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Any healthy bone requires a constant flow of blood like organs and tissues to be viable. AVN i.e., Avascular Necrosis of the hip is the death of bone tissue of the femoral head, which is the upper end of the thigh bone. This happens because of a lack of blood supply to that area due to various causes, but in many cases, the reason is not clear. A decrease in blood flow to the femoral head leads to cellular death, fracture, and collapse of the articular surface after a significant amount of bone underneath the cartilage is damaged.
AVN is generally seen in adults aged 20-45 years. Males are more commonly affected. Both hips involvement is frequently seen, the other hip may be involved in about 55% of the patients within 2 years. Over 80,000 to 90,000 new patients are getting affected by AVN of hip every year in our country. As per a recent case study, it is estimated that every 1 in 5 AVN patients has been through COVID-19.
Visit an ortho hospital in Millers Road if you need diagnosis and treatment for AVN.
What Causes AVN?
Various reasons might contribute to AVN like excessive alcohol use, long-term use of high-dose steroid medications, fracture–dislocations of the hip, late – COVID-19 infection and a few other uncommon diseases like - sickle cell disease, thalassemia, SLE, gout & rheumatoid arthritis.
In COVID-19 infection, the combination of increased tendency for blood clotting, white blood cells aggregation and inflammation induced in the small blood vessels can impair blood flow of the bone and contribute to the development of bone necrosis along with damage caused by the steroid medications used for its treatment.
How can I Identify Avascular Necrosis Hip?
Based on Symptoms & Signs, the phase of AVN which starts with reduced blood flow is unnoticeable and the earliest stage of bone death is asymptomatic. The following are the symptoms of AVN:
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Brief pain or hip irritation.
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Mild to moderate hip soreness.
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Limp while walking.
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Pain while sitting, walking, or lying down.
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Stiffness of hip - Difficulty in walking, stair climbing, sitting and getting up.
Based on Investigations
The early signs of ischaemia cannot be detected by X-ray radiography. The signs of the collapse of the bone beneath the cartilage, distortion of the rounded contour of the femoral head or arthritic changes are seen at later stages.
MRI scan is the most sensitive modality to diagnose AVN and can detect the presence of necrosis at a very early stage and it also helps in deciding on the management.
What Are the Treatment Methods for Avascular Necrosis Hip?
The goals of the management of AVN are - pain relief, arresting the progression of the disease, preventing the collapse of the head and preventing/treating secondary degenerative arthritis.
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Non - Surgical Treatment
Pharmacological: Lipid Lowering Agents, Anticoagulants, Vasoactive, Substances, And Bisphosphonates
Biophysical Treatments: Extracorporeal Shockwave Therapy (ESWT), Pulse, Electromagnetic Therapy, Hyperbaric Oxygen (HBO) therapy
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Surgical Treatment
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Core Decompression
It relieves intraosseous pressure and improves vascularity thus slowing the disease progression, but its role in the complete reconstruction of the necrotic area has not yet been established.
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Stem Cell Injections
Bone Marrow Aspirate Concentrate (BMAC) & Platelet-Rich Plasma (PRP) can induce osteogenic activity and stimulate the differentiation of stem cells in stage I and II patients when used in conjunction with core decompression.
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Bone Grafting
Non-vascularised grafts like allograft, autograft or artificial bone substitutes have been used to fill the necrotic area in the femoral head. Vascularised grafts combine the benefit of core decompression with an osteoinductive and osteoconductive graft in the devitalised femoral head.
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Total Hip Replacement (THR)
THR is the gold standard treatment for patients with late-stage AVN and those with arthritis where the affected hip joint is replaced with a prosthetic joint. With the improved surgical techniques, highly dedicated training of surgeons along with their experience and expertise in the specific subspecialties, and introduction of newer generation ceramic bearings, porous materials and high cross-linked polyethene, the survivorship of THR has increased, lasting for over 25 years.
Consult an ortho consulant in Millers Road for treatment and care for avascular necrosis.
Conclusion
Patients who have had COVID-19, receiving steroids or have any other diseases which can lead to AVN should be educated about the consequences and advised to monitor for the appearance of symptoms. Early detection is the key feature in halting the progression of avascular necrosis of the hip and initiating management of AVN according to the condition of the patient, as it is essential for reducing morbidity and improving an individual's quality of life.
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