Bone is a living tissue and it needs blood supply to survive. Avascular necrosis, blood supply femoral head everything you need to know dr. Most of the time it is the anterolateral region of the femoral head that is affected but no area is. This decreased circulation causes cells in the bone and bone marrow to. Evaluating the use of a proximal femoral nail in unstable trochanteric fracture of the femur. Avascular necrosis, death of bone tissue caused by a lack of blood supply to the affected area. Nontraumatic anfh continues to be a significant challenge to orthopedic surgeons. Avascular necrosis of the femoral head avnfh re fers to a progressive weakening o f the k nobby head of the thigh bone femur, resulting in eventual collapse of the bone structure if. Avascular necrosis is a disease resulting from the temporary or permanent loss of blood supply to the bone.
Pdf avascular necrosis of the femoral head in sickle. It is often just referred to as avascular necrosis, abbreviated avn. However, whether this effect is dependent on the dose of corticosteroids is not well known. Avn has a wide variety of causes and can affect nearly any bone in the body. Coverage rationale core decompression is proven and medically necessary for treating early precollapse stage i and ii avascular necrosis of the femoral head. Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur thighbone is disrupted. Avascular necrosis of the femoral head after intertrochanteric fractures. Both hypothesized that the effect of pemf stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bonemarrow edema. The usual earlyonset symptom is joint pain in both children and adults. K consultant orthopaedic surgeon, trauma, arthroscopy, arthroplasty surgeon apollo hospitals, hyderabad consultant orthopaedic surgeon at. Avascular necrosis of the femoral head is a frequent condition with an insidious presentation. Necrosis, bilateral lesion, and hip function were found to be associated with the loss of quality of life. If avn involves the bones near a joint, it may lead to collapse of the joint surface. When it occurs in children at the femoral head, it is known as leggcalveperthes syndrome.
For the state of tennessee, refer to the medical policy titled core decompression for avascular necrosis for tennessee only. Hips with stage i osteonecrosis of the femoral head at the time of surgery demonstrated total resolution of osteonecrosis based on preoperative and postoperative mri studies. Pathophysiology of nontraumatic necrosis of femoral head. It included 61 patients with avascular necrosis of. How to prevent avascular necrosis with pictures wikihow. Level of evidence iii, sectional comparative study. Avascular necrosis avn, or more correctly osteonecrosis, is a generic term referring to the ischemic death of the constituents of bone. Dec 17, 2014 avascular necrosis of the femoral head anfh is a pathologic process that results from interruption of blood supply to the femur bone resulting in the death of bone cells and collapse of the femoral head. It is a disease resulting from the temporary or permanent loss of the blood supply to the bone. We believe that all bone necrosis passes through a preradiologic stage, which is either painful and therefore stage i or asymptomatic and therefore stage o.
Necrosis results if the vascular supply to the proximal femur is interrupted. Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head preoperative necrotic area extent was measured with using mri scans and averaged limitations the limitations of our study are that it was a retrospective analysis performed over a short period of observation, and had a small cohort. Avascular necrosis of the femoral head is necrosis of the head of the femur to the vascular compromise. Features consistent of bilateral femoral head avascular necrosis. Cushings disease presenting with avascular necrosis of. Though the plain radiograph of the hip was negative, magnetic resonance imaging mri of the left femur showed a stage 2 avascular necrosis avn of the femoral head, with stage 1 being the earliest and stage 6 the most advanced. Moreover, the diagnosis of osteonecrosis cannot be made by standard xray technique, which means that a normal xray examination does not guarantee that the hip is normal. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis. Leo massari et al have analysed the effects of stimulation with pulsed electromagnetic fields pemfs on the treatment of avascular necrosis of the femoral head.
Avascular necrosis an overview sciencedirect topics. Avascular necrosis of the hip is a disease of the fourth and fifth decades of life and is more common in men, with an 8. Glucocorticoids are the most common nontraumatic cause of anfh as between 5% to 40% of patients treated with longterm gcs develop anfh 3, 18. Avascular necrosis of the femoral head physiopedia. The diagnosis in the early stage can be made only through the.
A retrospective study was carried out on the efficacy of core decompression of the femoral head. Avascular necrosis associated wim longterm steroid intake is welldocumented in the literature. All the other forms of this disease are secondary 28. Sickle cell disease is a risk factor for interrupting the blood supply of the femur and developing osteonecrosis of femoral head. Osteonecrosis, also known as aseptic necrosis, avascular necrosis avn, atraumatic necrosis, and ischemic necrosis, is a pathologic process that has been associated with numerous conditions and therapeutic interventions. Treatment of avascular necrosis of the femoral head. One of the most common reasons for secondary avascular necrosis is prolonged systemic steroid use in high doses equivalent to 4000 mg of prednisone for extended periods of up to 3 months, or longer. Avascular necrosis of the femoral head anfh has been described as a frequent outcome in patients with sickle cell disease scd. If there is damage to one of the blood supply, bone may depend on the accessory blood supply for the survival.
Learn more about the symptoms, causes, diagnosis, and treatment of. Avascular necrosis avn, or osteonecrosis, is defined as the death of bone tissue due to a lack and loss of blood supply to a particular bone. The objective of the current report is to present the prevalence. Avascular necrosis of the femoral head libre pathology. Avascular necrosis free download as powerpoint presentation. We conducted a casecontrolled study, which included 74 recipients of autologous or allogeneic hct with avn and 147 controls without avn that were matched by age, sex. In children idiopathic avn of the of capital femoral epiphysis is known as leggcalveperthes disease. Avascular necrosis avn is a disease where there is cellular death of bone component due to interruption of the blood supply. The aim was to increase the number of osteoprogenitor cells in the proximal femur to stimulate bone remodeling and creeping substitution. One of the most common reasons for secondary avascular necrosis is prolonged systemic steroid use in high doses equivalent to 4000 mg of prednisone for extended periods of.
Early suspicion is necessary and the person who has avn must be referred to a doctor, especially an orthopedic bone specialist. Exposure to corticosteroids increases the risks of avascular necrosis avn of the bone after hematopoietic cell transplantation hct. Avascular necrosis usually affects people between 30 and 50 years of age. Most sites of involvement have an eponym associated with avascular necrosis of that area, and these sites are discussed. Avascular necrosis of the femoral head is a frequent condition with an insidious pre. But certain bones in our body have precarious unidirectional blood supply like head of femur, scaphoid, and talus. Range of motion of her left hip joint was decreased, compared with the right hip joint. Avascular necrosis most commonly affects the epiphyses ends of the femur thigh bone. Common symptoms the highest incidence of leggcalveperthes disease occurs between 4 and 8 years of age. In patients in whom there is direct damage to bone vasculature eg, femoral neck fracture or direct injury of bone or. Avn of the femoral head is one of the most common affection and it can be bilateral. Avascular necrosis of hip avn hip linkedin slideshare. Avascular necrosis of the femoral head, also known as osteonecrosis, although this term isnt used that much anymore, is characterized by variable areas of dead trabecular bone and bone marrow, extending to and including the subchondral plate. Avascular necrosis of the femur head avnfh is a debilitating disease caused due to the use of alcohol, steroids, following trauma or unclear idiopathic etiology, affecting mostly the middle.