Avascular Necrosis

Avascular Necrosis
– Also called Osteonecrosis, aseptic necrosis, or ischemic bone necrosis.

– It is the death of bone tissue due to a lack of blood supply.

– The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated.

– Most common in people between the ages of 30 and 60.

– Head of the femur is a common site.

Causes of Avascular Necrosis of femoral head
1.Idiopathic – Most Common
3.Steroid therapy
4.Sickle cell disease
5.Patient on renal dialysis
6.Patient on anticancer drugs
7.Postpartum necrosis
8.Goucher’s disease
9.Caisson’s disease
Clinical Features
– The disease is bilateral in 75% of cases.

– The patient complains of pain in the groin or in front of the thigh.

– Pain is present at all times but increases on exertion.
– X-rays may be normal in the early stage.

– If suspicion is strong, a bone scan may be done.

– In the later stage, an osteolytic lesion can be seen in superolateral part of the head.

– There may be diffuse osteosclerosis of the head, but the shape of the head may be maintained.

– In the advanced stage, the head collapses.

– Eventually, changes of secondary osteoarthritis become apparent.

– MRI scan is the best modality for early diagnosis of Avascular Necrosis.
– Core decompression and fibular grafting are done if the head of the femur has not got deformed.

– In later stages, once the head gets deformed, muscle pedicle bone grafting using Tensor fascia lata has been shown to produce good results.

– In some cases with involvement of a part of the head, an Intertrochanteric Osteotomy has been described.

– In cases with changes of advanced osteoarthritis, Total Hip Replacement becomes necessary.

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