Hip joint necrosis: causes, symptoms and treatment
Necrosis — death of some tissues of the damaged organ. There is a ailment as a result of violation of blood supply, insufficient supply to the joint is essential nutrients. When necrosis of the hip joint is mainly damaged head bone.
The most dangerous complication of osteonecrosis — gangrene, often resulting in infection of blood or amputation of the limb. Therefore, the occurrence of pain in the hip or knee joint, as well as after the injury, you must immediately consult a specialist and conduct a survey. Timely diagnosis will help determine the nature of the pain and avoid the risk of developing severe disease.
The reasons of development and symptoms
Aseptic necrosis of the hip joint can develop for the following reasons:
- dislocation or fracture;
- frequent minor tissue damage and excessive loads (especially with regular exercise);
- arterial thrombosis;
- inflammatory disease;
- taking certain medicines (antibiotics and hormones in large doses and for a long time);
- pressure differences (for miners and divers);
- the abuse of alcohol.
In 80% of cases of osteonecrosis is bilateral. In addition to the head of the hip joint, it is quite often progresses in the knees, shoulder, elbows and ankles. Avascular necrosis may occur after several months or even years after the precipitating injury or pathological conditions.
The process of the disease is divided into stages depending on the degree of destruction of tissues of the knee or hip. Each stage is characterized by the same symptoms, but the intensity of their manifestation is different.
- atrophic changes in the soft tissues of the thigh or knee (if the patient has necrosis of the knee joint);
- the reduction in the amplitude of movements of the joints;
- the movement of the load body on the healthy leg.
At the initial stage of the main symptom of asthenic necrosis — the pain that appears spontaneously. She focuses in the area of the hip joint and gives in the groin, the area of the knee joint, lumbar and sacrum. Pain can interfere with walking and sitting. Gradually they become more intense and longer, especially at night. The possibility of movement joints does not change. Body weight is distributed evenly on both limbs.
The osteonecrosis stage 2 is characterized by growing pains, especially after physical exertion. Slightly reduced the range of motion of the joints. There is a significant withering away of the thigh muscles (the circumference of the affected thigh less healthy). The load of body weight is gradually transferred to the healthy leg.
At stage 3 of the disease even minimal load causes a significant increase in pain. The movement of the joint is limited. Muscles significantly atrophied. One leg may be slightly shorter.
The osteonecrosis stage 4 is characterized by the appearance of pain, which is the most pronounced. Observed gait disturbance. Pronounced muscle atrophy. Range of motion equal to zero.
Diagnosis and treatment of osteonecrosis
The sooner will be revealed avascular necrosis, the easier it is to treat disease. Often to diagnose prescribe x-rays, but in the initial stages of aseptic necrosis of the hip joint using this method is nearly impossible to determine. The affected joints on x-ray will be noticeable only in 2 or 3 stages of the disease. Ultrasound and laboratory tests in the diagnosis of necrosis is also ineffective. To detect the disease early in its development is possible only with CT and MRI.
Treatment can be traditional and operational. Aseptic necrosis of knee and head of the hip joint identified at the initial stage of development, lends itself to conservative therapy. The aim of such treatment is to prevent or slow the progression of the disease, to remove or to reduce pain, improve mobility of the affected joint.
Traditional treatment includes:
- taking pain, anti-inflammatory drugs (corticosteroids, non-steroidal drugs);
- physiotherapy (electrophoresis of novocaine, ozokerite, ultrasonic methods, the use of diadynamic currents etc.);
- massage that increase the functionality of the muscle tissues;
- the use of prophylactic orthopedic orthoses.
The main requirement to all methods of treatment, they should be applied to the biomechanical collapse of the head of the hip joint. Evidence of collapse is a symptom of a Crescent, which can be identified in the diagnosis.
Features of surgical methods of therapy
To determine what the treatment should a competent specialist. The choice of methods depends on how far gone the development of the disease, the age of the person and features of his body. Today there is no medication that can restore blood circulation in the damaged joint. Mostly avascular necrosis of the femoral head treated surgically.
In the early stages the main tasks of the operation are restoration of blood supply to the joint tissues and the elimination of venous stasis. If diagnosed with stage 2 disease, goals of surgical intervention are the following:
- to change the position of joint head of the femur against the acetabulum so as to eliminate the load on the affected part of the head;
- to improve blood flow to the joint and reduce blood pressure inside the bone;
- to increase the mechanical strength of the affected parts of the head.
In the later stages of the disease during the operation, the damaged joint is replaced with prosthesis
For the treatment of bone necrosis of the hip using several surgical techniques. Often shown holding operations, reducing blood flow to the joints:
- decompression of the lesion of osteonecrosis;
- osteotomy (intertrochanteric and intertrochanteric);
- the avascular bone grafting;
- vascularized bone grafting.
Avascular necrosis of the talus treated with chondroplasty — operation to replace the destroyed portion of the elements of the tibia. Also, the method of tunnelization (drilling of the affected area).
Hip and knee arthroplasty is performed 90% of patients with a diagnosis of «avascular necrosis of the hip», if they are scheduled for surgery. This process of replacing the damaged joint for a transplant. When the effective prosthetic the patient’s pain disappear and completely restored the amplitude of movement of the limb. But there are some risks of complications and infection. In addition, if the surgeon incorrectly adjusted the denture, it can quickly become loose, and then re-operation is inevitable. When properly carried out the operations of replacement of the implant will be required after 12-15 years.
The main thing is to diagnose avascular necrosis of the hip joint or other joints as early as possible to do without surgical intervention. Conservative treatment is initiated in a timely manner and under strict supervision of a specialist, gives good results. Any operation brings new problems and complications and requires long-term rehabilitation.
Careless attitude towards their health and untimely acceptance of measures at presence of symptoms of disease reduce the chances of recovery. Requires more effort and cost to restore the health of the joints.