Osteonecrosis of the Hip
Osteonecrosis, also known as avascular necrosis (AVN), is a disease caused by inadequate blood supply to bones, leading to bone death.
This disease is most common in adults aged 30-60 but can also occur in children, mainly from cancer therapy. It can affect one or more bones and if left untreated, can lead to the destruction of the adjacent bones, tissues and joints.
AVN is caused from insufficient blood supply to the bone leading to a loss of minerals and nutrients, which normally keep bones healthy. The common causes of avascular necrosis in children include:
- Trauma: Dislocation or bone fractures can injure blood vessels
- Long term or high dose steroid treatment
- Cancer treatments: Radiation or chemotherapy
- Blood disorders such as sickle cell anemia and leukemia
In the early stages of AVN, there are no symptoms. As the disease progresses, your child may experience the following symptoms:
- Joint pain that gradually increases
- Pain which occurs even at rest
- Limping and groin pain if the hip joint is involved
- Restricted range of motion
After your doctor performs a physical examination, the following diagnostic procedures may be ordered:
- Imaging tests: Imaging tests such as X-ray, magnetic resonance imaging (MRI), and computed tomography (CT) scan can determine the extent of bone damage and if the disease has spread to the surrounding tissues
- Bone scan: A small amount of radioactive material is injected into a blood vessel which collects in the bone. A special camera takes pictures of the affected areas of the bone.
- Biopsy: A tissue sample is removed and sent for microscopic examination to rule out the presence of cancer cells in the bone.
Your surgeon may recommend non-surgical or surgical methods for treating avascular necrosis.
Non-Surgical Treatment includes:
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be taken to relieve pain. Children with blood clotting diseases will be given blood thinners (anti-coagulants) to dissolve the clots.
- Reduced weight bearing: Your doctor may recommend rest and use of crutches to reduce weight on the affected bone in order to promote natural healing. It also helps to delay surgery in some children.
- Range-of-motion exercises can gradually improve movement of the restricted area.
- Electrical stimulation: Electric currents can induce bone growth. It may also be used during surgery where it can be applied to the damaged bone directly.
Non-surgical modalities may slow the disease progression but most patients will require surgery.
Surgical Treatment options include:
- Bone grafting: This surgery replaces diseased bone with healthy bone, taken from the patient or from a bone bank, to increase blood supply to the affected area.
- Vascular grafting: Bone along with blood vessels and arteries are surgically transplanted to the affected bone providing an immediate blood supply to the area.
- Arthroplasty or total joint replacement: This procedure is performed only when all other treatments are unsuccessful and when the joint is completely destroyed. The joint is replaced with artificial implants.
- Bone resurfacing: The femoral head is reshaped and implanted with a metal cap. This implant is reshaped to match the size of the femoral head. This helps to preserve the bone or joint, prevent fractures, and decrease risk of dislocation.
- Core decompression: In this surgery, the inner part of the bone is removed thereby reducing pressure within the bone, increasing blood flow, and helping to form new blood vessels. This procedure relieves pain and slows the progression of bone, and joint destruction and is best done in the early stages of AVN.
- Osteotomy: This is the surgical cutting and reshaping of the bone to reduce stress on the affected area. The affected area is rotated and turned in such a way that another portion of the bone becomes the new weight-bearing area. It is done on a small area of affected bone.
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Houston Hip Specialists
Advanced Orthopedics and sports medicine has numerous Board Certified/Eligible physicians who are thoroughly educated in the latest treatment techniques both surgical and conservative. They are well versed in advances in hip treatments including arthroscopic labral repairs, minimally invasive anterior hip replacement, total and partial hip replacements.
Drs Elbaz and Brooks now perform Platelet-Rich Plasma (PRP) injections for the treatment piriformis syndrome, greater trochanter bursitis, ischial bursitis, sacroiliac joint pain and hamstring tendonitis/tears. PRP stimulates a more rapid healing of tendon, ligament, muscle and bone.
Contact us today to Schedule an Appointment or call us at 281-955-2650 to learn more about our Shoulder Treatment Services.
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Each procedure done by Dr. Patel has been an improvement. Very pleased.
Dr. Patel has been a great Doctor for me. When I was referred to after discussion we decided to do injections in my back. The first two did not work so did two more in a different section of my back. These injections worked great. I’m now able to sleep at night and the numbness in my foot is almost gone. The tingling in my foot & leg is gone and I am very happy about that. I am extremely happy that Dr. Patel is my Doctor. She has been a good listener when I tell her where I hurt and talks to me about what she feels should be done. The final decision is always mine.
On Nov. 22, 2017, I had a spinal injection in my lower back and it was an instant miracle in my life! For the first time in 4 intolerable months of pain, I was finally pain free, and I am now getting a second chance to live again! I am so grateful to Dr. Patel for my new life, and to God for guiding me to her! Thank you so very much Dr. Patel – you are God’s gift to me, thank you for being so awesome at what you do.
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The surgery done by Dr. S. Patel (Actually injections) & the mild medications she has prescribed has surely made my lower back -hip-leg less painful. I have complete confidence in her medical judgement & advice. She will administer second injection in June.
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Thank you for the opportunity to express how pleased I am with the excellent care of Stacy A. Bacon, M.D. I have confidence in her ability to care for me as she successfully partially replaced a broken hip 10 years ago, 2007. I also want to compliment Cheryl who set up the appointment. She represents Advanced Orthopaedics & Sports Medicine very well.
It’s been over 8 years since Dr. Bacon replaced by right ankle. I still can’t thank her enough for the years of pain free walking I have done since! And I’m still going strong! I had numerous breaks in my ankle due an auto accident, repaired/set by a different doctor, after multiple surgery’s, I was still limping, in great pain every day. Then I found Dr. Bacon, now, no more pain, NONE, and no more limping after this ankle replacement. I rave about her constantly and would recommend her to anyone who has a foot or ankle issue
I had been in so much pain with my back for years. It got so bad that I knew I had to do something. I went to Dr Mohr for help. I was so afraid to have spine surgery as I had heard so many horror stories. He and his staff were very informative. I was amazed at the new technology in spinal surgery. December 8, 2016 I had rods and pins put in my back. I am so happy I did now. I am healing really fast and the pain is going away as my body heals. Thank you Dr Mohr for you expertise and sensitive nature. You were understanding about my fear and helped assure me so I could receive the help I needed. You are an excellent Doctor.