Diagnosis: Avascular Necrosis of the Femoral Head

Presentation:

Avascular Necrosis is a condition caused by lack of blood supply to the head of the femur, which makes up part of the hip joint. This lack of blood supply can cause the collapse of the hip if not properly managed or diagnosed. Avascular necrosis will cause a lot of pain in the hip as well as a limp and difficulty with most activity. The hip can even cause pain whilst sitting down, so most patients only find relief when lying down. When avascular necrosis is in the later stages, any activity that puts weight through the hip has the potential to cause pain. Patients will present with a variety of different complaints depending on the progression of the problem as it is a slowly progressing condition.

Diagnosis:

The diagnosis of avascular necrosis is normally confirmed using x-ray. Initially a physiotherapist will perform a physical exam where they assess the range and provide some pressure through the joint, they may also perform some special tests to rule out other possible hip conditions. The patient will then be referred for medical imaging to assess if they have Avascular necrosis. Medical imaging also aids in classifying the extent of hip damage and the best treatment approach for the patient (Giannoudis & Kanakaris, 2016).

Causes:

Avascular necrosis cannot be predicted, however there are many known risk factors that increase ones chance of getting this disorder of the hip:

• Corticosteroid use: drugs like prednisone and other prescription steroids can affect bone health which can affect the blood supply to the hip, causing it to become “necrotic”
• Trauma: general trauma i.e fractures of the hip/leg suffered during sports or motor vehicle accidents etc. can cause a disruption to the blood supply of the hip
• Certain Medical Treatments: radiation therapy and organ transplantation is known to be associated with loss of bone health and necrosis
• Alcohol/Smoking: excessive alcohol abuse and smoking are known risk factors/causes of avascular necrosis.

Treatment:

Conservative management of avascular necrosis has been shown to slow the progression of the condition. Physio management can involve a wide variety of things. The physio may play a role in the prescription of a mobility aid to unload the hip, this may be a crutch/crutches, a walking frame or a wheelchair. The physio will ensure appropriate ergonomics and set up of the mobility aid, also educating the patient about how to use this aid optimally. In addition to unloading, this condition can benefit from strengthening of the muscles around the hip and some manual therapy. Most cases of avascular necrosis will require surgical intervention to preserve the femoral head, however in some cases it is replaced. Some surgeries will involve drilling holes in the head of the femur to cause fresh blood to enter the region and for new blood vessels to form and regenerate the damaged bone. Despite new, more conservative therapies, total, uncemented hip replacement tends to have the best recovery (Kakaria, Sharma, & Sebastian, 2005).

Daniel O’Connor
Student Physiotherapist

References

Giannoudis, P. & Kanakaris, N. (2016). Trauma and Orthopaedic Classifications (pp. 409-412). London: Springer London Ltd.

Kakaria, H., Sharma, A., & Sebastian, B. (2005). Total Hip Replacement in Avascular Necrosis of Femoral Head. Medical Journal Armed Forces India, 61(1), 33-35.

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