AVN Hip - Symptoms, Diagnosis, Tests, Treatment

A 30-35 year young patient enters my clinic with a limping gait. He complains of pain in his Right hip joint especially while attempting to squat or sit cross legged. His wife describes numerous night awakenings due to sudden painful spasms. The pain has been there for almost 6 months now, and is worsening every week.

I asked for an X-ray of both the hip joints.

The X-ray did not reveal anything significant. So, I asked for an MRI of the hip joints. Now, the sequence of events started. There was evidence of Avascular necrosis of Femur Head in Right hip joint.

Avascular Necrosis of Hip or AVN as often used by Orthopaedic surgeons, describes damage to the Femur head (upper end of thigh bone) which forms an articulation with the Acetabulum (socket).

It produces pain in the Hip joint which gets aggravated with movements and in late stages blocks all movements due to florid arthritis.

Now, the important questions are
A) What do we do now?
B) What will be the long term fate?

AVN is presumed to be caused by raised Intra-osseous pressure within the femur head; which eventually causes destruction of bone cells resulting in collapse and later degenerative arthritis.

If presented early, the femoral head may be preserved by use of certain drugs which prevent bone destruction. These drugs have shown good improvement if continued over a period of 2-3 years.

If there are changes in the femoral head, or persistent pain; moderate relief may be obtained by core decompression of the femoral head and neck. This supposedly reduces intra-osseous pressure and preserves femoral head viability. However, there is no warranty against worsening of status.

In late stages, when the arthritis supervenes, the only option left is Total Hip Replacement.

Hip Resurfacing procedures often advocated, may not be viable in most cases because the quality of bone in the femoral neck is often compromised in such patients.