Can Hip Joint Necrosis Be Treated Without Surgery?

Q: Can Hip Joint Necrosis Be Treated Without Surgery?

Ms. <br>Chen： The majority of cases of avascular necrosis of the femoral head have unknown causes. <br>Risk factors include alcohol consumption, medications such as corticosteroids, certain occupations, as well as diseases and sequelae from trauma. <br>If the bone has already nec

Avascular necrosis of the hip joint?

Hello, I would like to ask: I currently have avascular necrosis in both of my hip joints.
The left side is probably in stages 3 or 4, while the right side has just begun.
Is it true that I can avoid surgery? Will extracorporeal shock wave therapy help?

Ms. Chen, 30~39 year old female. Ask Date: 2011/04/30

Dr. Wang Shouji reply Orthopedics

Ms.
Chen: The majority of cases of avascular necrosis of the femoral head have unknown causes.
Risk factors include alcohol consumption, medications such as corticosteroids, certain occupations, as well as diseases and sequelae from trauma.
If the bone has already necrosed and is deformed, and there is pain, the only options aside from surgery are pain management with medication, which is not a long-term solution.
Relying solely on extracorporeal shock wave therapy to treat avascular necrosis of the femoral head may not be very optimistic.
It is crucial to address the underlying risk factors or diseases.
Wishing you a speedy recovery.

Reply Date: 2011/04/30

More Info

Hip joint necrosis, also known as avascular necrosis (AVN), is a condition where there is a loss of blood supply to the bone, leading to bone death and potential joint collapse. The treatment options for this condition can vary significantly depending on the stage of necrosis, the patient's age, activity level, and overall health.

In the early stages of AVN (stages 1 and 2), non-surgical treatments may be effective. These can include:
1. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Additionally, medications that improve blood flow or bone health may be prescribed.

2. Physical Therapy: A structured physical therapy program can help strengthen the muscles around the hip joint, improve range of motion, and reduce pain. This may include exercises to enhance flexibility and strength, as well as modalities like ultrasound or electrical stimulation.

3. Activity Modification: Reducing weight-bearing activities can help alleviate stress on the affected joint. Patients are often advised to avoid high-impact activities such as running or jumping.

4. Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses shock waves to promote healing in the affected area. While some studies suggest it may help with pain relief and improve function, the evidence is not definitive, and it may not be effective for everyone.

5. Bone Regeneration Techniques: In some cases, procedures like core decompression, where a small portion of the bone is removed to relieve pressure and promote blood flow, may be considered. This is a minimally invasive procedure that can sometimes delay the need for more invasive surgery.

However, as the condition progresses to later stages (stages 3 and 4), the likelihood of needing surgical intervention increases. In these stages, the bone may collapse, leading to significant joint dysfunction and pain. Surgical options include:
1. Osteotomy: This procedure involves cutting and reshaping the bone to relieve pressure on the joint.

2. Core Decompression: As mentioned, this can be performed in earlier stages but may also be considered in more advanced cases to relieve pressure and promote healing.

3. Total Hip Replacement: In cases where the joint has significantly deteriorated, a total hip replacement may be necessary. This procedure involves removing the damaged joint and replacing it with an artificial joint.

Regarding your specific situation, with both hips affected and the left hip at a more advanced stage (3-4), it is crucial to have a thorough evaluation by an orthopedic specialist. They can assess the extent of the necrosis and recommend the most appropriate treatment plan. While non-surgical options may provide relief and improve function in the early stages, they may not be sufficient for advanced AVN.

In conclusion, while there are non-surgical treatment options available for hip joint necrosis, their effectiveness largely depends on the stage of the disease. For advanced stages, surgical intervention is often necessary to restore function and alleviate pain. It is essential to have a detailed discussion with your healthcare provider to understand the best course of action tailored to your specific condition.

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