Avascular necrosis of the femoral head is caused by impaired blood flow in the vascular system that feeds this area. Such phenomena occur as a result of squeezing or twisting during blockage of a small thrombus of an artery or injury. Next, we consider in more detail what is avascular necrosis of the femoral head.
Provocative factors
Prolonged vascular spasm and increased blood viscosity, venous congestion and impaired outflow significantly worsen the nutrition of the femoral head. In this regard, internal pressure increases, ischemia develops. This provokes a violation of the mechanical properties of bone tissue. As a result, voids form. Over time, the bone begins to deform, articular cartilage, collapsing, exfoliates from it.
Pathology Features
Necrosis (avascular) of the bone is detected quite often. Mostly, pathology is detected in men aged 20 to 45 years. Avascular necrosis of the femoral head is also diagnosed in children aged 2 to 12 years. At the same time, boys get sick more often. The symptoms that accompany avascular necrosis are difficult to differentiate in some cases. This makes it difficult to make an accurate diagnosis. In particular, the symptoms of avascular necrosis are almost impossible to distinguish from the manifestations of the pathological process in the hip joint.
Progression
Avascular necrosis develops quite rapidly. Already on the third day the patient feels intolerable pains, the intensity of which is increasing. When you try to get up, while walking appears soreness in the groin. She also appears on the side and front of the thigh and gives to the knee. In many patients, the pain can be exhausting and permanent. It can last at night and subside in the morning. When moving loads provoke soreness in the lower back or buttock. The limitation of mobility, the appearance of lameness should immediately alert the person and become the reason for the speedy appeal to a specialist.
Avascular necrosis of the femoral head: causes
According to many experts, the development of pathology is facilitated by the long-term intake of alcohol in large volumes. Also, prolonged treatment with high doses of corticosteroid hormones can become the cause of necrosis. Among the popular factors provoking the condition, it should also be noted injuries: fractures, dislocations, bruises. Bone necrosis (avascular) can begin due to normal fatigue, stress, emotional overstrain. Cases have been reported when the pathology developed as a result of chronic or acute pancreatitis. Irradiation in large doses can also act as a provoking factor. Pathology can accompany sickle cell anemia, osteomyelitis. In medical practice, there is such a thing as idiopathic necrosis. It is used if it is impossible to establish what exactly provoked the pathology.
Diagnostics
Avascular necrosis must be detected as early as possible. In this case, there is a high probability of doing without surgical intervention. However, as a rule, pathology is diagnosed quite late. This is due to the fact that with the appearance of pain in the thigh, the patient is sent for x-ray examination. In the pictures, the first stage of the pathology is not detected. Violation becomes noticeable on x-rays after a few months. Identify necrosis (avascular) bone in the initial stages using MRI or CT. A blood test and an ultrasound scan do not give an accurate result. As diagnostic methods, scanning and measuring internal bone pressure are used.
Stages of the development of pathology
How does avascular necrosis of the femoral head progress? The stages of pathology are as follows:
- Violation of vascular function. At this stage, it is necessary to avoid jumping, carrying heavy loads, prolonged standing in one place, running. The patient is recommended rest and relaxation. Treatment at this stage should be aimed at restoring blood circulation in the femoral head, as well as regeneration in the tissue. The patient was recommended special gymnastics to prevent the development of muscle atrophy. At this stage, a specialist can recommend taking vasodilator drugs. Medications will help to eliminate stagnation and restore the structure of the head by normalizing arterial circulation and eliminating cramping. Effective in this case are non-steroidal anti-inflammatory drugs, novocaine blockade, hirudotherapy, massage. Decompression of the greater trochanter or femoral head is also used.
- Deformation and destruction of a damaged element. At this stage, walking in slow steps of 30-50 minutes, exercising on a stationary bike, and swimming in sea water are useful. Of the medications, drugs that promote bone restoration and vasodilators are recommended . Hirudotherapy, massage, decompression are also prescribed.
- Hip arthrosis. At this stage of the pathology, gymnastics and massage are recommended. Of the drugs, a specialist can prescribe chondroprotectors and vasodilators.
At a later date, lameness and marked shortening of the affected limb are noted. This is especially noticeable when the patient is in a horizontal position. Against the background of pathology, muscle atrophy progresses: tissues begin to dry out and decrease in volume.
Avascular necrosis of the femoral head: treatment with NSAIDs
Recommended drugs in this group include drugs such as Diclofenac, Indomethacin, Ketoprofen, Piroxicam, Butadion, Meloxicam, Nimulide, Celebrex and derivatives thereof. These medications help reduce soreness. It should be noted that NSAIDs do not treat necrosis (avascular) of the bone. However, these medicines can bring the patient quite tangible benefits. Appointed in a timely manner, the drugs prevent reflex muscle spasm that appears in response to unbearable pain. The relaxation of the fibers helps to restore blood circulation in the affected area. However, taking NSAIDs can be dangerous for the patient. The fact is that after the use of medicines, a person ceases to feel pain and loads the affected area as well as a healthy one. This, in turn, contributes to the rapid destruction of the bone head. In this regard, the patient must remember that, despite the absence of pain, the damaged area should be protected from stress.
Vasodilator
This category includes drugs such as Trental (Pentosyphylline, Agapurin) and Theonicol ( xanthinol nicotinate). They are quite effective in avascular necrosis. These medications help to eliminate stagnation in the blood circulation. When they are taken, the recovery of bone head tissue is accelerated. This is made possible by stabilizing the arterial blood flow and eliminating spasm in small blood vessels. Among the additional advantages of vasodilator drugs , their almost absolute harmlessness should be called. When following the doctor's recommendations and taking in therapeutic doses, they have almost no contraindications and side effects. They are not prescribed for acute myocardial infarction, as well as for patients who have recently had a hemorrhagic stroke. When taking vasodilators, often patients experience a feeling of heat, their face reddens. This is quite normal in such cases. It is due precisely to the active expansion of blood vessels. Medications of this category are taken twice a year in courses lasting 2-3 months.
Tissue Repair Product
This category should include medicines such as Calcium D3 Forte, Alpha D3 TEVA, Osteomag, Oksidevit and others. These funds are very useful in pathology. Vitamins of group D improve the absorption of calcium. Due to this, its content is significantly increased. This, in turn, prevents the reverse excretion of calcium from bone tissue into the blood. Due to this, the compound accumulates in the skeletal elements. In particular, its concentration increases in the tissues of the femoral head. Significant help with pathology bring calcitonins. These include, in particular, such funds as Sibakaltsin, Alostin, Miacaltsik and others. These drugs stimulate bone formation and eliminate soreness. Thanks to their use, calcium outflow is significantly reduced and the activity of osteoblasts (โbuildingโ cells) is stabilized.
additional information
Avascular necrosis of the femoral head (ICD-10: M91.1) has another name. It is referred to as Legg-Calve-Perthes disease. The most common pathology in England. In this country, 1 case is recorded per 1800 inhabitants.