Also known as avascular necrosis (AVN), osteonecrosis of the hip can cause pain which can be debilitating in and around the hip joint. In the vast majority of cases, the condition worsens over time, and without treatment, it can cause the tissue in the hip to die, and the affected bone in the hip joint collapses over a few months or years. Because it may take from several months to over a year for osteonecrosis of the hip to progress, and because for some people, osteonecrosis of the hip is asymptomatic and discovered incidentally, early diagnosis and treatment can delay the condition’s progress. The place to start is with the best orthopedic specialists who have performed multiple surgeries to treat osteonecrosis of the hip. You’ll find them at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. The most experienced professionals ensure the best outcomes.
OVERVIEW
Avascular necrosis (AVN), also known as osteonecrosis, is the death of bone tissue caused by a disruption of blood flow within a bone. The condition usually affects the ends of bones where they terminate in a joint. Though AVN can occur in the ankle, elbow, shoulder, and jaw, it most commonly affects the hip joint. There are an estimated 20,000 to 30,000 new AVN diagnoses in the United States every year. The condition can occur in people of any age, but it is most commonly diagnosed in people between ages 30 and 65. Osteonecrosis of the hip is the underlying cause of around 10% of all total hip replacement procedures. About 20% of people who dislocate their hips (the hip is no longer aligned in the joint as it normally would be) develop AVN. Unlike osteoarthritis of the hip which generally develops slowly over years, the different stages of AVN progress fairly quickly. There is no definitive answer; it could take 12-18 months or could develop much more rapidly over a few months.
ABOUT THE HIP
The hip is one of the largest joints in the body. It is a connection point between the legs and the torso. Specifically, it’s made up of the thigh bone (femur)and the hip bone (pelvis). The femur is a long bone with a rounded top. The round part of the femur fits into a cup-like socket in the pelvis called the acetabulum. A ball-and-socket joint, lets the leg move at 3 degrees to allow for the following movements: flexing, extension, rotation, a back-and-forth motion, and a circular motion. Several components that make up the hip joint are bones, cartilage, ligaments, and tendons. Muscles in the hips include gluteals, adductor muscles, iliopsoas muscle (a deep muscle group that connects the spine to the lower limbs), quadriceps, and hamstrings.
WHAT IS OSTEONECROSIS OF THE HIP?
Osteonecrosis of the hip (avascular necrosis) is a painful condition that occurs when the blood supply to the head of the femur is disrupted. Because bone cells need a steady supply of blood to stay healthy, the blood vessels gradually cut off nourishment to the top of the thighbone where it fits into the hip socket. Without blood, the head of the femur dies and collapses. If AVN happens near a joint, the joint surface may collapse. Some people can develop AVN on both sides. Traumatic osteonecrosis of the hip happens after breaking a bone or dislocating a joint. Non-traumatic AVN happens if one has an illness or medical condition that keeps blood from flowing to the bone tissue. Osteonecrosis of the hip typically progresses through four stages:
Stage 1: initial or preclinical stage, with often asymptomatic symptoms or mild pain and discomfort. Pathology: early death of bone cells, with no significant changes in bone structure yet.
Stage 2: early stage with increasing pain, particularly with weight-bearing activities. Pathology: early structural changes in the bone with more noticeable cell death and the beginning of bone fragmentation.
Stage 3: persistent and possibly severe pain and decreased joint function. Pathology: significant bone fragmentation and the collapse of the subchondral joint leading to joint instability.
Stage 4: Late Stage: severe pain and disability, major impairment of joint function. Pathology: complete collapse of the affected bone, severe arthritis, and potential involvement of adjacent bones and joints.
CAUSES
Several nontraumatic risk factors have been associated with osteonecrosis of the hip. In particular, the prolonged use of corticosteroids and excessive alcohol use. Together, these two factors account for over 80% of nontraumatic AVN. Other causes include:
- Injury
- Fracture
- Damage to blood vessels
- Blood clotting disorders
- Certain medical treatments: radiation therapy, organ transplants
- HIV/AIDS
- Sickle cell anemia
- Pancreatitis
- Gout
- Systemic lupus erythematosus (SLE)
- COVID-19
In many cases, the cause is unknown.
SYMPTOMS
Some people have no symptoms in the early stages of AVN. As the condition worsens, affected joints might hurt only when putting weight on them. Eventually, one might feel the pain even when lying down. It might be weeks or months before noticeable signs indicate osteonecrosis of the hip. Some symptoms that might be red flags:
- Groin pain
- Intermittent pain that appears and eases when putting pressure on the bone and then removing it
- Increasing pain and stiff joints
- Limited range of motion
- Limping
- Difficulty climbing stairs, standing, or walking
NON-SURGICAL TREATMENTS
If bone damage is limited to smaller bones that don’t bear weight, non-surgical treatments might include:
- Rest
- Cold packs
- Heat treatments
- Nonsteroidal anti-inflammatory drugs (NSAIDs ) such as ibuprofen can help with pain and inflammation
- Crutches
- Physical therapy to help maintain range of motion and build strength in muscles that surround and support the joint
- Statins- Statins are medications that lower cholesterol levels by reducing the amount of fatty substances called lipids in the bloodstream. If statins remove lipids from blood vessels leading to a diseased bone, more blood can reach the bone, allowing it to rebuild bone tissue. This may slow or stop the progression of osteonecrosis.
WHEN IS SURGERY INDICATED?
In most cases, surgery will be required to treat osteonecrosis of the hip. These can include:
- Core decompression: The surgeon removes part of an inner layer of bone. Besides reducing pain, the extra space inside the bone triggers the production of healthy bone tissue and new blood vessels
- Bone transplant (graft): can help strengthen the area of the affected bone. The graft is a section of healthy bone taken from another part of the body
- Bone reshaping (osteotomy): A wedge of bone is removed above or below a weight-bearing joint to help shift weight off the damaged bone. This may help postpone joint replacement
- Joint replacement: If the affected bone has collapsed or other treatments aren’t helping, surgery can replace the damaged joint with plastic or metal parts
New treatments are being discovered that help osteonecrosis of the hip in its early stages.
GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.
Because of the speed with which osteonecrosis of the hip can happen, early diagnosis and treatment are key in helping delay the condition’s progress and can significantly affect your quality of life. The first-class orthopedic specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado have extensive experience treating AVN. Treating osteonecrosis of the hip takes rigorous attention and the specialists at CCOE are known not just for their medical skill and exacting diagnoses, but also for their ongoing consideration of all your mental and physical needs. They understand all that you are going through and how frightening AVN may be, so with meticulous care, they help you through every step. They are there to answer all your questions and discuss every option so that you feel well-informed about your treatment options and confident they can give you the most successful results.