Avascular Necrosis: Causes, Treatments, and Recovery Tips

Avascular necrosis of the femoral head?

Hello! I have been experiencing pain in my right hip joint for about four months.
In May, I was diagnosed with avascular necrosis of the femoral head at Chi Mei Medical Center in Tainan, and I underwent total hip replacement surgery in early June.
It has been about two months since the surgery, and my recovery has been good.
However, recently, I have started to feel pain in my left hip joint for about a month.
The doctor suspects it to be stage II avascular necrosis of the femoral head, which has left me quite shocked and frustrated.
The doctor mentioned that the majority of the causes for this condition are unknown, which I find very difficult to accept and distressing.
1.
I would like to ask if it is true that most causes are unknown, and if there are any methods to identify the cause in order to prevent its occurrence.
I am not a long-term user of corticosteroids, I do not drink alcohol, and my daily life and diet are normal.
2.
Besides the methods suggested by my doctor, such as electrical stimulation, shockwave therapy, and hyperbaric oxygen therapy, are there any other methods to prevent further deterioration and avoid future joint replacement? Which of these methods is currently considered the most effective with the least side effects, and which hospital and doctor would be best for treatment? Is it necessary to undergo all these treatments? I really do not want to have to replace the artificial joint again.
Alternatively, do you suggest a more passive approach and not pursue preventive measures, considering that joint replacement surgery is a well-established procedure?
3.
Since I have already undergone total hip replacement on my right leg, I would like to know if there are any post-operative precautions or lifelong restrictions on positions or activities.
Can I return to work normally (I currently work in accounting)? If so, when would be the most appropriate time to return to work, or should I stop working to focus on treating the condition in my left leg? I would greatly appreciate your answers! Thank you!

angela, 20~29 year old female. Ask Date: 2006/08/01

Dr. Shi Guozheng reply Orthopedics

The causes of avascular necrosis of the femoral head are mostly unknown, but some are due to the use of corticosteroids, alcohol consumption, or conditions such as decompression sickness and other specific diseases.
The left hip is currently in stage two, and it may improve or continue to deteriorate.
Reducing the load on it is the most important factor, and the methods suggested by the physician can be tried.
The longevity of a total hip arthroplasty is a concern; for younger individuals (under 50 years old), it may only last up to twenty years, after which if it becomes loose (fails), a revision surgery will be necessary.
Therefore, it is advisable to postpone surgery until an older age if possible.
Since the right side has already undergone surgery, it should be used carefully, avoiding any vigorous activities.
Currently, due to issues with the left side, it is best to use two crutches for three months to prevent collapse of the left femoral head.
Additionally, it is important to avoid squatting for six months post-surgery, and the right hip should not be flexed beyond 90 degrees due to the risk of dislocation of the artificial joint.

Reply Date: 2006/08/01

More Info

Avascular necrosis (AVN), also known as osteonecrosis, is a condition that occurs when blood supply to a bone is disrupted, leading to bone death and potential joint collapse. It most commonly affects the hip joint, but can occur in other areas as well. Understanding the causes, treatment options, and recovery strategies for AVN is crucial for managing this condition effectively.

Causes of Avascular Necrosis
The exact cause of AVN is often unknown, which can be frustrating for patients. However, several risk factors have been identified, including:
1. Trauma: Fractures or dislocations can damage blood vessels, leading to AVN.

2. Chronic use of corticosteroids: Long-term use of these medications is a well-known risk factor.

3. Alcohol abuse: Excessive alcohol consumption can interfere with blood supply to the bones.

4. Medical conditions: Certain diseases, such as lupus, sickle cell disease, and Gaucher's disease, can increase the risk of AVN.

5. Radiation therapy: This treatment can affect blood flow to bones.

In your case, since you do not have a history of corticosteroid use or alcohol consumption, it may be challenging to pinpoint a specific cause. However, it is essential to discuss this with your healthcare provider, who may recommend further testing, such as blood tests or imaging studies, to rule out underlying conditions that could contribute to AVN.

Treatment Options
The treatment for AVN varies depending on the stage of the disease and the severity of symptoms. Here are some common approaches:
1. Conservative Management: This may include pain management with medications, physical therapy, and lifestyle modifications to reduce stress on the affected joint.

2. Surgical Options: If conservative measures fail, surgical interventions may be necessary. These can include:
- Core Decompression: A procedure that removes a portion of the inner bone to reduce pressure and improve blood flow.

- Bone Grafting: Involves transplanting healthy bone tissue to the affected area.

- Joint Replacement: In advanced cases, total hip replacement may be required, as you have already experienced with your right hip.

Regarding your left hip, since you are experiencing pain and your doctor suspects early-stage AVN, it is crucial to address this promptly to prevent further deterioration. The treatments your doctor suggested, such as electrical stimulation, shockwave therapy, and hyperbaric oxygen therapy, are all options that may help improve blood flow and promote healing.

Efficacy and Side Effects of Treatments
Among the treatments mentioned, the efficacy can vary from person to person. Generally, physical therapy and lifestyle modifications are low-risk and can be beneficial. Shockwave therapy and hyperbaric oxygen therapy have shown promise in some studies, but their effectiveness can depend on the individual case. It is advisable to consult with specialists in these areas to determine the best course of action tailored to your needs.

Post-Surgery Care and Activity Restrictions
After undergoing hip replacement surgery, it is essential to follow your surgeon's recommendations for rehabilitation and activity restrictions. Common guidelines include:
- Avoiding high-impact activities that could stress the joint.

- Gradually increasing activity levels as tolerated.

- Engaging in low-impact exercises, such as swimming or cycling, to maintain fitness without overloading the joint.

Regarding your return to work as an accountant, many patients can resume desk jobs relatively quickly, often within a few weeks, depending on their recovery progress. However, it is crucial to listen to your body and consult with your healthcare provider about the appropriate timeline for returning to work.

In conclusion, managing avascular necrosis requires a comprehensive approach that includes understanding the underlying causes, exploring treatment options, and adhering to post-operative care guidelines. Open communication with your healthcare team is vital to ensure the best outcomes and to address any concerns you may have about your recovery and future joint health.

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