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Osteonecrosis of the Hip

What is Osteonecrosis of the Hip?

Osteonecrosis of the hip is a painful condition caused by the disruption of blood flow to the head of the femur (hip bone). This lack of blood supply leads to the deterioration of the hip joint, resulting in severe arthritic pain.

What does Osteonecrosis of the Hip feel like? 

The progression of osteonecrosis often occurs in stages. Initially, individuals may experience discomfort, presenting as an ache or throb in the buttocks or groin area. As the condition advances, standing and putting weight on the affected hip become increasingly difficult, and joint movements become extremely uncomfortable.

What causes Osteonecrosis?

Osteonecrosis begins with the blockage of blood supply to the femoral head (thighbone), stopping the bone from receiving adequate nutrition and causing it to deteriorate over time. This deterioration of the femoral head results in the collapse of the articular cartilage coating the hip bones, leading to arthritic disability. This condition is more common in men aged 40 to 65.

Although the exact causes of diminished blood flow remain unknown, physicians have identified several risk factors that increase a person’s susceptibility to osteonecrosis. These include: 

  • Injury: Hip injuries like dislocation or fracture can damage blood vessels and impair circulation to the femoral head.
  • Excessive Alcohol: Long-term excessive alcohol consumption can lead to fat buildup in blood vessels, reducing blood flow to the bone.
  • Corticosteroid Medications: Extended use of corticosteroids for conditions like asthma or arthritis is linked to osteonecrosis.
  • Medical Conditions: Other conditions linked to Osteonecrosis are Caisson disease (or “the bends”), sickle cell disease, myeloproliferative disorders, Gaucher’s disease, systemic lupus erythematosus, Crohn’s disease, arterial embolism, thrombosis, and vasculitis.

What are the non-surgical options for Osteonecrosis?

While anti-inflammatory drugs, lifestyle changes, and crutches can alleviate symptoms and slow down the condition, the most effective treatments are surgical. An early diagnosis, particularly before the femoral head collapses, facilitates the implementation of procedures specifically designed to preserve the hip joint.

What are the surgical options for Osteonecrosis?

There are several surgical options available to treat osteonecrosis of the hip:

Core Decompression and Grafting

When osteonecrosis is identified in its early stages, core decompression becomes an effective treatment option to help prevent the onset of arthritis. This procedure involves the careful drilling of either one large hole or several smaller ones into the femoral head. This relieves pressure within the bone and creates pathways for new blood vessels to deliver essential nourishment.

Core decompression is often combined with bone and cartilage grafting, which can significantly contribute to the regrowth of healthy bone and the reinforcement of cartilage within the hip joint. The procedure entails using healthy bone tissue, which can be sourced as an allograft (donor) or autograft (from another part of the patient’s body), and skilfully transplanting it into the affected hip region.

Today, there are also various synthetic bone grafts available, expanding the choices available for patients. Additionally, some procedures involve the blending of bone marrow cells with the graft material, aiding the process of bone regeneration.

Your surgeon will discuss all potential options for your procedure to ensure the best possible outcome.

Vascularised Fibula Graft

An alternative surgical treatment involves extracting a segment of the smaller bone in your leg, known as the fibula, along with its connected blood vessels (an artery and a vein), and grafting it into a surgically crafted hole in the femoral neck and head. This process reconnects the artery and vein, fostering healing within the region affected by osteonecrosis.

Total Hip Replacement

When osteonecrosis has progressed to the stage of a collapsed femoral head, a total hip replacement becomes the optimal treatment choice. In this procedure, the surgeon removes the compromised bone and cartilage and replaces them with artificial joint components crafted from metal or plastic, aiming to restore your hip’s natural functionality.

To learn more about the hip replacement procedure, as well as what you can expect prior to, during, and after the surgery, please visit our Hip Replacement page.

Contact Us

For further inquiries or to arrange a consultation, please contact Professor Al Muderis’ office at +61 2 88829011 or book an appointment online.