restore the function of the hip.
Homeopathy:
The patient, as an individual, gets assessed in homeopathy. Based on his/her physical symptoms, a complete profile is built. Once this profile matches with the most appropriate remedies, the medicine gets prescribed. It has been observed that many patients with AVN condition can be benefited with the homeopathic management.
Ref/Image courtesy: https://orthoinfo.aaos.org/en/diseases--conditions/osteonecrosis-of-the-hip/
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