Avascular Necrosis of the Hip (AVN)

What is Avascular Necrosis of the Hip (AVN)?

Avascular necrosis (AVN), also called osteonecrosis, bone infarction, aseptic necrosis, and ischemic bone necrosis, is cellular death (necrosis) of bone due to interruption of the blood supply. Without blood, the bone tissue dies and the bone collapses. If avascular necrosis involves the bones of a joint such as the hip, it often leads to destruction of the joint articular surfaces.

There are known causes of AVN, but often no obvious cause is identified. Common causes include corticosteroid use, excess alcohol intake, and previous trauma to the hip joint (fracture of the hip, traumatic dislocations of hip).

How will it affect me?

Usually, AVN of the hip causes groin and thigh pain. In the early stages of the condition, it may not cause any symptoms. As it progresses it will cause pain on weight-bearing, and eventually will cause pain at rest. Eventually, the joint collapses and severe degenerative changes occur leading to severe pain and stiffness of the hip.

What is the treatment?

Plain radiographs (x-Rays) often demonstrate later changes of AVN. The gold standard investigation is magnetic resonance imaging (MRI).  AVN of the hips almost always deteriorates if left untreated. Causes should be identified if possible and these factors removed or treated.  It is usual that people with AVN require some form of surgical intervention. This depends on how advanced the condition is.  The early stages of AVN are usually treated with a core decompression of the hip (see below).  The later stages of the condition are not reversible. This is usually treated with a Total Hip Replacement.

Core Decompression of the Hip

This treatment is specifically for those diagnosed with avascular necrosis of the hip (AVN). It is only indicated when the shape of the femoral head (the ball of the hip joint) is unaltered.

After an appropriate anaesthetic (general or spinal), a very small incision is made to the side of the affected hip. A small drill is passed up into the femoral head under X-ray guidance to the area affected by the AVN. This allows new blood vessels to grow into the affected area and re-establish a blood supply to this area of bone.

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