Downloaded 1,467 times
Uploaded byDr.A.Mohan krishna
AVASCULAR NECROSIS OF HIP (AVN HIP)
Avascular necrosis (AVN) of the femoral head is a condition characterized by the loss of blood supply to bone, leading to bone death and potential collapse of the hip joint. Causes include traumatic injuries and steroid use, while symptoms encompass pain and stiffness in the hip. Diagnosis typically involves imaging techniques like X-rays and MRIs, with treatment options ranging from medical management to surgical interventions such as core decompression or total hip replacement, depending on the disease stage.
In this document
Powered by AI
Overview of AVN, its impact on femoral head due to interrupted blood supply and consequent bone death.
Details on traumatic (e.g., fractures) and nontraumatic causes (e.g., steroid use, alcohol), highlighting significant risks involved.
Common patient symptoms include hip pain, stiffness, limp, and night pain, indicating severity of AVN.
Importance of X-rays, MRI, and Bone Scans in detecting AVN stages and identifying affected areas.
Treatments vary by disease stage; includes decompression techniques aimed at alleviating symptoms and delaying progression.
Advanced procedures like stem cell treatment and vascularized fibular graft aimed at restoring blood supply and reducing collapse.
Post-surgical care focuses on protecting the femoral head, allowing gradual weight bearing and healing.
Comprehensive overview of hip replacement options, materials, and considerations for surgical decisions.
More Related Content
Similar to AVASCULAR NECROSIS OF HIP (AVN HIP)
AVASCULAR NECROSIS OF HIP (AVN HIP)
- 1. AVASCULAR NECROSIS OF FEMORAL HEAD (AVN)
- 2. Dr. A.MOHAN KRISHNA M.S.ORTHO, MCh ORTH(U.K) Consultant Orthopaedic surgeon , Trauma, Arthroscopy, Arthroplasty Surgeon Apollo hospitals, Hyderabad Consultant Orthopaedic Surgeon at www.drmohankrishna.com www.healthyjointclub.com www.bonesandjointsclinic.com
- 3. DISCLAIMER This presentationis solely for educational purpose. The material included in the presentation represents educational material for the patients and not intended for any treatment purpose
- 4. INTRODUCTION Avascular Necrosisis condition in which there is loss of blood supply to the bone. Bone is living tissue loss of blood supply bone death If bone death progresses leads to bone collapse
- 5. AVASCULAR NECROSIS OFFEMORAL HEAD Blood supply to femoral Head (ball of hip joint) is interrupted by 1. Traumatic 2. Nontraumatic Femoral head: Death of bone cells and marrow Dead segment of bone Further collapses and loss of sphericity
- 6. CAUSES Traumatic Fractureneck of Femur Fracture dislocations of hip Injuries /surgeries around hip Nontrauamtic Steroid use Excess Alcohol intake Sickle cell disease Other blood cell disorders Deep sea divers and miners
- 7.
- 8. STEROID INDUCED Corticosteroids:Prednislone / Methyprednislone: used in management of Asthma Skin diseases Immunological diseases Renal transplant In the above conditions there is no choice Steroid induced is usually Bilateral
- 9. COMPLAINTS Hi, What’syour complaints?
- 10. COMPLAINTS Pain:groin,buttocks, Frontof thigh Limp Stiffness in hip Night pain
- 11. COMPLAINTS Pain:groin,buttocks, Frontof thigh Stiffness Limp
- 12.
- 13. X-RAYS X-Rays 1.Earlystages of AVN : X ray not useful even though there is pain 2.Advanced Stages of AVN : Bone cyst and collapse of dead bone and arthritic changes can be seen AVN femoral head
- 14. PROGRESSION OF AVN-X-RAYS
- 15. MRI MRI 1.If X ray fails to show AVN. 2.Can detect AVN of HIP within days 3.Can be used for staging the disease 4.MRI takes multiple slices of images of hip and can show even tiny areas of damage.
- 16. BONE SCAN Bonescan 1. A very sensitive investigation 2. Scan shows cold spot at places of AVN 3. Replaced now by MRI
- 17. TREATMENT Once AVNstarted : treatment depends on Stage of Disease and symptoms/Age/general health of patient AVN is irreversible: no drugs can restore blood supply to femoral head
- 18. MEDICAL MANAGEMENT Keepingweight of affected hip Crutch walking Anti inflammatory medications initially • Simple analgesics for pain Bisphosphnates :Reduces risk of femoral head collapse Blood thinning drugs with a hope of maintaining precarious blood supply
- 19. SURGERY AVN femoralhead • No Collapse operations to increase blood supply • Core Decompression with or with out bone graft AVN Femoral Head : Advanced stage • Arthritic Hip • Total Hip Replacement
- 20. DECOMPRESSION OF FEMORALHEAD Drilling one or several holes through the neck of femur into areas of head where there is lack of blood supply Principle: 1. It decreases the pressure inside the femoral head 2. It helps to stimulate budding of new blood vessels in affected areas Reliving pressure helps in reduction of pain. It does not cure the disease but can help to delay the progression of AVN
- 21. DECOMPRESSION OF FEMORAL HEAD+ BONE GRAFTING Decompression of femoral head Inserting freeze dried allograft into the decompressed canal Pain relief due to decompression • Graft acts as structural support preventing further collapse.
- 22. DECOMPRESSION OF FEMORAL HEAD+ BONE GRAFTING
- 23. DECOMPRESSION + STEMCELL TREATMENT Decompression of femoral head Harvesting stem cells from the patient and filling into the decompressed femoral head Pain relief due to decompression • Stem cells helps to form new bone, which in turn can give structural support
- 24. DECOMPRESSION OF FEMORALHEAD + VASCULARISED FIBULAR GRAFT Decompression of femoral head is done by making a hole into femoral head. A fibular graft along with its blood vessels is removed from the leg and inserts into the hole created in femoral neck and head. Surgeon then connects the blood vessels of the fibula to the blood vessels around the hip. It can help to restore the blood supply . Fibular graft act as strut and help in preventing collapse of femoral head
- 25. This procedure iscomplicated. Success rates depend on the patency of newly formed blood vessel connection between the graft and hip blood vessels.
- 26. POSTOPERATIVE MANAGEMENT Afterdecompression it weakens the femoral neck & head Protected weight bearing with aid of crutches and walker for 6 weeks Weight bearing after 6 weeks and return to regular activities.
- 27. TOTAL HIP REPLACEMENT Advanced Stage of AVN: Femoral head collapse Secondary osteoarthritis of Hip joint Total Hip Replacement
- 28. TOTAL HIP REPLACEMENT Different designs & materials in Hip replacement • Consists 2 basic components Ball & Socket components Ball component • Highly polished Metal • Ceramic material Socket component . Plastic (High molecular weight polyethylene) . Ceramic . Metal
- 29. CHOICE OF MATERIAL Total hip replacement could be CEMENTED and CEMENTLESS. Decision is based on number of factors like age, quality & strength of bone and cost factor in some instances. Surgeon can decide and choose that meets patients needs.
- 30. CONTACT Dr.A.MOHAN KRISHNA M.S.Ortho., MCh Ortho(U.K)., Consultant Orthopaedic Surgeon, Apollo Hospitals, Hyderabad. Appointments: Secretary : 09441184590 08332936085 www.drmohankrishna.com www.healthyjointclub.com www.bonesandjointsclinic.com Email: [email protected]