Avascular Necrosis of the Hip: Treatment and Causes

Think of blood as the major transportation hub of your body. Its job is to provide oxygen and nutrients to all your tissues and remove metabolic byproducts. So, what happens to the tissue when it doesn’t get enough oxygen and nutrients? Well, what would happen to any living thing under such circumstances? It withers and dies.

When this happens to the tissue, avascular necrosis is the term that is used. Translated into plain English, it means tissue death due to the lack of blood supply. It often happens to your hip bone, so this situation is called avascular necrosis of the hip.

Now that we have the definition (and etymology) out of the way, here’s all you need to know about this condition and what to do if you suspect you’re developing it.

Does avascular necrosis cause hip pain?

The only symptom that is always present is pain. Early on, it may not actually cause any pain. However, as it progresses, it may cause pain l to make any movement that puts pressure on the affected area. While in some cases, it can occur on only one side, it can sometimes affect both hips.

As the affliction progresses, the situation can worsen. During the earlier stages, X-ray images may not reveal the pathology or may be extremely subtle, which makes the diagnosis of avascular necrosis of the hip difficult.  An MRI may be the only reliable imaging modality to detect the extent of the lesion. If the condition worsens, subchondral cysts and sclerosis may be more apparent. Ultimately, this condition can evolve into femoral head collapse resulting in severe secondary osteoarthritis of the hip, which can be debilitating.

What causes avascular necrosis of the hip?

The most common cause is “idiopathic” (simply meaning we do not know what the true cause is).

However, there are both traumatic and atraumatic causes. In both cases, it is the disruption of blood flow to the femoral head that leads to necrosis.

• Trauma
• Fractures, dislocation
• Atraumatic reasons
• Illnesses such as HIV/AIDS, sickle cell anemia, renal disease, Caisson’s disease, glycogen storage disease
• History of radiation, chemotherapy, or certain drugs
• Long-term steroid use
• Alcohol abuse

It’s also worth mentioning that smoking, lack of hydration, and poor diet may reduce circulation to your lower body. Indirectly, this increases the risk of avascular necrosis and several other hip conditions.

Treatment Options for Avascular Necrosis of the Hip

Avascular necrosis won’t heal independently, and there are no effective non-surgical treatments. Medication can alleviate the symptoms of pain in the early stages, but this is not a cure, and it won’t reverse any damage. The issue is that the lack of blood supply kills the bone cells, which normally maintain the microarchitecture of the bone.

Since they are no longer working, the microarchitecture starts to fail, and this causes the smooth round ball of the femur bone of the hip to become soft, flat, and even misshapen. If this process is caught early enough, hip preservation methods may be used, with varying success rates.

Unfortunately, if left alone, the collapse of the ball of the femur results in end-stage osteoarthritis of the hip, necessitating total hip replacement, the most common procedure for treating avascular necrosis of the hip.

Other than this, bone reshaping (also known as an osteotomy) and core decompression are methods to treat AVN of the hip. The latter procedure is when a surgeon drills into a part of the inner layer of dead bone. This creates more space inside the bone and triggers bone tissue and blood vessels to grow.

Lately, there’s been a push for regenerative medicine treatment using stem cells. The idea behind this is to stimulate new bone growth. Still, this is far from standard treatment procedure.

How Long is Hip Replacement Recovery?

Everyone’s body recovers differently. You may return to the basic tasks in six weeks. Most patients start walking on the day of the surgery and might not need bed rest. In fact, some doctors suggest that you keep moving to keep your new joints from becoming too stiff.

Still, you should avoid drastic movements and minimize activities in which you risk falling.

In other words, if you schedule your surgery soon after the diagnosis of avascular necrosis of the hip, you can be fully back to strength in weeks to months.

It Is Not Life-Threatening

Some people are concerned with questions like: “How long can you live with avascular necrosis?” The truth is that AVN of the hip is not life-threatening. However, it drastically reduces your lifestyle quality, which you must take seriously.

It limits your mobility and causes immense pain. Enduring this is incredibly unpleasant and may restrict you even in some basic activities.

When you consider that hip replacements have a 95% success rate after ten years and 80-85% after 20 years, it has certainly proved to be a reliant surgical option long term.

Wrap Up

Avascular necrosis of the hip is a serious condition that must be taken seriously. It can’t improve on its own, so you need to diagnose it as soon as possible and look for a surgical solution. While alleviating pain through medication is fine, this is not a long-term solution. Hip surgery, on the other hand, has an incredibly high success rate. When done by professionals, it can have you walking out of the clinic and on your way to full recovery in a matter of weeks.

Find a hip expert at the Orthopedic Institute of New Jersey to learn more.