In aseptic necrosis, the head of the femur is damaged, due to a violation of its supply of oxygen. The most serious complication of this ailment is gangrene, which eventually leads to limb amputation. Doctors strongly recommend treating aseptic necrosis of the head of the hip joint with the first symptoms. Diagnosis in the early stages of the disease will help to avoid the risk of many serious ailments.
Causes and symptoms of aseptic necrosis
There are several reasons for the development of aseptic necrosis of the head of the hip joint. These are vascular diseases, when microcirculation of blood changes, which leads to the development of foci of tissue necrosis. The cause of the disease can be and excessive strain on the hip joint. This is due not only to the human profession( truckers, parquet floor workers, gas welders), but also with excess weight, and with a shift in the center of gravity when walking.
Causes of development of hip joint necrosis may be associated with metabolic disorder
Depending on the degree of severity of the hip joint, the course of the disease has stages, each of which is characterized by the following symptoms:
- At the first stage of the development of the disease, rare pain and small bone changes are observed. A slight pain gives out in the groin, but the mobility in the hip remains.
- In the second stage, cracks appear on the head of the hip, which can occupy up to 30% of its surface. Pain in the affected area is intensified.
- In the third stage of the disease, the acetabulum is involved in the process, and up to 50% of the joint tissues are affected. Painful sensations become permanent and strong, the mobility of the joint decreases.
- The motor function of the hip joint is completely reduced, severe pains never stop, muscles of the buttocks and hips atrophy.
Types and stages of the development of the disease
Stages of development of aseptic necrosis of the head of the hip joint do not have a clear distinction between themselves. The first stage lasts about six months, when pain occurs during exercise or during bad weather, after the disappearance of the provoking factor, it goes away. The second stage also lasts about six months. In this period there is a thinning of the muscles of the buttocks and thighs.
The third stage lasts longer - up to 2.5 years, during which the surrounding tissue necrosis zone is absorbed. Patients already begin to move exclusively with a cane. At the fourth stage, which develops about 6 months, patients can not move themselves. However, the duration of the disease in each person is individual, depends on the concomitant diseases, timely treatment and other factors.
Physicians distinguish four types of hip joint necrosis:
- Segmental( observed in 48% of patients with this diagnosis).A small area of necrosis occurs as a cone on the upper part of the femoral head.
- Complete necrosis( diagnosed in 42% of patients).The whole head is affected.
- Peripheral( occurs in 8% of cases).Pathology affects the external part of the head, located under the articular cartilage.
- Central( observed in 2% of cases).The necrosis zone is formed in the center of the head of the hip bone.
For pains that occur in the hip joint, consult a doctor who, based on the symptoms, will prescribe a diagnostic checkup. With early detection of the disease and adequate treatment, patients have a chance to avoid subsequent surgical intervention. The choice of the method for studying necrosis of the head of the hip joint depends on the stage of the disease.
The mandatory hardware diagnosis of aseptic necrosis includes the control of blood pressure( to exclude the presence of hypertension), an electrocardiogram( to exclude heart disease) and ultrasonic densitometry, when the state of the patient's bone tissue is determined by the degree of absorption of ultrasonic waves and the rate of their passage through it. Hardware diagnostic methods are effective both in the early stages of the disease, and at later stages, when it is necessary to track changes in bone tissue during treatment.
To check the condition of the hip bone, the doctor will definitely send the patient to a radiograph. When it is carried out, pictures are taken, which are carried out in two projections: from the side or directly. In the first case, the patient is laid on the table, lying on his back, the leg being examined is bent in the knee and taken to the side by 90 degrees. In the second - the patient lies on his back with straight legs, and stops using special rollers are fixed inward. If the joint is immobile, the patient is placed on the stomach, and the opposite side of the pelvis is fixed with rollers.
Using CT( computed tomography), the bones and soft tissues of the patient are examined layer by layer. X-rays are absorbed by tissues of different density during passage through the body, and then fall on a sensitive matrix, which transfers data to the computer. Computer tomography determines the structure of the articular cartilage and the damaged head of the hip bone. During the procedure, the patient is placed on the tomograph table, lying on his back, and the doctor moves the table with the help of the remote control so that the necessary field of research is in the frame of the device.
Magnetic resonance imaging
The principle of this study is to obtain images of the bones and soft tissues of a patient using electromagnetic waves. Magnetic resonance imaging( MRI) helps to identify at the earliest stage the focus of changes in the head of the femur and to detect even a small intraosseous edema or inflammation. During the study, the person is placed in a tomograph bulb in which he must lie still for 10-20 minutes. At this time a number of pictures are taken, and the doctor monitors the subject with a video camera.
If suspected of aseptic necrosis of the head of the hip, the patient is always referred for urine and blood tests. They are taken to determine the level of minerals in the body and to identify markers of bone formation. With aseptic necrosis, natural collagen breaks down, and, disintegrating, forms markers that are excreted from the body along with the urine. These studies are assigned, both for the diagnosis of the disease, and for evaluating the treatment.
To which doctor should
be applied If the mobility is disturbed in the hip joint or if pain occurs during walking, then the surgeon or rheumatologist should be contacted immediately. For more informative diagnosis, one specialist often directs the patient to a consultation for another. In multidisciplinary clinics, the joints are handled by an arthrologist who determines all types of aseptic necrosis.
Treatment of aseptic necrosis of the head of the hip
After medical examination and diagnosis, the doctor prescribes treatment of femoral necrosis. The complex of medical measures in the early stages of the disease includes: medicamental therapy, massage, mud baths in sanatoriums, vitamin therapy, hirudotherapy( leech treatment), swimming. However, conservative methods do not lead to a complete cure of the disease, but only hamper its development, keeping the joint work for many years.
No modern medicine can completely destroy the necrotic process. If you can not slow down the progress of the disease, then doctors use surgery. This is the only radical treatment for necrosis of the head of the femur, which can significantly improve the conditions of life of a person with such a disease. Surgical operations are used in all four stages of the disease.
The tactics of drug therapy for aseptic necrosis of the hip are dependent on the development of symptoms, the age of the patient and the complete picture of the disease after a thorough diagnostic examination. Medicines prescribed by doctors for this disease:
- Non-steroidal anti-inflammatory drugs. They are prescribed to relax the muscles of the thigh, restore normal circulation and stop pain. The course of treatment - intramuscularly for one ampoule daily for a week. Known drugs are Naklofen, Diclofenac, Xsefokam, Ibuprofen.
- Vasodilators. They can eliminate stagnation of blood, improve arterial blood flow. The regimen depends on the severity of the course of necrosis of the hip joint, but is no less than 8 weeks with repetitions of the courses every six months. Popular vascular remedies are Kurantil, Trental, Dipiridamol, Xanthinal Nicotinate.
- Calcium metabolism regulators to prevent excessive loss of calcium. They improve the process of bone repair, reduce the destruction of collagen. Apply drugs at least 8 months continuously or with interruptions in a few weeks. The best drugs are Calcium D3 Nycomed, Xidiphon, Bonviva, Fosamax, Vitrum, Osteomag, Osteogenon, Alfacalcidol.
- Chondroprotectors. These are the most effective drugs in the 3 stages of necrosis of the hip joint, when the cartilage begins to peel off and collapse in the femoral head. They help restore cartilaginous tissue, stimulating the regeneration of ligaments. These drugs should be taken in long courses, at least 6 months, with an interval of six months. The most famous chondroprotectors are "Structum", "Chondroitin sulfate", "Chondrolon".
- Muscle relaxants. These drugs are able to relax the muscles, than inhibit the transmission of the nerve impulse, improving blood circulation. The course of treatment is 15-20 days for one tablet 2 times daily. The best relaxing medications are "Midokalm", "Sirdalud".
If the medication fails to produce results, a surgical procedure is performed. In the first stages of aseptic necrosis of the hip joint, it is used to decompress twisted vessels that do not provide adequate nutrition to the head of the femur, or to transplant the graft. Types of surgical treatment:
- tunneling, when additional holes are formed in the bone to reduce pain and intraosseous pressure;
- transplantation of the musculoskeletal graft to increase local blood flow and eliminate pain syndrome;
- interstitial osteotomy to eliminate the worn out portion of the femoral head and redistribute the load to other parts of the femoral head;
- arthrodesis( artificial splice) to give the joint a stillness to eliminate pain;
- arthroplasty to increase the volume of movements, eliminate lameness, improve blood supply to the hip joint.
At 4 stages of the disease, endoprosthetics are used, when the destroyed joint is replaced with an artificial joint. Duration of use of the prosthesis is about 15 years, after which it requires replacement. All surgical operations are performed under general or epidural( in the lumbar region) anesthesia. Terms, level and scope of rehabilitation depend on the procedure of operation and individual characteristics of the organism.
Therapeutic gymnastics and massage
One of the main methods of treatment of aseptic necrosis is therapeutic gymnastics. Physical exercises do not require any financial investment. All that is necessary for the patient to maintain health is a bit of free space on the floor and a rug. Instead of active dynamic exercises, you need to do static movements, lying on your back, for example, slowly raising your leg and keeping it on the weight.
Massage therapy can also bring tangible benefits to a sick person, provided that it is done by a professional, and mismanagement will only lead to deterioration. Proper massage with necrosis of the hip joint is done gently, smoothly, without sudden movements. It should cause the patient a feeling of warmth and comfort, without provoking pain or trauma.
Medical centers for the treatment of aseptic necrosis
Conservative and surgical treatment of hip bones necrosis is carried out in Russia and abroad. But the prices for services in clinics in Germany, Israel and other countries are much higher than in medical centers in Moscow or St. Petersburg. The quality of Russian medicine is in no way inferior to foreign clinics. Here are the addresses of the leading medical institutions in Russia, where the effective treatment of aseptic necrosis is carried out, and the prices for the services:
|Name of the procedure||Price, rub.||Address of the clinic|
|Correcting osteotomy of the femur with necrosis of the head of the hip joint||39600||"GrandMed", ul. Sadovaya, 35|
|Revision endoprosthetics of the hip joint( without implant cost)||85000||"Garant Clinic" Moscow, ul.|
|Endoprosthetics of the hip joint( without consumables and cost of prosthesis)||75000||"Central Clinical Hospital of Customs Service" Moscow, Open highway, 32|
|Hip replacement with necrosis of the femoral head( without implant cost)||69000||"Medical Union"St. Petersburg, Grazhdansky Prospekt 68 A|
|Complex of procedures for rehabilitation after endoprosthetics||3000-4000||"Baltic Guesthouse" St. Petersburg, ul. Baltic, 2/14|
Video about methods for diagnosing aseptic necrosis of the femoral head
Statistically, necrosis of the femoral head is more common in men than in women. The disease affects, as a rule, people 20-50 years old and often leads to disability, so it is very important to diagnose it in the early stages. How is the diagnosis of aseptic necrosis of the femoral head, find out from the video speech of the head of the orthopedic department of the Soyuz Clinic: