Avascular Necrosis/Osteonecrosis of the Hip

What are the symptoms of osteonecrosis of the hip?

Initially you may notice few symptoms but as the condition progresses you may feel pain in and around your hip joint, in the back, buttocks, groin or thigh that increasingly limits your range of motion. Eventually, you may feel pain even when lying down.

How can you reduce the risk of avascular necrosis of the hip?

Preventing osteonecrosis is really a matter of following general advice for good health:

• Don’t drink excessively because we know heavy drinking is one of the factors most commonly associated with avascular necrosis
• Don’t smoke because smoking can narrow the blood vessels, reducing blood flow to the bones and elsewhere in your body
• Maintain a healthy cholesterol level
• Monitor your use of steroids. Repeated courses of high-dose steroids appear to increase the risk of avascular necrosis. If your GP or other health professional is about to prescribe another dose of steroids, always ensure you raise this issue with them

How do you diagnose osteonecrosis of the hip?

Visit our Cheltenham hip clinic and Alex will diagnose osteonecrosis through physical examination followed by one or more of an X-ray, MRI scan and bone scan.

How to reduce symptoms of avascular necrosis of the hip without surgery?

Once the bone is dead, you can’t bring it back to life. There are, however, things you can do to alleviate the pain of osteonecrosis and to limit the loss of bone. In the earlier stages of the condition you may also be able to slow its progression.

Over the counter pain relief: Non-steroidal painkillers (such as ibuprofen) may help lessen pain in the early stages of the condition although they are unlikely to have much effect as it progresses. You should avoid prolonged use of ibuprofen and similar drugs.

Statins and similar cholesterol-lowering drugs: We know high cholesterol can be a contributory factor in the development of avascular necrosis. Reducing your cholesterol level can help remove a risk factor.

Blood thinners: In narrowed blood vessels, blood thinners can help maintain a supply of blood to the bone.

Physiotherapy: Can help maintain a range of motion in the joint.

Activity modification: Rest, using crutches or altering your activities to keep weight off the hip can help slow the rate of bone damage.

Surgical treatment of hip osteonecrosis in the Cotswolds, Cheltenham & Gloucester

Non-surgical treatments may help slow the progression of osteonecrosis and delay the need for surgical treatment. Eventually, however, surgery will probably be required.

Surgery can be used in a variety of ways:

To encourage new bone growth: In some patients, removing inner layers of bone can help reduce pain and create space into which new, healthy bone tissue can grow.

To replace the damaged bone: A hip replacement will replace the damaged and/or collapsed parts of the joint with implants of titanium, ceramic and plastic. The result is a new hip joint that should last for at least 15 years*. Evidence suggests more than 50% of hip replacements last at least 25 years**.

At his private Gloucestershire hip surgery Alex uses the Zimmer CPT system, a system which has been proven over 25 years and delivers near frictionless movement.

To postpone the need for hip replacement: Avascular necrosis of the hip is most common in people between the ages of 30 and 50. Hip replacement is most common in over-60s. Although it is technically possible to perform a hip replacement in younger patients, we know that implants, although long-lasting, won’t last forever and a second (revision) hip replacement will never be as good as the first. For that reason, hip surgeons will always aim to delay hip replacement for as long as possible.

One way of doing that could be with an osteotomy, where a small wedge of bone is pinned above the thigh bone to help take the weight off the joint. This may help postpone the need for hip replacement surgery.

To ‘shore up’ the bone: A bone graft can act as a sort of scaffold around affected bone, helping to strengthen it and delay the need for hip replacement.

* https://www.nhs.uk/conditions/hip-replacement/
** https://www.hey.nhs.uk/patient-leaflet/total-hip-replacement-benefits-risks-outcome/

Talk to Alex Dodds, Gloucestershire hip surgeon

If you are living with pain in your hip or the surrounding area, book an appointment at our private hip surgery for Cheltenham, Gloucester and the Cotswolds.