Avascular Necrosis: Non-Surgical Treatments and Recovery Options

Avascular necrosis of the femur?

Hello Director Chen, I am a young person in my twenties, but I have been diagnosed with avascular necrosis of the femur.
I consulted an orthopedic surgeon who recommended extracorporeal shock wave therapy, which can promote neovascularization and achieve tissue regeneration through improved blood circulation.
If I opt for a hip replacement, there is a risk of wear and tear as I age, necessitating a second surgery, which carries higher risks.
On the other hand, extracorporeal shock wave therapy could help me avoid the complications and risks associated with surgery.
This treatment seems to be quite versatile, as it can also be used for conditions like tendinitis, frozen shoulder, tennis elbow, and plantar fasciitis.
I am quite apprehensive about it, fearing that proceeding without caution might lead to unpredictable negative side effects.
My question, Director Chen, is: if I choose to have a hip replacement and then diligently focus on rehabilitation and recovery, can I still achieve good health? Thank you for your response! Osier

Osier, 20~29 year old female. Ask Date: 2006/10/07

Dr. Chen Xianchang reply Rehabilitation

1.
Rehabilitation is essential after joint replacement surgery, which includes deep heat therapy, joint mobilization, and strength training.

2.
The materials used for hip joint prosthetics have improved compared to the past.
Unless there is a new injury, such as a fall, a replacement is generally not necessary.
It is advisable to consult an orthopedic surgeon to determine whether the procedure is covered by insurance or if a better quality implant would require out-of-pocket expenses.

3.
Shockwave therapy is a recent development over the past two years, and its potential miraculous effects are still under investigation.

Reply Date: 2006/10/07

More Info

Avascular necrosis (AVN), also known as osteonecrosis, is a condition that occurs when there is a loss of blood supply to the bone, leading to bone death and potential joint collapse. It commonly affects the hip joint but can occur in other areas as well. Your concerns about the treatment options and recovery are valid, especially considering your young age and the implications of such a diagnosis.

Non-surgical treatments for AVN primarily focus on relieving symptoms, improving function, and preventing further damage to the joint. Extracorporeal shock wave therapy (ESWT) is one of the non-invasive options that has gained attention. This treatment uses acoustic waves to promote healing by enhancing blood flow and stimulating tissue regeneration. While some studies suggest that ESWT may help in the early stages of AVN, its effectiveness can vary, and it is not universally accepted as a standard treatment.

In addition to ESWT, other non-surgical options include:
1. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Bisphosphonates and other medications may be prescribed to help strengthen bone and slow the progression of AVN.

2. Physical Therapy: A tailored rehabilitation program can help maintain joint function and strengthen the surrounding muscles, which can alleviate some of the stress on the affected joint.

3. Activity Modification: Reducing weight-bearing activities can help minimize pain and prevent further damage to the bone. Crutches or a brace may be recommended to offload the affected area.

4. Lifestyle Changes: Addressing underlying risk factors, such as alcohol use, smoking, and certain medical conditions (like corticosteroid use or blood disorders), can be crucial in managing AVN.

Regarding your concerns about joint replacement surgery, it is indeed a viable option, especially if non-surgical treatments do not provide relief or if the condition progresses. Total hip arthroplasty (THA) can significantly improve quality of life by alleviating pain and restoring function. While it is true that artificial joints can wear out over time, advancements in materials and techniques have improved the longevity of these implants. Many patients lead active lives post-surgery, and with diligent rehabilitation, they can achieve excellent outcomes.

It is essential to weigh the risks and benefits of both non-surgical and surgical options. If you opt for surgery, a comprehensive rehabilitation program will be crucial for recovery. This typically includes physical therapy to regain strength, flexibility, and function in the joint.

In conclusion, while non-surgical treatments like ESWT may offer some benefits, they may not be sufficient for everyone, especially in advanced cases of AVN. Surgical intervention, such as joint replacement, can provide significant relief and improve quality of life, even for younger patients. It is vital to have open discussions with your orthopedic surgeon about your specific condition, treatment options, and expected outcomes. They can help you make an informed decision that aligns with your lifestyle and health goals. Remember, early intervention and a proactive approach to managing your condition can lead to better long-term results.

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