Avascular Necrosis: Recovery Tips After Hip Surgery

Avascular necrosis of the femoral head?

Hello Dr.
Zhou,
In November 2007, I suffered a femoral head fracture near the hip joint due to a car accident.
After being treated with steel nails, there were no signs of necrosis on X-rays for the first six months.
However, due to (excessive) alcohol consumption (not confirmed) or smoking (a pack a day), I discovered signs of necrosis on an X-ray in February of this year.
The doctor recommended excising the necrotic area and replacing it with donated bone marrow from another person.
I underwent surgery on March 23, 2009.
The doctor advised me not to walk on both feet for three months and to quit smoking and drinking.
My questions are: First, it is very inconvenient to walk with two crutches every day.
After two weeks, I started using one crutch, but I am putting almost no weight on my right foot, only touching it to the ground (the steel nail has not been removed and does not hurt).
I am unsure if this is very bad, or if you would recommend that I continue using two crutches instead.

Second, I have completely quit drinking alcohol, but due to my nicotine addiction, I still smoke several cigarettes a day, sometimes more than ten.
I would like to know if smoking is a significant enemy to the recovery from bone necrosis.
If so, I should take it seriously and quit completely.
Thank you, doctor, for taking the time to respond.

Xiao Nan, 20~29 year old female. Ask Date: 2009/04/11

Dr. Zhou Lizhi reply Orthopedics

According to online users, there is currently a fracture plate in place, and the femoral head is necrotic with a history of bone grafting.
The key focus is on whether the bone graft is growing (it is advisable to avoid weight-bearing activities, and abstaining from alcohol and smoking can affect blood circulation).
It is best to wait for three months and have regular X-ray follow-ups to assess the effectiveness of the bone graft growth.

Reply Date: 2009/04/11

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. In your case, following a femoral head fracture and subsequent surgery, the development of AVN can be attributed to various factors, including trauma, alcohol consumption, and smoking. Understanding the implications of AVN and the recovery process after hip surgery is crucial for your rehabilitation.

Recovery Tips After Hip Surgery for Avascular Necrosis
1. Follow Medical Advice: It is essential to adhere to your surgeon's recommendations regarding weight-bearing activities. If your doctor has advised against putting weight on your leg for three months, it is crucial to follow this guidance to allow proper healing of the bone graft and to prevent further complications.

2. Use of Assistive Devices: While it may be tempting to use only one crutch for mobility, it is generally advisable to use two crutches as recommended. This provides better stability and reduces the risk of falls, especially when you are not fully weight-bearing. Transitioning to one crutch can be done gradually, but ensure that you are not placing weight on the affected leg until cleared by your physician.

3. Smoking and Bone Health: Smoking is known to have detrimental effects on bone healing and overall health. Nicotine restricts blood flow, which can hinder the healing process and exacerbate conditions like AVN. Given your history of AVN, it is advisable to quit smoking entirely. The benefits of cessation include improved circulation, enhanced bone healing, and a lower risk of complications.

4. Alcohol Consumption: You mentioned a history of heavy drinking. Alcohol can also impair bone healing and contribute to the development of AVN. Since you have already made the decision to stop drinking, this is a positive step towards recovery. Continuing to abstain from alcohol will support your overall health and recovery process.

5. Physical Therapy: Once your doctor permits, engaging in physical therapy can be beneficial. A physical therapist can guide you through exercises that promote strength, flexibility, and stability in your hip joint without compromising the healing process. They can also help you learn how to safely transition from crutches to walking independently.

6. Monitoring Symptoms: Pay attention to any changes in your symptoms. If you experience increased pain, swelling, or any new symptoms, it is essential to contact your healthcare provider. Regular follow-ups and imaging studies may be necessary to monitor the healing process and ensure that the graft is integrating well.

7. Nutrition: A balanced diet rich in calcium and vitamin D is vital for bone health. Consider incorporating foods such as dairy products, leafy greens, and fatty fish into your diet. Additionally, staying hydrated and maintaining a healthy weight can support your recovery.

8. Patience and Realistic Expectations: Recovery from AVN and hip surgery can be a lengthy process. It is important to set realistic goals and be patient with yourself as you progress. Celebrate small milestones in your recovery journey, and remember that healing takes time.

In conclusion, your recovery from avascular necrosis and hip surgery will require a multifaceted approach that includes following medical advice, using assistive devices appropriately, quitting smoking, and maintaining a healthy lifestyle. By taking these steps, you can optimize your recovery and improve your overall quality of life. Always consult with your healthcare provider for personalized advice and guidance tailored to your specific situation.

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