Avascular Necrosis of hip

Hip pain is one of the most common types of pain in the world. It causes due to various problems with hip muscles, ligaments, tendons and other soft tissues surrounding the hip. Avascular Necrosis (AVN) is commonly occurs in the Hip. Bone is a living tissue hence it requires blood. In Avascular Necrosis (AVN), bone tissue dies due to a lack of blood supply. If this problem is not treated on time then it can lead to tiny breaks in the bone and finally causes bone to collapse.

Avascular Necrosis (AVN) is also known as Osteonecrosis, Aseptic Necrosis or Ischemic Bone Necrosis. People between the age group of 30-50 are mostly affected by Avascular Necrosis disease.

Symptoms- Avascular Necrosis of Hip:

At early stage, many patients do not show any specific symptoms. But as the condition becomes worse the affected joint starts hurting and patient can feel extreme pain in the hip.

Patient starts experiencing pain gradually. Pain can be mild or severe depending on the level of bone damage.

Patient suffering from the Avascular Necrosis of the hip can feel pain mainly in the groin, thigh or buttock area. But sometimes pain can be spread to shoulder, knee, hand and foot areas.

Diagnosis- Avascular Necrosis of Hip:

Orthopedic doctor or Hip Surgeon performs physical examination of patient like pressing joints and checking tenderness. Doctor also ask patient to move joints in various positions to observe the range of motion. Many times doctor does not find exact location of pain. In such situation, doctor asks for imaging tests such as:

X rays: In the initial stage, X rays appears normal but in the later stages X rays shows changes in the bone.

CT or MRI Scan: These tests produce detailed images which show early changes in bone. This test reports are used to indicate Avascular Necrosis.

Bone Scan: In Bone Scan test, a small amount of radioactive material is injected into the vein. This tracer travels to the parts of bones that are injured or healing and shows up as bright spots on the imaging plate.

Treatment- Avascular Necrosis of Hip:

The Avascular Necrosis treatment is mainly depending on the level of bone damage. The main goal of treatment is to prevent further bone loss. The treatment of Avascular Necrosis of Hip is divided into two types’ medications or physical therapy and surgical procedures.

Medications and Therapies

In the early stage of Avascular Necrosis of Hip, doctor prescribes effective medicines to cure symptoms. A doctor recommends various medicines and therapies such as

Nonsteroidal Anti-Inflammatory Drugs: These medicines help to relieve the pain in the Avascular Necrosis of Hip.

Osteoporosis Drugs: These drugs are used to slower the progression of Avascular Necrosis.

Cholesterol-Lowering Drugs: These drugs are used to reduce the amount of cholesterol and fat in blood to prevent the vessel blockages that can cause Avascular Necrosis.

Blood thinners: Doctor recommendeds Blood Thinners to prevent blood clots in the vessels.

Rest:  Rest is very important to cure Avascular Necrosis of hip. Patient should reduce the weight and stress on affected bone as well as should avoid heavy physical activity.

Exercises: Physiotherapist teaches suitable exercises to patient for marinating or improving the range of motion in hip joint.

Causes- Avascular Necrosis of Hip:

Avascular Necrosis (AVN) mainly occurs when the blood flow to a bone is get interrupted or reduced. This insufficient blood supply is caused by various factors such as:

Joint or Bone Trauma

Road accidents can cause severe hip injury like Hip dislocations, severe hip fractures and other injuries to the hip which can damage the functions of blood vessels. These damaged blood vessels are unable to supply sufficient amount of blood to the femoral head.

Excessive Alcohol Intake

Excessive alcohol intake can cause fatty substances to deposit in the blood vessels so that the blood supply to the bones decreases.

Corticosteroids Medicines

Steroid medicines are used to treat many diseases such as Asthma, Rheumatoid Arthritis and Systemic Lupus Erythematosus. This reason is still unknown but research shows that the high dose of Corticosteroids can increase lipid levels in the blood reducing blood flow to bones.

Medical Treatments

Certain medical treatments such as radiation in cancer treatment can weaken the bone. Organ transplantation especially Kidney transplant also causes Avascular Necrosis of Hip.

Other Medical Diseases

Avascular Necrosis of Hip is also associated with other diseases such as Caisson disease (diver’s disease or the bends), Sickle cell disease, Myeloproliferative disorders, Gaucher’s disease, Systemic lupus erythematosus, Crohn’s disease, arterial embolism, thrombosis and vasculitis.

Surgical Treatment

If medicines failed to cure Avascular Necrosis of Hip then doctor decides surgical treatment option. Today, hip surgery is performed by Minimally Invasive Technique. Various surgical options are:

Core Decompression Surgery: In this surgery, Surgeon removes part of the inner layer of bone. This surgery not only reduces the pain but also stimulates production of healthy bone tissues and new blood vessels.

Bone Transplant (Graft): This surgery is helpful to strengthen the area of bone affected by Avascular Necrosis. The graft is a section of healthy bone taken from another part of body.

Bone Reshaping (Osteotomy): In Osteotomy procedure, a wedge of bone is removed above or below a weight-bearing joint to help shift weight from damaged bone. Bone reshaping postpones joint replacement surgery.

Joint Replacement Surgery: This surgery is performed to replace the damaged parts of joint with plastic or metal parts.

Regenerative Medicine Treatment: Bone Marrow aspirate and concentration is a newer procedure which is used for early stage Avascular Necrosis of the hip. In this surgery, Stem cells are harvested from patient’s bone marrow. During surgery a core of dead hipbone is removed and stem cells inserted in its place which allows for growth of new bone. More research is going on to get best results.

If Avascular Necrosis of the hip is diagnosed after collapse of the bone and core decompression surgery failed to prevent further collapse. In this situation, the patient is best treated with a total hip replacement surgery which is very effective in relieving pain and restoring motion.

Today, Hip Replacement Surgery is performed by minimally invasive technique over traditional technique. Minimally Invasive surgery has lots of benefits such as less pain, minimal blood loss, faster recovery and no scarring. Dr. Bakul Arora is a well experienced and proficient Minimally Invasive Hip Replacement surgeon. Doctor has done lots of complicated hip replacement surgeries successfully.

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The Arora Clinic is one of the most advanced Orthopaedic clinic in Thane region and dedicated to providing the best, personalised healthcare with a breadth of surgical and medical expertise. Arora Clinic offers the modern surgical treatments like “Minimally Invasive Knee Replacement Surgery” which is also called as “PAIN-LESS SURGERY” for any complex knee diseases.

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Dr. Bakul Arora is a Consultant Joint Replacement & Orthopaedic Surgeon is one of the leading Knee Replacement Surgeon in Thane and Mumbai with over 4000+ successfully surgeries. Dr. Bakul Arora specialises in Mini-invasive techniques which offer multiple benefits to patients. He does the surgery using Subvastus approach for Knee Replacement surgery and Direct Anterior Approach for Hip replacement Surgery . This new techniques has many advantages for patients like its pain-less , stich-less surgery, patients walks on the same day after surgery, no blood loss, faster recovery etc.

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    Knee replacement is required for advanced arthritis of the knee joint, producing painful limitation of movements and restriction in activities of daily living. Knee replacement as a solution should be offered when all non–surgical methods of treatment failed and painkiller medicines and injections also failed to reduce the Knee and hip pains.

    Knee replacement can be total or unicondylar, depending on the number of compartments involved. Among the total knee replacement, there are two popular designs- Cruciate Retaining, and Posterior Stabilized. The decision for the design is best taken by the operating orthopedic surgeon based on the integrity of ligaments. Patella resurfacing as a routine is a debatable subject.

    Yes, most knee replacement surgeries are minimally invasive, with numerous benefits to the patient, including smaller incisions, less tissue trauma, bleeding and post–operative pain, shorter hospital stays, faster recovery, and earlier return to work and activities — in weeks rather than months. Advantages of Minimally Invasive Knee Replacement Surgery. Patients Start walking in few hours of surgery. Patients start climbing the staircase from second day of his surgery. Patients Discharge with in 3 Days from the Hospital after surgery. No blood loss during the surgery, no blood Transfusion required. Less Physiotherapy.( No Physiotherapist required for home) Less Antibiotic. Stitchless Surgery. Recovery time is just two – three week.

    Bilateral knee replacement in the same sitting, can be performed if both the knee joints are damaged to the same extent, however, the medical condition of the patient, and bone quality must be kept in consideration.

    Surgery through Minimally Invasive technique patients start walking on the same day and staircase climbing starts from the second day of surgery. Patients can resume his work after 3 – 4 week.

    The most significant risks include Infection, Deep vein thrombosis,and Aseptic loosening of implants. The risks correlate with the co-morbid medical condition, and must be discussed with the patient before surgery.

    Patients normally require hospitalization for 3-4 days in single knee replacement, and up to 5-6 days in both knee replacement surgery

    A single knee replacement takes approximately 90 min- 2 hours. Both knee replacement surgery takes approx 2-3 hours.

    Years ago, knee replacement surgery was reserved for elderly patients due to a high complication rate and lack of implant durability. Modern techniques have allowed orthopaedic surgeons to base surgical decisions on a patient’s pain and disability, and not necessarily chronological age. Most patients who undergo knee replacement are between the ages of 50 and 80, but surgeons evaluate patients individually and primarily on their physiologic age and demands.

    Patients can resume his/her light work after discharge from the hospital, no need for rest.

    Patients are given epidural anesthesia for surgery, and post op pain relief. They are expected to follow instruction from physiotherapist regarding muscle training.

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