AVASCULAR NECROSIS OF HIP (AVN)

HIP (AVN)
AVN of the femoral head is a pathologic process that results from
interruption of blood supply to the bone.

Femoral head ischaemia causes bone marrow and osteocytic

death, leading to collapse of the necrotic segment of the head of
femur..
ETIOPATHOGENESIS OF HIP AVN
Etiopathogenesis is not well understood Risk Factors include:
•Genetic predilection[1]
•Corticosteroid intake[2]
•Alcohol
•Smoking
•Various chronic diseases [3] eg sickle cell disease, human immunodeficiency virus ,
hypercoagulable states, autoimmune disorders[4][5].
STAGES OF HIP AVN
AVN progresses through four stages:
1.Initial/necrosis: blood supply gets disrupted, and necrosis begins
2.Fragmentation: the body resorbs the necrotic bone and replaces it with woven bone that is weak
and vulnerable to breaking and collapse
3.Reossification: stronger bone develops
4.Healed/Remodeling: bone regrowth is complete, and final shape present (depending on damage
may be normal or abnormal).[6]
FICAT-ARLET CLASSIFICATION
 DIAGNOSIS OF HIP AVN
•Earlier diagnosis of AVN in the disease process leads to success of the
treatment, as it relates to the stage at which the treatment starts.
•Diagnosis be made with plain radiographs in moderate/late disease
•MRI may be required to detect early or subclinical osteonecrosis.

•Crescent Sign: On Xray, a thin, curvilinear lucent line parallel to the

cortical margin of the femoral head, in a patient with AN.
 SYMPTOMS OF HIP AVN
 Patients complaints of groin pain , but symptoms can also radiate to the knee or
buttocks.

 On examination - painful range of motion, especially on forced internal rotation

 Investigators need to be wary of avascular necrosis in any patient who has pain in
the hip, negative radiographic findings, and any of the risk factors, described above.
The other hip must also be evaluated.
 MANAGEMENT

The precise therapy used depends on many factors, with each patient being evaluated individually for best
outcomes.
 Factors such as
• age of the patient,
• level of pain/discomfort,
• location and extent of necrosis and
• comorbidities.

Treatments are best implemented at the pre-collapse stage and include both operatives as well as non-
operatives options. If left untreated, femoral head AN may lead to subchondral fractures within only 2 to 3
years.
MANAGEMENT

•If femoral collapse has occurred or acetabular involvement is present, arthroplasty is indicated.
•Core decompression - is a surgical procedure that requires surgical drilling into the area of dead
bone near the joint, reducing pressure, allows for increased blood flow.
This aims to slows or stops bone and/or joint destruction.

•Post surgical rehabilitation is a key component for recover, which It starts immediately after
surgery.
CONSERVATIVE MANAGEMENT

Conservative management includes :--

 Targeted pharmacologic therapy - pain control medication
 Alcohol cessation
 Discontinuation of steroid therapy
 Physiotherapy –
 restricted weight-bearing by using walking aids
 Range Of Motion exercises
 Strengthening exercises with in the limit of pain
 Balance and gait training
THANK YOU