Femoral head necrosis

The Femoral head necrosis, also Femoral necrosis called, represents a serious disease of the hip bone. A severe circulatory disorder leads to the death of the bone tissue. The consequences for the avascular, i.e. no longer supplied with blood, and necrotic femoral head are possible in the further course of development, a hip arthrosis up to the stiffening of the hip joint and in the worst case disability.

What is femoral head necrosis?

The femoral head necrosis generally belongs to the osteonecrosis, i.e. a death of the bone substance as a result of circulatory disorders. The most common osteonecrosis is femoral head necrosis, in which the bone cells in the hip joint die off.

The painful disease often occurs in middle-aged adults and is often accompanied by sharp pain in the affected hip joint area and restricted mobility even in the early stages. As the femoral head necrosis progresses, the disease leads to a collapse of the femoral head or the joint surfaces. This results in osteoarthritis, i.e. premature wear of the hip joint.

A characteristic and causal factor for femoral head necrosis, which is one of the aseptic bone necrosis, is a circulatory disorder, which then results in necrosis of the bone tissue. In femoral head necrosis, a distinction must be made between the post-traumatic form, e.g. after an injury such as the femoral neck fracture and spontaneous femoral head necrosis.

In the case of post-traumatic femoral head necrosis, an acute circulatory disturbance occurs suddenly due to injury, whereas spontaneous femoral head necrosis is characterized by chronic, recurring circulatory disorders. In very rare cases, femoral head necrosis also occurs in childhood, the so-called Perthes disease.

causes

The causes of femoral head necrosis can be varied. In post-traumatic, i.e. In the case of femoral head necrosis caused by an accident, the trauma is clearly recognizable as the cause of the circulatory disorder. Here, the vessels are damaged as a result of an accident or acute injury, which leads to severe circulatory disorders in the hip area.

These include e.g. a fracture of the femur, a fracture of the femoral neck, a serious injury to the joint, or in the course of a hip dislocation. In the case of spontaneous femoral head necrosis, however, there are many possible causes. One of the most frequent risks and possible causal factors is the lipid metabolism disorder, which can be recognized or suspected in around half of femoral head necrosis cases.

However, the causal relationship has not been clearly proven, as is the case with other influencing factors that are observed in connection with femoral head necrosis: These include the use of corticoids (e.g. medication in the form of cortisone or steroid doping), excessive alcohol consumption, nicotine consumption, Coagulation disorders, but also diving accidents that lead to decompression sickness. In many cases of femoral head necrosis, however, the exact cause remains unknown.

Typical symptoms & signs

• Hip pain
• Restrictions on movement
• Hip arthrosis

Diagnosis & course

Patients with femoral head necrosis usually see a doctor relatively late in the course of the disease due to pain in the hip joint. At this stage, these symptoms are mostly stress-dependent, and in the further course a difference in leg length due to femoral head necrosis can even be determined.

The most important diagnostic methods are Targeted magnetic resonance imaging is available in the initial stage, which can make (intraosseous) edema formation in the bone visible. In the further, advanced course of the disease, an X-ray shows the progressive deformation and "rounding" of the femoral head. The course of femoral head necrosis takes place in several stages, with no pain at first, later increasing after exercise and often in a sudden and stabbing form.

The further the femoral head necrosis progresses, the more immobile and stiff the hip joint becomes and it already hurts when it is at rest. In the later course of the necrosis of the femoral head, the hip joint can collapse and lose its original shape, which can lead to severe joint damage and hip joint wear. The result is a considerable reduction in quality of life and mobility, which can lead to disability.

Another diagnostic option for identifying the stage of femoral head necrosis in a more differentiated manner is hip arthroscopy, which is performed as an operative reflection of the hip joint, among other things. its cartilage and bone condition helps to better assess.

Complications

As a rule, the femoral head necrosis leads to the death of the bone tissue and thus to severe circulatory disorders. Furthermore, severe pain and restricted mobility occur in the patient, which not infrequently also cause psychological complaints and depression. The hip hurts relatively badly and can also be affected by pain at rest.

Pain at rest can also lead to insomnia and thus extremely reduce the patient's quality of life. Furthermore, a leg length difference can develop without treatment, which leads to considerable restrictions when walking and standing of the patient. The bone tissue continues to recede and so-called joint wear can occur.

In the worst case, the person affected is dependent on a walking aid or a wheelchair if he can no longer move himself. Necrosis of the femoral head can be treated relatively well, with no further complications. Medicines, therapies and surgical interventions are used. The course of the disease is always positive and the person affected can usually resume his or her normal activities after the treatment. As a rule, femoral head necrosis does not affect life expectancy.

When should you go to the doctor?

A visit to the doctor is indicated if hip pain occurs during exercise. Femoral head necrosis manifests itself at the beginning of the disease through unspecific symptoms that must be clarified, for example restricted mobility and a feeling of pressure in the hip area. If these symptoms are noticed, the doctor or an orthopedic surgeon should be contacted. Medical advice is required at the latest when the hip pain also occurs during a period of rest. Increasing restrictions on movement are another warning sign that requires immediate clarification by a doctor. If there are complications such as severe pain at rest or a stiffening of the hip, the person concerned must be taken to the nearest hospital.

If there are further problems or if the person concerned suffers a fall, it is best to call the emergency doctor. In the event of psychological complaints, the doctor can put you in touch with a therapist. This is especially necessary in the case of protracted illnesses that have been a burden for the patient for a long time. People who notice signs of femoral head necrosis after a femur fracture, joint injury, or hip dislocation should speak to their healthcare professional. Alcohol consumption, coagulation disorders and the use of certain medications are also risk factors that need to be clarified.

Doctors & therapists in your area

Treatment & Therapy

The attending physician has a variety of possible therapies to choose from. Above all, the respective stage of the disease is decisive, because the further course of femoral head necrosis can be estimated from the shape of the femoral head, the extent of the femoral head necrosis (i.e. the dead area) as well as the specific head changes and whether and to what extent the acetabulum is already present is involved.

As a therapy, strict relief of the hip joint by means of externally applied aids (orthotics) comes into consideration, as well as an adapted movement therapy. As far as drug treatment is concerned, iloprost can be administered as the agent of choice to improve blood circulation, and bone-building preparations (such as bisphosphonates) are also administered. In the early stages of the disease, so-called hyperbaric oxygen therapy and shock wave therapy are sometimes helpful and successful.

Drilling into the femoral head in an initial stage of the femoral head necrosis can also be considered as a therapeutic option: Here there is the possibility of performing what is known as medullary canal decompression as a measure to increase blood flow. Drilling the diseased femoral head bone supports the formation and ingrowth of new blood vessels in order to heal or at least significantly improve the femoral head necrosis. If the cartilage condition is stable, it can also be filled with bone substitutes, known as retrograde cancellous bone transplantation.

In advanced stages and in the case of a collapsed femoral head and cartilage damage, only a total hip endoprosthesis can help as a joint replacement. Especially with young patients, however, prostheses specially adapted to the extent of the necrosis are being used more and more frequently instead of standard prostheses.

There are e.g. a button-shaped prosthesis that acts as a femoral head resurfacing. These surface replacement prostheses can be used as “bone-saving” as possible, which is of particular benefit to the younger sufferers. The same applies to femoral head necrosis: the earlier a clear diagnosis is made, the more beneficial the course can be therapeutically.

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prevention

According to the current state of knowledge, a generally active, conscious and healthy lifestyle can be recommended as a preventive measure. The permanent reduction of excess weight is certainly one of the best measures to prevent femoral head necrosis.

However, it is also advisable to consume stimulants such as alcohol and cigarettes as sparingly as possible, as they are also possible risk factors for this disease. An excessive use of cortisone and steroids in connection with femoral head necrosis should also be warned, because these are considered to be extremely "favorable" for the development of osteonecrosis in general and of femoral head necrosis in particular.

In addition, if there is the slightest pain in the hip area, a medical and differential diagnostic clarification should be carried out in order to identify any existing femoral head necrosis at the earliest possible stage and to be able to treat it optimally.

Aftercare

In most cases, the follow-up measures for femoral head necrosis are severely limited or are not available to the person concerned. In the case of this disease, a diagnosis should therefore be made very early so that the symptoms cannot worsen further. In the case of femoral head necrosis, self-healing cannot usually occur, so that the person affected should ideally consult a doctor as soon as the first complaints and symptoms appear.

Most of those affected with this disease are dependent on physical therapy and physiotherapy in order to permanently alleviate the symptoms. Many of the exercises from these therapies can also be performed in your own home, so that the treatment is accelerated. Furthermore, the support and care of one's own family and friends has a positive effect on the further course of the disease.

Depressive moods or other psychological complaints can also be prevented. The further course of the femoral head necrosis depends very much on the time of diagnosis so that a general prediction is not possible. However, the disease does not usually reduce the life expectancy of those affected.

You can do that yourself

Patients with femoral head necrosis particularly suffer from pain and limited mobility, which interfere with everyday life. The pain emanating from the affected hip joint occurs both during movements and in phases of inactivity as pain at rest. For many sufferers, relieving pain is an important aspect in improving their quality of life. Each patient must find the right way to deal with the pain and appropriate measures to alleviate it for himself. In general, it is important to find the right balance between stressful and stressful activities.

Over-exertion of the diseased hip must be avoided in any case, but it is not recommended to reduce physical activity to a minimum. Physical activities must be coordinated with the attending physician and physiotherapist and help to maintain a certain level of fitness and mobility.

Often, patients with femoral head necrosis undergo various medical procedures with the aim of slowing the progression of the disease or relieving pain. Before and after these interventions, those affected have to strictly follow the doctors' instructions and, for example, change their diet or observe scheduled rest periods. The independent performance of medically prescribed physiotherapy at home supports the well-being of the sick.