Osteonecrosis is a condition due arising from a diminution of blood supply to bone. It affects most importantly the upper end of the femur. If left untreated it progresses to bony collapse and arthritis. The causes are many like alcohol abuse, steroid intake, Caisson's disease, Gaucher's disease. The patient can experience sudden pain in the hips which radiates to the knee and can be confused for knee pain.Gait is painful. In early cases, x- rays are negative and MR scans are diagnostic. Treatment in Late cases Treatment in late cases is by an Hip replacement either total if bony destruction is extensive. A partial or total surface hip replacement is done if destruction is confined to the surface cartilage alone. Since it occurs in young individuals, a Surface Hip replacement is a better option as it conserves bony stock and a total hip replacement can still be done at a later date. Treatment in the early stages is controversial and there are no clear guidleines. Prolonged bedrest and crutch walking have not been shown to relieve pain or halt progression of the disease. Core decompression does ameliorate symptoms. It is minimally invasive and does not involve a replacement. If it fails then a replacement is possible at a later date. Vascularised fiblar graft is done with the help of a microvascular surgeon. |
