Hip avascular necrosis (commonly called “AVN”), now better known as osteonecrosis (“osteo” means bone; “necrosis” means death), results from interruption of the normal blood flow to the femoral head, or the “ball” that fits into the hip’s socket. If left untreated, this loss of blood flow to the hip ultimately causes the “ball” to die and collapse, leading to extreme pain, loss of hip motion, and eventually, severe arthritis.
Diagnosing avascular necrosis can be very difficult. Most young adults do not think about themselves getting ill or let alone having “arthritis” – a rite of passage envied by anyone over 40 years of age. However, this youthful mindset can delay its diagnosis. But what makes the diagnosis of AVN most elusive is its ability to exist “silently.”
In fact, about 25% of patients with AVN of the hip develop the disorder for no apparent reason. About two-thirds of the people who develop avascular necrosis of the hip are in their 20s and 30s. Avascular necrosis is diagnosed in about 20,000 people each year.
There are two major forms of AVN, traumatic or non-traumatic (meaning no injury). Hip fractures or hip joint dislocations, partial or complete, are the most common causes of AVN.
The most common risk factor is the use of oral or IV steroid medications (corticosteroids such as Prednisone). Another very common risk factor is excessive use of alcohol: the greater the consumption of alcohol, the higher the risk of developing AVN.
Once the hip joint is severely damaged (severe collapse and arthritis), then hip replacement essentially becomes the only reasonable treatment option. If AVN is diagnosed in its earliest stages and the diseased area of the femoral head is very small, a procedure called core decompression and bone grafting can be done with some success.
Fortunately, there is good news for adolescents and young adults under the age of 50 diagnosed with hip avascular necrosis, including select patients with later stages of disease, larger sized lesions, and limited collapse. A highly specialized surgical procedure called free vascularized fibular grafting – a unique form of bone grafting – can restore the dying hip and prevent hip replacement with much greater success.
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