• Aseptic Necrosis of the Hip

    (Osteonecrosis; Avascular Necrosis; Ischemic Necrosis; Osteochondritis Dissecans)

    Definition

    Aseptic necrosis of the hip is the death of bone tissue in the head of the femur due to an inadequate blood supply.
    Certain bones have a fragile blood supply. The head of the femur in the hip joint is the most likely to suffer loss of blood supply. This can cause tissue death. If unidentified and uncorrected, it will progress to deformity, causing pain and a limp.
    The Hip Joint
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    Causes

    Any event or condition that damages the arteries that feed the head of the femur raises the risk of aseptic necrosis. The most common events are fractures in the upper femur and dislocations of the hip. Other causes reduce the blood supply by closing off or compressing the blood vessels.
    There is a specific type of aseptic necrosis of the hip called Legg-Calvé-Perthes disease that affects the growth plate at the upper end of the femur in children. It most commonly affects boys aged 5-10 years old.
    In the US, about 10,000-20,000 new patients are diagnosed each year. They are predominantly males, typically under 40 years old.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition.
    The following factors increase your chance of developing aseptic necrosis of the hip. If you have or have had any of these risk factors, tell your doctor:

    Symptoms

    The few symptoms of aseptic necrosis of the hip are nonspecific and may be caused by other, less serious health conditions. If you experience one of them and are at risk for aseptic necrosis of the hip, see your physician.
    • Groin pain is the most common symptom, especially with weight-bearing actions
    • Buttock, thigh, and knee pain
    • Limping
    A small number of patients do not experience the typical symptoms.

    Diagnosis

    Your doctor will ask about your symptoms and medical history and perform a physical exam. If the diagnosis is suspected, you will be referred to an orthopedic surgeon.
    Tests may include the following:
    • X-ray —This test uses radiation to take a picture of structures inside the body, especially bones. When the disease is seen on an x-ray, it is usually too advanced to be reversed with treatment.
    • CT scan —This type of x-ray uses a computer to take pictures of structures inside the body.
    • Radioisotope bone scan —Technetium bone scan is quite sensitive, but nonspecific.
    • MRI Scan —This test uses magnetic waves to make pictures of structures inside the body. This is the most useful test and can detect the condition early enough to begin effective treatment.

    Treatment

    Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Conservative Treatment

    Taking nonsteroidal and other pain relievers and performing non-weight-bearing exercises may prevent or minimize disease progression.

    Surgery

    There are several surgical procedures used to treat aseptic necrosis of the hip. The choice depends upon the extent of disease and the age and health status of the patient. Bone grafts, decompression of the inside of the bone, realignment of the bone, and prosthetic hip replacement are all available.

    Prevention

    To help reduce your chances of getting aseptic necrosis of the hip, take the following steps:
    • Minimize the dose and duration of cortisone-like drugs
    • Avoid decompression disease when diving underwater

    RESOURCES

    Johns Hopkins University Medical School http://www.mri.jhu.edu

    Penn State Milton S. Hershey Medical Center http://www.pennstatehershey.org/home/

    CANADIAN RESOURCES

    BC Health Guide http://www.healthlinkbc.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Abeles M, Urman JD, Rothfield NF. Aseptic necrosis of bone in systemic lupus erythematosus. Relationship to glucocorticoid therapy. Arch Intern Med . 1978;138:750.

    Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology (Oxford) . 2005;44:352.

    Avascular necrosis. DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed August 9, 2005.

    Avascular necrosis. The Merck Manual . 17th ed. West Point, PA: Merck and Co; 1999.

    Martin K, Lawson-Ayayi S, Miremont-Salame G, et al. Symptomatic bone disorders in HIV-infected patients: incidence in the Aquitaine cohort (1999-2002). HIV Med . 2004;5:421.

    Matsuo K, Hirohata T, Sugioka Y, et al. Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop . 1988;234:115.

    Metselaar HJ, van Steenberge EJ, Bijnen AB. Incidence of osteonecrosis after renal transplantation. Acta Orthop Scand . 1985;56:413.

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