New Frontiers in Treating Avascular Necrosis of the Hip
Understanding Avascular Necrosis (AVN)
Avascular Necrosis (AVN) of the hip, also known as osteonecrosis, is a painful condition due to the interruption of the blood supply to the bone, leading to the eventual death of bone tissue components. The hip is one of the joints affected, and can lead to pain and joint dysfunction, and an untreated case can cause irreversible joint damage, severely affecting the physical quality of life.
The Importance of Early Detection
Early detection of AVN is crucial if favorable treatment outcomes are desired, but unfortunately, due to the nature of the condition, it is quite difficult to achieve an early diagnosis. Usually, the patient will only present with symptoms once the condition has become advanced. Treatment in the initial stages provides the best chances to attempt preserving the integrity of the joint, minimize discomfort, and hopefully avoid invasive surgical procedures.
Determining the Best Course of Treatment
With most conditions, there are two methods of treatment. However, it is imperative that a complete staging of the condition be performed to select the best mode of treatment. This is important in explaining the prognosis to the patient and also allows the healthcare provider to manage the expectations of the patient and caregivers.
Conservative Treatment Options
The entire panel of treatment options is beyond the scope of this article, but your healthcare provider might initiate early-stage methods such as protected weight bearing and activity modification by using a walker or a crutch, along with implementing occupational and lifestyle changes that reduce stress on the affected joint. Strength and functional training can also be beneficial, and it is important to seek the advice and guidance of a qualified physical therapist who can optimize and guide you through these exercise modifications.
Pharmacological Approaches
From a pharmacological standpoint, a newer class of drugs known as bisphosphonates can be initiated. They are designed to prevent bone loss and maintain bone density and have been shown to prolong the integrity of the bone quality, and hopefully delay any surgical interventions.
The Role of Cellular Therapies
Cellular therapies use stem cells harvested from the bone marrow or even the umbilical cord, and they play a key role in bone and cartilage regeneration. Some of these stem cells can be injected directly into the affected areas and initiate the healing cascade, which helps to repair compromised tissues.
Surgical Interventions
If surgical intervention has been advised by your healthcare provider, the early procedure performed is often core decompression. This is traditionally done in an open manner, but recently, it is being performed in an arthroscopic manner, also known as keyhole surgery. Both techniques involve the removal of the dead bone, allowing for some reperfusion of the joint, which helps to improve the blood supply in the compromised area. The arthroscopic technique is less invasive and avoids bone penetration while allowing for a more complete debridement of the affected area. This has shown good results in the earlier stages with a significant reduction of pain and higher rates of native joint preservation.
In Conclusion
AVN of the hip can be a debilitating condition if left untreated. There can be drastic reductions in physical quality of life, along with long-standing physical and mental effects. An early diagnosis is key to starting treatment and allowing you to lead a normal life. It is also important to remember that treatment varies and is based on the stage at presentation. Please reach out to one of our Rothman hip specialists, and they will guide you on the correct treatment path.
