Avascular necrosis of the femoral head is a condition where the blood supply to the ball-shaped top part of the thigh bone is lost, causing bone cell death. Causes include drugs, alcoholism, and injury. Symptoms include pain and stiffness, and treatment can include surgery or medication. Core decompression can prevent progression, while total hip replacement is recommended for advanced cases.
The femoral head is the ball-shaped top part of the femur, or thigh bone. It fits inside a socket-shaped cavity in the hip bone, known as the acetabulum, and the two parts make up the hip joint. Avascular necrosis of the femoral head is a condition in which the blood supply to the femoral head is lost, resulting in osteonecrosis or bone cell death. Causes of the condition can include steroids and other drugs, alcoholism, and accidental injury. While medications and a combination of rest and stretching exercises can help with symptoms, surgical treatment is usually required to effectively treat the condition.
Blood is supplied to the femoral head through arteries that travel along the femoral neck, a narrow section of bone that connects the femoral head to the shaft of the femur. Since this is the only blood supply, if the flow is cut off, the bone in the femoral head dies and its rounded structure can collapse and flatten. Once the hip joint no longer fits snugly, the joint surfaces can wear out and deterioration of the joint can occur.
Avascular necrosis of the femoral head typically leads to pain, which occurs when weight is placed on the hip. Most often, the pain is felt in the groin, but it can also be felt in the buttock or thigh. If femoral head necrosis progresses, hip pain may occur even when the person is at rest, and walking may become difficult, with stiffness and lameness developing over time. Femoral neck fractures can cause avascular necrosis, as can hip dislocation. Conditions like alcoholism and diabetes can damage the blood supply to the femoral head, as can taking steroids in high doses or for a long time.
If avascular necrosis of the femoral head has not progressed too far and the femoral head has not collapsed, the most common treatment is a surgical procedure called core decompression. During the core decompression operation, the surgeon punctures the femoral neck, creating channels through which new blood vessels can grow and form a blood supply to the head. The procedure can be performed using minimally invasive techniques, often known as keyhole surgery, and does not require a hospital stay.
Decompression of the core usually prevents progression and relieves any pain due to avascular necrosis of the femoral head. In cases where the condition is advanced and the hip joint has deteriorated, arthritis usually develops. Thus, the recommended treatment is to remove the femoral head and neck, along with the acetabulum, and insert artificial hip parts instead. This operation is known as a total hip replacement.
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