The hip bone is a part of the human body that is considered one of the most complex in structure. It includes the head and articular cavities, which are a rather complex mechanism. Thanks to the hip bones, the human body is able to maintain balance. Therefore, people are able to sit or move.
However, in some situations, aseptic necrosis of the head of the hip joint occurs (according to ICD-10, code M87). In this case, the development of pathology is explained by the fact that this area is subject to inflammatory processes that lead to destruction. As a rule, the hip joint suffers very often.
There is an opinion that in this situation it is not recommended to use painkillers, since they can only contribute to the deterioration of the situation. However, the opinions of doctors differ, so it is worth considering the problem in more detail.
Features of the development of pathology
If we talk about a person who does not suffer from serious diseases, then in this case the femoral head is correctly located in a special deepening of the pelvic bone. She is held there by bundles. If in this zone there is a violation of the normal process of blood supply, then this leads to a gradual deformation and subsequent destruction of the bone. Against this background, the natural processes of restoration of living tissues are stopped. Disrupted nutrient transfer to this zone. Ultimately, cartilage wears out completely, and the femoral head can completely die.
Pathology Features
If we talk about who is most prone to aseptic necrosis of the head of the hip joint, then we can say with confidence that men are more likely to suffer. Experts record 8 times more such cases that occur with representatives of the stronger sex. As a rule, 2/3 of people suffering from pathology are in the middle-aged group. This means that those who are between 20 and 50 years old, mostly men, suffer from the disease. Aseptic necrosis of the head of the hip joint in children is extremely rare. Only in the case of individual characteristics of the body or congenital anomalies. Therefore, more careful to be adults.
In 60% of cases, aseptic necrosis of the head of the hip joint of the left or right leg is fixed. In the remaining 40%, damage occurs simultaneously in both limbs.
Risk factors
If we talk about who is at risk of developing head necrosis of the hip joint, then, as a rule, this category of people includes patients suffering from systemic lupus erythematosus, sickle cell anemia, vascular diseases, osteochondrosis, dysplasia, and chronic or acute pancreatitis. However, the features of a person’s professional activity can also lead to the development of pathology. Divers and miners who are forced to carry out their work under high pressure are most prone to this ailment.
Also, people who are overweight can suffer from necrosis of the head of the hip joint. In this case, the load on the limbs is significantly increased. It is also worth being extremely attentive to those people who have suffered injuries in the pelvic area in the past or who were forced to undergo a surgical procedure in this area.
With special care, older men, as well as those who are treated with corticosteroids, should treat their health. If a person abuses alcohol, then he is also at risk.
In addition to this group, patients who suffer from pathology of blood coagulation or those who have undergone radiotherapy or chemotherapy due to cancer are belong to this group. Also, this is possible with the development of anemia. However, it is worth considering in more detail all cases in which pathology can develop.
Causes
If the femoral head does not receive the required amount of arterial blood, then in this case it is squeezed or twisted. Against this background, thrombosis may develop. If the femoral head does not receive the necessary volume of venous blood, then this can lead to stagnation, prolonged spasms of blood vessels, increased blood viscosity or impaired venous outflow.
So, many factors can lead to the development of the disease. In fact, any reason that resulted in impaired blood flow in the arteries and veins of the thigh can serve as an impetus for the development of necrosis.
The aseptic necrosis of the head of the hip joint is caused by the fact that a person:
- For a long time they drink alcohol.
- For a long time takes corticosteroids in too large doses.
- Suffers from chronic pancreatitis.
- Forced to be irradiated in the treatment of oncology.
- Suffers from decompression sickness, osteomyelitis and other pathologies.
Mechanical theory
Speaking about the causes of aseptic necrosis of the head of the hip joint, specialists often also consider mechanical damage. According to this theory, the femoral head does not receive impulses from the brain. A failure occurs during signal processing, against the background of which metabolic processes are disrupted. As a result of this, decay substances accumulate in the bones. Ultimately, changes in the physical, chemical, and structural properties of bones occur. This in turn leads to difficulty in local circulation. Pathologies of metabolic processes in the human body develop.
With injuries, necrosis can develop in a few months, but the first signs, as a rule, appear much later (1.5-2 years after the injury).
In some situations, birth defects are recorded. Sometimes people are born with a dislocation of the hip. In this case, dysplasia is most often diagnosed.
Symptoms and stages of aseptic necrosis of the head of the hip joint
In medical practice, several degrees of development of this pathology are distinguished. They differ in their symptoms:
- First one. The patient does not even suspect the development of the disease. Not all diagnostic methods can detect microscopic changes that occur in the structure of the bone. There is a development of cartilage osteonecrosis, in which the disease affects the spongy substance of the head of the bone, but the cartilage is not modified. Area of structural changes - no more than 10%.
- The second one. At this stage of aseptic necrosis of the head of the hip joint, patients feel a little discomfort. As a rule, it appears in the groin, sometimes in the hips, knee joints and lower back. However, the joints retain their mobility completely. Therefore, a person does not experience serious difficulties in moving. An impression fracture occurs. It is characterized by cracks on the surface of the femoral head. Bone plates in the load zone of the trabeculae have irregular cracks. The affected area is 10 to 30%
- The third. The patient complains of pain in the joints, even in conditions of complete rest in a prone position. The stage of fragmentation sets in, characterized by uneven contours of the femoral head, the occurrence of several foci of cystic degeneration or compaction, and a mild degree of collapse. The inter-articular space narrows or expands. The affected area is not more than 30-50%.
- Fourth. The patient feels acute unbearable pain even when lying down. The joint loses functionality. Subluxation or dislocation occurs. The head of the bone is almost completely destroyed. There is a displacement of the internal or external edges of the acetabulum. The articular space narrows or completely disappears. The zone of structural changes increases to 50-80%.
According to observations, the duration of the first and second stages is about 6 months, of the third - from 3 to 6 months, followed by the transition to the fourth stage.
If the patient is concerned about at least one of the symptoms of aseptic necrosis of the head of the hip joint, then you need to contact a specialist as soon as possible. It is also worth paying attention to the features of the manifestation of symptoms.
If a person experiences discomfort in the inguinal zone, hips or knees, then this may be the cause of this particular pathology. It becomes difficult for the patient to step on the affected leg, as a result of which it is impossible to walk or run normally. In this case, you should immediately consult a doctor.
The same applies to situations where discomfort appears not only during exertion on the limbs, but also during the rest period, for example, night sleep. Lameness during walking is also a pretty serious signal that irreversible changes begin to develop. It is necessary to pay attention to the restriction of mobility, muscle atrophy, as well as to the change in the length of the diseased limb. It is worth noting that in some situations the leg does not shorten, but rather lengthens. It is also one of the symptoms of aseptic necrosis of the head of the hip joint. The radiologists portal provides an exhaustive listing of all the signs of pathology. If discomfort occurs, it is important not to start the process and consult with specialists in time.
Diagnostics
If the specialist after the examination prescribes the treatment of aseptic necrosis of the head of the hip joint in CITO, then this indicates that the studies will be carried out as soon as possible. First of all, MRI is performed . Magnetic resonance imaging can detect the disease at an early stage. Additionally, computed tomography can be performed. In this case, the diagnosis will be made with absolute accuracy.
It is worth noting that when performing an x-ray of the head of the hip joint, aseptic necrosis is almost impossible to detect if it comes to the initial stage of the pathology. If the lesion has become more apparent, then such a study will help the doctor make the correct diagnosis. But with the help of X-ray this is possible only starting from the second stage of the development of the disease. As a rule, this occurs during the period when the patient suffers from the disease for more than a year. In this case, there is a chance to see fairly clear signs of aseptic necrosis of the head of the hip joint (ICD-10 code M87). In this case, there is no longer any point in performing a CT scan or an MRI scan, since everything is already very clear.
A radioisotope scan may also be performed. The essence of this method is that a drug labeled with radioactive isotopes, which is injected into the human body, affects the human body. In this case, it is quite easy to identify a pathological or normal condition of bone tissue. By and large, a certain dose of a substance that marks abnormal zones in the bones is injected into the human body. Thanks to the study, the specialist receives a two-dimensional image of the structure of the human body, on which all affected areas are marked. After receiving the diagnostic results, the doctor can prescribe the appropriate therapy.
Treatment features
Having identified signs of aseptic necrosis of the knee joint (by X-ray, MRI or CT), the specialist prescribes medications. If we are talking about the fact that a person only noticed the first manifestations of the disease, then it is necessary to provide rest to the affected limb.
Do not be shy to use a cane while walking. Also, the patient needs a good rest. If he is forced to continue his professional activity, then every minute of free time must be spent so that the leg rests as much as possible. At the same time, it is strictly forbidden to engage in running, jumping, and carrying heavy loads. You should not spend much time hiking. However, this does not mean that a person should completely abandon physical activity.
On the contrary, experts strongly recommend that during the treatment of aseptic necrosis of the knee joint for 40 minutes a day to perform a set of special exercises that will help strengthen the leg muscles.
However, the schedule and features of therapeutic exercises should be developed by a doctor based on research and an accurate diagnosis, as well as depending on the individual characteristics of the patient. If a person does not perform the necessary set of physical exercises, it will be much more difficult to restore the standard working functions of a limb. Similar procedures are also recommended for aseptic necrosis of the knee joint. In this case, recovery will be faster.
Drug therapy
As a rule, in order to get rid of aseptic necrosis of the head of the hip joint, combined treatment is prescribed. Be sure to include a course of anti-inflammatory drugs of the non-steroid group in therapy. However, in this case, you need to understand that we are not talking about the treatment of the disease. Drugs in this category are used only to relieve pain. Also, non-steroidal drugs help get rid of a spasm of the thigh muscles, which occurs in response to pain.
If you get rid of such tension, then muscle relaxation will occur, which in turn has a positive effect on blood circulation. However, when taking these drugs, you must not forget that the sick leg can not be subjected to intense physical exertion, you need rest.
If we talk about the treatment of aseptic necrosis of the head of the hip joint with the help of such agents, then the most effective drugs are Ibuprofen and Ortofen, as well as their analogues in composition.
Also, in the treatment of this pathology, vasodilators are used. Medicines in this category are needed in order to improve blood circulation in the area of the femoral head. Also, these drugs help eliminate blood stasis and relieve vasospasm. As a rule, Trental is used for this.
Additionally, preparations for bone restoration can be prescribed. In order to quickly restore efficiency to the limbs, experts recommend taking Group D vitamins, which help improve calcium absorption processes. They also favorably affect its accumulation in bone tissues.
In the treatment of aseptic necrosis of the head of the hip joint, chondroprotectors are also used. Means of this type help accelerate the regeneration of cartilage in the joints. Drugs should be used only if a person is diagnosed with stage III of the development of pathology. These medications must be taken for at least three months, only in this case there will be a positive trend. The following chondroprotectors are often prescribed to patients: Arthra, Teraflex, Don, Glucosamine and Chondroitin, etc.
Local remedies will help. Immediately it is worth saying that ointments, creams and gels are not able to relieve the causes of the development of pathology, however, they well ease the patient's condition with exacerbation of the pain syndrome. In addition, some drugs help establish local blood circulation. Such funds include, among others, Diclofenac, Dolgit.
Physiotherapy
Quite often, experts on the radiologists portal recommend aseptic necrosis of the head of the hip joint to be treated, including using physiotherapeutic procedures. However, separately from others, this method of therapy is considered the least effective. But as an addition to the main course of treatment, of course, suitable.
With physiotherapy, it becomes possible to slightly improve the circulatory process, as well as relieve pain. The most effective show: laser therapy, mud therapy, paraffin therapy.
Magnetotherapy
This is another way to improve the condition of the patient. If we talk about the treatment of aseptic necrosis of the knee joint, magnetotherapy is considered a fairly effective method. Thanks to such procedures, toxins can be removed from the body and cell permeability can be improved. Against the background of magnetotherapy, the vitality of red blood cells increases.
Thanks to such procedures, a person gets rid of pain, swelling subsides, and microcirculation improves. However, any activities can begin to be carried out only after consulting a doctor.
Aseptic necrosis of the head of the hip joint: operation
As a rule, surgical intervention is recommended only if the person experiences severe pain, and he does not have the ability to stop it with medications or conservative treatment. If therapeutic measures do not produce any result, then you will have to seek help from a surgeon.
In this case, endoprosthetics are usually performed. The procedure involves the introduction of an implant into the hip joint. However, it is worth noting that this type of surgical intervention is performed only in extreme cases.
The components of the joint are replaced with implants that have an anatomical shape, it is they that allow you to perform all movements. As a rule, after surgery, the patient returns to an active life after a rehabilitation course. Endoprostheses are highly durable and well take root in the human body. Their average service life is 15-20 years; when worn, the old prosthesis is replaced with a new one.
Folk remedies
Aseptic necrosis of the head of the hip joint (according to ICD-10 code M87) can be tried to cure with the help of traditional medicine. However, you need to understand that this pathology refers to quite serious diseases, so if natural preparations are the only way to treat, then you should not hope for the high efficiency of the procedures.
First of all, it is worth consulting a doctor. If he allows the use of such drugs, then in this case pine buds are considered the best remedy. You can make an infusion. To do this, mix the pine buds and sugar in a container. Spread them in layers. After that, the container is covered with a lid and put in a dark place for a week. After 7 days, a syrup appears in the vessel, which must be used to rub into the affected joint. It is also recommended to use this liquid for oral administration. For this, you need to drink syrup three times a day for 3 tablespoons. The duration of admission is 2 months.
Another effective remedy is tincture of saberfish. This natural preparation helps to get rid of pain, and also improve blood circulation. To do this, 50 g of dry grass of the saberfish must be filled with a liter of vodka. After that, the container is tightly closed and cleaned for a month in a dark, cool place. After 30 days, it must be filtered and taken 30 drops every day. Also, this drug can be rubbed into the affected area of the joint.
Cabbage is often used for pathologies of the limbs. Therefore, it is not surprising that in the treatment of aseptic necrosis, this vegetable is also very effective. For the procedure, you must use several large leaves of cabbage, which must be well greased with honey. After this, the sheet is applied to the affected area. Next, the application is wrapped in polyethylene and wrapped in a warm scarf. In this condition, the diseased joint should be left overnight. The procedure can be performed daily. The duration of treatment with this tool is 4 weeks.
Peppermint ointment also has a wonderful effect. To prepare this composition, you need to mix 50 g of eucalyptus, mint and aloe leaves. All components should be finely chopped and mixed into the pulp. After that, the composition is poured with water and boiled until the components become a homogeneous mixture. The resulting thick fluid is applied to the hip joint overnight. The procedure can be repeated until the pain completely disappears.
Turpentine is also used. To reduce the discomfort in this disease, it is recommended to take a bath with this remedy. In order to increase the effectiveness of the procedure, it is also worth adding a little Jerusalem artichoke, pine branches, sea salt to the bath. In such water must be at least 10 minutes. After that, it will not be superfluous to apply an iodine grid to the affected area and cover the skin with honey. The course of such home therapy is at least 20 procedures.
Also, few people know that ordinary ficus can alleviate the condition. Tincture from this plant can also be very effective. For its preparation, it is necessary to prepare two large leaves of ficus, pour them with 1 liter of vodka and leave in a dark place for a week. After this, the liquid must be filtered and rubbed into the skin before going to bed.
Some use animal fat. This tool helps to activate the blood vessels. To prepare the composition does not require any major events. It is necessary to mix fat of pig and nutria in equal proportions. After this, the composition is first heated, and then cooled until an ointment is obtained. After this, the finished product must be rubbed into the affected area for a month.
However, before using any herbs and other natural remedies, you should make sure that the patient is not allergic. Some natural ingredients can cause quite a strong side reaction. In this case, skin irritation or rash may appear.
What is the pathology fraught with?
With untimely treatment of aseptic necrosis of the head of the hip joint, the consequences of the disease can be very serious. If the patient did not contact the specialist at the right time, this can lead to loss of limb mobility and disability. This means that a person will not be able to normally perform the usual daily routines. If the mobility of the joint is impaired, then even climbing the stairs will be associated with severe pain.
Therefore, when the first symptoms of the disease appear, it is necessary to immediately undergo an examination. The sooner the patient begins treatment, the more favorable the prognosis. It is impossible to prescribe certain procedures for yourself.