Aseptic necrosis of bones in the knee joint

Treatment of aseptic necrosis

Part 1. Treatment tactics for aseptic necrosis

The treatment tactics for aseptic necrosis are somewhat different from the treatment tactics for coxarthrosis.
The main emphasis in the treatment of joint infarction is primarily on restoring blood circulation to the femoral head and restoring bone tissue (in contrast to coxarthrosis, in which the main goal of therapy is restoration of cartilage). In addition, the treatment tactics for aseptic necrosis depend on the duration of the disease: it is very important to treat the patient taking into account how much time has passed since the onset of the disease, since the onset of severe pain.

1st period of the disease: the duration of the disease is from several days to 6 months from the moment of the onset of severe pain. This is the stage of vascular disorders.

At this stage, the patient must maintain as much peace as possible: try to walk less, and when walking, it is imperative to use a cane (how to use a cane correctly is discussed below). You need to take advantage of every opportunity to lie down and relax. You should not put stress on your leg by standing for long periods of time, and, of course, you should avoid carrying heavy objects, jumping, and running.

Instead, in order to avoid atrophy of the thigh muscles, and at the same time “pump” the blood vessels, the patient must do strength exercises for at least 40 minutes a day to strengthen the leg muscles (exercises will be discussed later). Without special therapeutic exercises, the patient will not have a single chance of recovery or at least a noticeable improvement in well-being.

Among the medications, the patient can benefit from non-steroidal anti-inflammatory drugs and vasodilators. In addition, novocaine blockades of the lumbar spine, decompression of the head of the femur or greater trochanter (more on this method of treatment below), as well as massage and the use of medicinal leeches (hirudotherapy) can have a good effect.

2nd period of the disease: the duration of the disease is from 6 to 8 months from the onset of pain. At this time, destruction of the bone beams occurs, “crushing” and deformation of the femoral head.

At this stage, the patient can put a little more weight on the leg. For example, leisurely walking for 30–50 minutes a day (with breaks), as well as walking up stairs, is useful. Exercise on an exercise bike (at a calm pace) or slow cycling, and leisurely swimming, especially in salty sea water, bring certain benefits.

The following therapeutic measures are necessary: strengthening therapeutic exercises and vasodilators. Decompression of the femoral head or greater trochanter, massage, and hirudotherapy will still be helpful.

In addition, to these procedures at this stage it is necessary to add the use of drugs that stimulate the restoration of bone tissue (see below).

3rd period of illness: duration of illness is more than 8 months. At this time, in most patients, aseptic necrosis “smoothly” turns into coxarthrosis (arthrosis of the hip joint).

Treatment of this stage of aseptic necrosis is almost 100% identical to the treatment of coxarthrosis: gymnastics, massage, use of vasodilators and chondroprotectors (glucosamine and chondroitin sulfate).

Below we will talk about the main methods of treating avascular necrosis in more detail.

Part 2. Basic methods of treating avascular necrosis

1. Non-steroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs): diclofenac, piroxicam, ketoprofen, indomethacin, butadione, meloxicam, Celebrex, nimulide and their derivatives are prescribed to reduce pain in the groin and thigh.

And although NSAIDs do not treat aseptic necrosis, they can sometimes bring tangible benefits to the patient: timely prescribed anti-inflammatory drugs, due to their analgesic effect, prevent reflex spasms of the thigh muscles that occur in response to severe pain.

And when the reflex spasm that arose in response to pain goes away, the thigh muscles relax. As a result, blood circulation to the affected area is partially restored.

However, non-steroidal anti-inflammatory drugs have one danger: a patient with avascular necrosis taking these drugs stops feeling pain, stops taking care of the leg and loads it in the same way as if it were healthy. And such behavior can lead to rapid progression of destructive processes in the head of the femur.

Therefore, a patient taking non-steroidal anti-inflammatory drugs must remember that the sore leg at this time must be spared and protected from stress.

Read more about anti-inflammatory drugs here*

***

2. Vasodilators

Vasodilators such as trental (aka agapurine, pentoxifylline) and theonicol (xanthinol nicotinate) are very useful in the treatment of avascular necrosis.

They eliminate stagnation of blood circulation, help restore the head of the femur by improving arterial blood flow and relieving spasm of small blood vessels. In addition, the use of vasodilators helps reduce nighttime “vascular” pain in the damaged joint.

An additional advantage of vasodilators is their almost complete “harmlessness” - when used correctly, they have virtually no serious contraindications.

They just should not be used in acute cases of myocardial infarction and “fresh” hemorrhagic strokes, when the effect of vasodilators can increase bleeding from burst cerebral vessels. It is also undesirable to use vasodilators with low blood pressure, because they slightly reduce the pressure, and with a tendency to bleeding: nasal, uterine, hemorrhoidal.

But vasodilator drugs improve the well-being of patients during the recovery period after a stroke or myocardial infarction, help with poor patency of blood vessels in the legs, with obliterating endarteritis and diabetes mellitus, and bring relief to hypertensive patients when the pressure is moderately elevated.

Those suffering from hypertension should keep in mind that while using vasodilators, it is necessary to reduce the dose of other drugs used to reduce high blood pressure. Otherwise, the effect of two different medications is additive and can lead to an excessively sharp drop in pressure, causing fainting or collapse.

In general, to prevent any unexpected similar reactions to vasodilator drugs, I recommend that my patients use these drugs only at night for the first three days. Having thus checked his individual tolerance to vasodilators, the patient subsequently switches to the prescribed two or three times a day of medication.

By the way, one side effect of vasodilator drugs is normal and almost obligatory. When using them, a feeling of heat and redness of the face very often appears, associated with the active expansion of small blood vessels. There is no need to be afraid of this effect of the drug: such a reaction usually does not cause any harm to health.

Vasodilators for aseptic necrosis should be taken 2 times a year, in courses of 2 to 3 months.

***

3. Drugs that stimulate bone tissue regeneration

These drugs can be very useful for avascular necrosis. Doctors usually prescribe to their patients products containing vitamin D (natecal D3, alpha D3 TEVA, calcium D3 forte, oxidevit, osteomag, etc.)

In case of aseptic necrosis, vitamin D preparations promote better absorption of calcium from the intestine, due to which the amount of calcium in the blood increases sharply. A higher concentration of calcium in the blood prevents its return from bone tissue into the blood and, accordingly, promotes its accumulation in the bones - in particular, in the head of the damaged femur.

***

4. Chondroprotectors - glucosamine and chondroitin sulfate

Glucosamine and chondroitin sulfate belong to the group of chondroprotectors - substances that nourish cartilage tissue and restore the structure of damaged joint cartilage.

As mentioned above, for aseptic necrosis, chondroprotectors are effective only in the 3rd period of the disease, when the disease lasts more than 8 months - when aseptic necrosis gradually transforms into coxarthrosis (arthrosis of the hip joint).

To achieve the maximum therapeutic effect, chondroprotectors must be used in courses, regularly, for a long time. It is practically pointless to take glucosamine and chondroitin sulfate once or occasionally.

In any case, if used correctly, any proven chondroprotectors will bring clear benefits for the treatment of aseptic necrosis, which has already turned into arthrosis.

But to get real results, you need to undergo at least 2-3 courses of treatment with these drugs, which usually takes from six months to one and a half years.

Read more about chondroprotectors here *

***

5. Hirudotherapy (treatment with medicinal leeches)

Hirudotherapy is a fairly effective treatment method for many diseases. By sucking, the leech injects a number of biologically active enzymes into the patient’s blood: hirudin, bdellins, elgins, destabilase complex, etc.

These enzymes resolve blood clots, improve metabolism and tissue elasticity, and increase the body's immune properties. Thanks to leeches, blood circulation improves and blood stagnation in the affected organs is eliminated.

In case of aseptic necrosis, enzymes injected with medicinal leeches can significantly improve blood circulation in the damaged femoral head.

To achieve maximum effect, you need to conduct 2 courses of hirudotherapy per year. Each course consists of 8 sessions. Sessions are carried out at intervals of 4 to 7 days. In this case, leeches should be placed on the lower back, sacrum, lower abdomen and sore hip.

From 4 to 6 leeches are used in one session. At the beginning of treatment with leeches, a temporary exacerbation often occurs (usually after the first 3-4 sessions).

And improvement usually becomes noticeable only after 5-6 sessions of hirudotherapy. But the patient reaches the best form 10–15 days after completing the full course of treatment.

Contraindications to hirudotherapy treatment : this method should not be used to treat people suffering from hemophilia and persistently low blood pressure, pregnant women and young children, frail and elderly patients.

***

6. Therapeutic massage

There is no need to expect any super miracles from a massage - therapeutic massage is used only as an additional method of treating aseptic necrosis.

But by improving blood circulation, massage of the back and massage of the thigh muscles still brings tangible benefits for aseptic necrosis - provided that the massage is performed correctly, gently, without rough influences.

It is important to know: after inept intervention, the patient’s condition may worsen rather than improve. Pain and muscle spasms in the affected leg may increase.
In addition, blood pressure may increase, nervousness and overexcitation of the nervous system may appear. This usually happens when the massage is too active and forceful, especially if the massage therapist’s manipulations themselves are rough and painful.

Normal massage should be performed smoothly and gently, without sudden movements. It should give the patient a feeling of pleasant warmth and comfort, and in no case should it provoke pain or bruising.

In general, many insufficiently skilled massage therapists justify the appearance of bruises and sharp pain from their effects by saying that they massage diligently and deeply. In fact, they are simply not qualified enough, they act with inflexible, tense fingers and at the same time seem to “tear” the skin and muscles.

If you do the massage correctly, with strong but relaxed fingers, you can knead the muscles quite deeply and thoroughly, but without pain, discomfort and bruises.

Dear readers, when entrusting your joints or back to a massage therapist, try to remember that the procedure should be painless, causing warmth, comfort and relaxation. And if you find a massage therapist who achieves such an effect with his actions, consider yourself lucky.

Then I recommend that you get massages from him regularly, twice a year, in courses of 8–10 sessions held every other day.

However, it is necessary to remember the standard contraindications to massage treatment.

Massage is contraindicated for:

all conditions accompanied by an increase in body temperature
inflammatory diseases of the joints in the active phase of the disease (until stable normalization of blood counts)
bleeding and tendency to it
for blood diseases
thrombosis, thrombophlebitis, inflammation of the lymph nodes
the presence of benign or malignant tumors
aneurysms of blood vessels
significant heart failure
for severe skin lesions in the massaged area
massage is contraindicated for women on menstruation days.
***

7. Physiotherapeutic treatment

From my point of view, most physical therapy procedures are poorly suited for the treatment of avascular necrosis. The fact is that the hip joint is a “deep-lying” joint. That is, it is hidden under the thickness of the muscles, and most physiotherapeutic procedures simply cannot “get” it. Therefore, they cannot radically influence the course of aseptic necrosis.

And although sometimes such procedures can still bring some relief to the patient (thanks to improved blood circulation and reflex analgesic effects), in general, physiotherapeutic procedures for aseptic necrosis bring little benefit: doctors prescribe them either out of ignorance or to simulate vigorous activity.

Only laser therapy and thermal treatment (ozokerite, paraffin therapy, mud therapy) can bring some benefit.

Laser therapy is a good and fairly safe method of treatment (in the absence of contraindications), but you still cannot expect to cure aseptic necrosis with laser alone. Laser therapy is precisely an additional method of treatment as part of complex therapy. The course of treatment is 12 sessions, performed every other day.

Contraindications to the use of laser: tumor diseases, blood diseases, hyperfunction of the thyroid gland, infectious diseases, physical exhaustion, bleeding, myocardial infarction, stroke, tuberculosis, cirrhosis of the liver, hypertensive crisis.

Thermal treatment (ozokerite, paraffin therapy, mud therapy) is used to improve blood circulation in the damaged femoral head. For thermal effects on the body, substances are used that can retain heat for a long time, slowly and gradually releasing it to the patient’s body: paraffin (a product of petroleum distillation), ozokerite (mountain wax), therapeutic mud (silt, peat, pseudovolcanic).

In addition to the temperature effect, such coolants also have a chemical effect on the patient’s body: during the procedure, biologically active substances and inorganic salts penetrate into the body through the skin, helping to improve metabolism and blood circulation.

Contraindications to heat therapy: acute inflammatory diseases, cancer, blood diseases, inflammatory kidney diseases, bleeding, purulent lesions of the body, hepatitis, exacerbations of inflammatory rheumatic diseases.

***

8. Decompression of the femoral head or greater trochanter

The principle of this procedure is to pierce the femur with a thick needle. A puncture, one or two, is most often made in the area of the greater trochanter of the femur (the trochanter is located on the lateral surface of the thigh, in the “breeches” area, where any of us feels a protruding bone - this protrusion is the trochanteric tubercle).

Decompression has two goals: to increase blood supply to the area by growing new blood vessels inside the newly formed canal (puncture) and to reduce intraosseous pressure inside the femoral head. Reducing intraosseous pressure helps reduce pain in approximately 60–70% of patients with aseptic necrosis.

In addition to puncturing the greater trochanter, there is also a decompression surgical method: a channel is drilled through the greater trochanter and the femoral neck directly into the femoral head, into an area where there is no blood flow. The effectiveness of this technique is slightly higher than that of a needle puncture, but this procedure is more complicated and is usually performed in a hospital setting.

***

9. Manual therapy

Manual therapy for aseptic necrosis is performed extremely rarely, mainly only when we are sure that the necrosis was caused by a pinched joint. For example, if the joint is pinched during an injury, from a strong blow, or if the pinching remains after an imperfectly reduced dislocation of the hip joint. And such variants of aseptic necrosis, as you remember, occur infrequently - in 10% of cases. With most other types of necrosis (when it is caused by alcohol consumption, taking corticosteroid hormones, radiation, pancreatitis, anemia, etc.), there will be very little benefit from manual therapy.

Manual therapy, when it is still necessary, for aseptic necrosis should always be carried out with the utmost caution - since rough manual pressure can lead to fracture of bone beams weakened by the disease. And then the condition of the femoral head will deteriorate sharply. Even manual therapy of the lumbar spine can lead to unpleasant consequences if the doctor performs manipulations on the lumbar vertebrae according to “classical principles”, leaning on the patient’s sore leg while adjusting the vertebra.

***

10. Healing ointments and creams

Medicinal ointments and creams are often advertised as guaranteeing cure for joint diseases. Unfortunately, as a practicing physician, I have to disappoint you: I have never encountered cases of healing of advanced arthrosis, arthritis, and especially aseptic necrosis with the help of any medicinal ointment.

But this does not mean that ointments are useless. Although ointments and creams cannot cure avascular necrosis, their use sometimes significantly alleviates the patient's condition.

For example, I sometimes recommend warming or irritating ointments to my patients in order to improve blood circulation in the joint. For this purpose, I periodically prescribe Menovazin, Gevkamen, Espol, Finalgon, Nicoflex or other similar ointments.

It has been proven that the irritation of skin receptors that occurs when rubbing these ointments leads to the production of endorphins - our internal painkillers “drugs”, due to which pain is reduced and painful spasm of the periarticular muscles is partially eliminated; In addition, warming ointments help increase blood circulation in the affected joints.

Ointments based on bee venom (apisatron, ungapiven) and snake venom (viprosal) also have an irritating and distracting effect, but, in addition, being absorbed in small quantities through the skin, they improve the elasticity of ligaments and muscles, as well as blood microcirculation. However, there are more side effects from their use: such ointments quite often cause allergies and inflammation of the skin at the sites of their application. You should also know that they are contraindicated for women during menstruation and for children.

Ointments based on non-steroidal anti-inflammatory substances (indomethacin, butadione, dolt, voltaren-gel, fastum, etc.), unfortunately, do not work as effectively as we would like - after all, the skin allows no more than 5-7% of the active substance to pass through. And this is clearly not enough to develop a full anti-inflammatory effect. But these ointments extremely rarely cause the side effects that occur from the internal use of non-steroidal anti-inflammatory drugs in tablets, suppositories or injections.

***

11. Using a stick or cane

If conditions permit, it is advisable to use a stick or cane when moving. Leaning on a stick when walking, patients with aseptic necrosis greatly help their treatment, since the stick takes on 20–40% of the load intended for the joint.

However, in order for the stick to be useful, it is important to choose it exactly according to your height. To do this, stand up straight, lower your arms and measure the distance from your wrist (not your fingertips) to the floor. This is exactly the length the cane should be. When buying a stick, pay attention to its end - it is advisable that it be equipped with a rubber nozzle. Such a stick cushions and does not slip when people lean on it.

Remember that if your left leg hurts, you should hold the stick in your right hand. Conversely, if your right leg hurts, hold the stick or cane in your left hand.

Important: train yourself to transfer your body weight to the stick exactly when you take a step with your sore leg!

***

12. Reducing the harmful load on the joint

A person suffering from aseptic necrosis should try to avoid fixed diseases. For example, prolonged sitting or standing in one position, squatting or in a bent position (say, when working in the garden or vegetable garden). Such postures impair blood flow to the diseased joints, as a result of which the condition of the femoral head also worsens.

You should also try to put as little stress on the sore leg as possible at first, avoid jumping, running, squats, long walks and carrying heavy objects.

It is necessary to develop such a rhythm of motor activity so that periods of load alternate with periods of rest, during which the joint should rest. The approximate rhythm is 20–30 minutes load, 5–10 minutes rest. You need to unload the sore leg in a lying or sitting position. In the same positions, you can perform several slow exercises to restore blood circulation in the leg after exercise (see below).

***

13. Therapeutic gymnastics

Therapeutic exercises are the main method of treating aseptic necrosis. Without it, we will not succeed in combating the progressive deterioration of blood circulation in the head of the femur and in the fight against rapidly increasing atrophy of the thigh muscles.

Almost no person suffering from aseptic necrosis will be able to achieve real improvement in their condition without therapeutic exercises.

After all, in no other way is it possible to strengthen muscles, “pump” blood vessels and activate blood flow as much as this can be achieved with the help of special exercises.

At the same time, gymnastics is almost the only method of treatment that does not require financial costs for the purchase of equipment or medications. All the patient needs is two square meters of free space in the room and a rug or blanket thrown on the floor. Nothing more is needed except consultation with a gymnastics specialist and the desire of the patient himself to do this gymnastics. True, there are big problems with desire - almost every patient has to be literally persuaded to engage in physical therapy. And it is most often possible to convince a person only when it comes to the inevitability of surgical intervention.

The second “gymnastic” problem is that even those patients who are committed to physical therapy often cannot find the necessary sets of exercises. Of course, on the Internet there are sets of exercises for patients with aseptic necrosis, but the competence of a number of authors is questionable - after all, some of them do not have a medical education. This means that such “teachers” themselves do not always understand the meaning of individual exercises and the mechanism of their action on sore joints. Often, gymnastic complexes are simply thoughtlessly copied from one article to another. At the same time, they contain such recommendations that you can just grab your head!

For example, many authors prescribe a patient with aseptic necrosis to “spin the bicycle vigorously” or do active leg swings, squats at a fast pace, etc. Patients often follow such advice without first consulting a doctor, and then are sincerely perplexed as to why they feel worse .

In fact, such overly vigorous exercises cause a fracture of the weakened bone beams of the femoral head, and the head of the femur quickly collapses - “crushes”.

To avoid such problems, from all the exercises you need to choose only those that strengthen the muscles and ligaments of the sore leg, but do not put pressure on the sore head of the femur.

That is, instead of the usual fast dynamic exercises, active flexion and extension of the legs, we need to do static exercises.

For example, if, while lying on your back, you slightly lift your straightened leg up and hold it suspended, then after a minute or two you will feel fatigue in the muscles of your leg and abdomen, although the joints in this case did not work (they did not move or were loaded). This is an example of a static exercise.

Another variant. You can very slowly raise your straightened leg to a height of 15 - from the floor and slowly lower it. After 8 to 10 such slow exercises, you will also feel tired. This is an example of a gentle dynamic exercise. This movement algorithm is also very useful.

It’s a completely different matter if the exercise is performed quickly and energetically, with maximum amplitude. By swinging your legs or actively squatting, you place increased stress on the head of the femur, and its destruction accelerates. But the muscles, oddly enough, are strengthened much worse with such movements. We conclude: to strengthen muscles and ligaments, exercises (for aseptic necrosis) must be done either statically, fixing the position for a certain time, or dynamically, but slowly.

By the way, it is slow dynamic and static exercises that most of my patients do not like to do, since they are especially difficult to perform. But this is how it should be: correctly selected, these exercises strengthen those muscles and ligaments that have atrophied in a person due to illness. Therefore, at first, be patient. But, having endured the first 2 - 3 weeks, you will be rewarded with an improvement in the condition of your leg and general well-being, increased strength and increased performance.

A video of gymnastics for the treatment of avascular necrosis can be viewed here *

***

14. Surgical treatment of avascular necrosis

Surgical treatment for aseptic necrosis is carried out if conservative therapy has failed.

Experience shows that if proper therapeutic treatment is started on time (in the first year of illness), more than half of patients manage to improve or stabilize their condition within a few months and do without surgery.

But if time is lost, the percentage of lucky people who can do without surgery drops sharply. Those patients who begin to be treated only a year or two after the onset of a joint infarction are most often forced to operate on the hip joint.

Typically, two types of operations are performed for avascular necrosis.

Most often, endoprosthetics , that is, a complete replacement of a deformed hip joint with an artificial one (more than 90% of all operations for aseptic necrosis are endoprosthetics).

It looks something like this: the part of the femur on which the head of the joint is located is cut off. A pin made of titanium, zirconium (or other materials) is inserted into the cavity of the femur, with an artificial articular head at the end.

The pin is fixed inside the cavity of the femur with a kind of cement or glue (sometimes using the “dry” fixation method). At the same time, another articulating surface of the hip joint is operated on: part of the acetabulum is removed from the pelvic bone, and a concave bed made of high-density polyethylene is placed in its place. In this bed, under pressure, the titanium head of the joint will further rotate.

As a result of successful endoprosthetics, pain in the joint disappears and its mobility is restored. However, the following must be taken into account. Firstly, such operations are technically complex. Secondly, with endoprosthetics the risk of complications and infection is quite high. In addition, if the operation is not performed perfectly and the joint is poorly “fitted,” disturbances in its fixation occur, and the prosthesis becomes loose very quickly. In this case, a repeat operation may be required after 1-2-3 years, and it is unknown whether it will be more successful than the previous one.

But the most important thing is that in any case, even with the surgeon’s impeccable work, the artificial joint becomes loose and requires replacement after a maximum of 12–15 years.

The fact is that the leg (pin) of the artificial joint is subject to constant overload, and after some time its fixation inside the femur is disrupted. At some point, after an unsuccessful movement or load, the leg of the joint can completely loosen the niche inside the femur, and then it begins to “shaker”. From this moment on, the dynamic operation of the entire structure is disrupted, and loosening occurs at a particularly rapid pace - excruciating pain resumes and the need for repeated endoprosthetics arises.

Now imagine: if the patient had his first operation at the age of 35–45, then at a maximum of 55–60 years he will need a second operation with all possible consequences: infections, complications, etc.! Moreover, each operation is a serious stress and burden for the body. Naturally, it is more advisable to undergo endoprosthetics for patients over 50–60 years of age.

For young people, if surgery is necessary, it seems to me that it is more reasonable to undergo arthrodesis of the hip joints, although this operation is now rarely performed. When performing arthrodesis, the ends of the articulating bones are cut off and then connected to each other so as to ensure their future fusion. Fusion of the bones leads to a decrease or disappearance of pain, but the joint completely loses mobility.

It is clear that the lack of mobility of the hip joint significantly reduces a person’s ability to work. When walking, he is forced to compensate for the immobility of the hip joint by increased movement of the lower back and knee, that is, he walks at an unnatural pace. As a result, due to overload, changes in the lumbar spine very often develop and back pain appears. In addition, after arthrodesis and fusion of bones, all those operated on find it difficult to walk up the stairs and not very comfortable to sit.

Now, I think it is clear to you that surgery on the hip joint does not solve all problems at once, and sometimes even creates new ones. And while there is a possibility, we should try to avoid surgery or delay it for as long as possible. In addition, the operation is quite expensive, and after it a fairly long period of recovery is required. Therefore, I always tell those of my patients who have a chance to do without surgery: direct the energy and resources that are necessary for the operation to therapeutic treatment - and perhaps you will be able to avoid the operating table altogether.

READ MORE:

Symptoms of aseptic necrosis
Causes of aseptic necrosis
Development of aseptic necrosis
Diagnosis of aseptic necrosis
Exercises to treat avascular necrosis

Structure of the hip joint

One of the most dangerous injuries is avascular necrosis of the femoral head (AFH). It is a consequence of a gross disruption of local microcirculation with the development of ischemia and necrotization of the bone marrow components of the femoral head. DDI is a consequence of previous operations on the hip joint, a history of trauma, previous osteomyelitis of the femur, and the development of epiphyseal and/or spondyloepiphyseal dysplasia.

We list several causes of vascular disorder leading to necrosis:

repeated heart attacks due to arterial thrombosis;
long-term insufficiency of arterial blood supply to the joint;
venous stasis;
combined disorder of the arterial-venous network.

The factors that provoke this situation are: congenital hypoplasia of the vessels of the hip joint, disruption of neurohumoral regulatory mechanisms, insufficient vascularization of the femoral head associated with the anatomical and functional immaturity of the vascular network.

Blood supply to the hip joint

Malnutrition of the bone components of the hip joint is the cause of necrotic changes.

If left untreated

Aseptic necrosis of the head of the hip joint is a severe pathology that will not resolve on its own. If the situation is left without proper attention, the disease can lead to disability. In one case, secondary coxarthrosis may develop, requiring replacement of the joint with a prosthesis (hip arthroplasty). During the operation, the head of the hip joint is removed along with part of the femur and a prosthesis is placed in its place.

Joint replacement allows you to count on a favorable prognosis. The prosthesis allows you to completely restore lost functions.

Another outcome of the disease can be ankylosis - complete immobility in the joint. Complete degeneration of the cartilaginous cover of the articular surfaces occurs with the proliferation of connective fibrous or bone tissue.

Symptoms and differences from coxarthrosis

The symptoms of ANFH are determined by the stages of the pathology. The onset is marked by asymptomatic symptoms or minor pain for no apparent reason. At the same time, the normal range of motion in the joint is maintained, pain is noted when the hip rotates inward.

The progression of the disease is expressed by paroxysmal, severe pain. Such a symptom may indicate the presence of collapse or fracture of the femoral head, inherent in the final stage of degenerative changes. They lead to a decrease in range of motion and the presence of constant pain, crepitus and instability of the femoral head.

The clinical symptoms of ANFH are similar to the classic picture of coxarthrosis:

pain in the groin that runs along the anterolateral surface of the thigh and radiates to the knee joint. The load only intensifies these sensations, with the pain moving to the lumbar region. They always bother a person, even at night;
the range of motion in the affected joint is noticeably limited. These people need help with self-care;
severe lameness on the affected leg when walking;
rapidly progressive hypotrophy of the muscular frame of the thigh on the affected side;
shortening of the thigh.

Necrosis of the right hip joint