Avascular Necrosis

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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
2.Alcoholism
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.

Diagnosis

- 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.

Treatment

- 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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