Sickle cell disease is a risk factor for interrupting the blood supply of the femur and developing osteonecrosis of femoral head. We can alter the course of the disease by early recognition, diagnosis and targeted treatment. Nonsurgical treatment of avascular necrosis of the. Avascular necrosis is a wellknown complication of sickle cell.
Current concepts on osteonecrosis of the femoral head. Rapidly destructive osteoarthritis of the hip joint. Usually, the patients are in their third, fourth or fifth decade of life at the time of diagnose. The ideal management of avascular necrosis avn of the femoral head continues to be controversial. Avascular necrosis, or osteonecrosis of the femoral head, is a condition that results when blood flow to the head ball of the hip is reduced or stopped, resulting in the death of cells in the bone tissue. A groove was milled through the ceramic surface of an oxinium head and pinondisk tests were performed. Displaced articular fracture of head of left femur, initial encounter for open fracture type i or ii. Most sites of involvement have an eponym associated with avascular necrosis of that area, and these sites are discussed individually as each site has unique clinical, etiologic and.
Avascular necrosis avn of the femoral head is a disease commonly associated with corticosteroid use, alcohol abuse, trauma, and sickle cell disease. Mri can help in identifying patients at risk of collapse of the femoral head. The head is globular and forms rather more than a hemisphere, is directed upward, medialward, and a little forward, the. Ficat and arlet classification of avascular necrosis of. After 10 million cycles of the pin moving across the groove, there was no. The avascular necrosis avn or osteonecrosis of the femur head onfh, an illness with several etiological factors.
Femoroacetabular joint narrowing has progressed compared with the previous imaging. Avascular necrosis avn of the femoral head is a relatively uncommon complication following an extracapsular hip fracture. Osteonecrosis of the femoral head is the end point of a disease process that results in bone necrosis, joint edema, and cartilage damage. Subsequently, interruption of blood flow to the femoral head leads to the death of bone marrow and osteocytes and usually causes the collapse of the necrotic segment 1. As a result of the collapse, the normally round femoral. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Avascular necrosis avn, or more correctly osteonecrosis, is a generic term referring to the ischemic death of the constituents of bone. Replacement procedure remains the main treatment after failure of preserving procedures and in the latestage onfh, involving collapse of the femoral head and degenerative changes to the acetabulum. Avascular necrosis avn of the femoral head is a pathologic process that results from interruption of blood supply to the bone. Avascular necrosis of the femoral head orthopaedic snafus. Osteonecrosis on of the femoral head onfh is the final common pathway of a series of derangements that result in a decrease in blood flow to the femoral head fh leading to cellular death, fracture, and collapse of the articular surface1,2.
The neck is flattened from before backward, contracted in the. These include steroid use, trauma and sickle cell disease. Avascular necrosis represents a spectrum of issues that advance from mild hip pain early in the process and heads toward varying degrees of femoral head collapse and severe pain with limited function. Femoral neck exostosis, a manifestation of campincer combined. The femoral head is most commonly affected by this disease. Express the lateral extrusion as a percentage of femoral head width or in millimetres. Avascular necrosis of the femoral head in patients with. The femoral head femur head or head of the femur is the highest part of the thigh bone femur. Pdf avascular necrosis of femoral head researchgate. Avn of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head.
The ficat and arlet classification uses a combination of plain radiographs, mri, and clinical features to stage avascular necrosis of the femoral head. Many surgical interventions are used to treat osteonecrosis of the femoral head. A geographic zone method to describe intraarticular pathology in. Avascular necrosis of the femoral head avnfh re fers to a progressive weakening o f the k nobby head of the thigh bone femur, resulting in eventual collapse of the bone structure if. Osteonecrosis on of the femoral head is a potentially disabling condition affecting primarily young active adults. A novel method dai miyasakaa, tomoyuki itoa, norio imaia, ken sudaa, izumi minatob, yoichiro dohmaec, and naoto endoa adivision of orthopaedic surgery, department of regenerative and transplant medicine, niigata university graduate school of medical and dental sciences, niigata 9518510, japan. Ischiofemoral ligament femoral head arthritis research. We therefore sought to determine trends in the types and numbers of procedures performed for atraumatic osteonecrosis from 1992 through. Treatment of avascular necrosis of the femoral headbone angbk presents great complexity. There has been an increasing trend in its diagnosis. Threedimensional assessment of femoral head coverage in normal and dysplastic hips. Development stages in order to understand the modifications of the blood flow it is necessary to be acquainted with the vascularisation of the femoral head and upper extremity of the femur.
Femoral nerve block a guide for medical students and junior doctors. It typically affects relatively young, active people between 20 and 40 years and regularly follows an unrelenting course resulting in. Occasionally, grade iv acetabular lesions with healthy surrounding articular cartilage may be candidates for microfracture and represent a small subpopulation of patients who may respond remarkably well. Ceramax ceramic insert options srom 11 heads size od cat. It leads to joint arthritis that necessitates total hip. Pigmented villonodular synovitis causing osteonecrosis of. Treatment of femoral head osteonecrosis in the united. Comparison of the sliding and femoral head rotation among three. Displaced artic fx head of l femur, init for opn fx type i2. It can lead to pain and limping, hip collapse, and cause the legs to be of unequal length. Preoperative xray images showed joint narrowing and severe.
This can ultimately cause weakening and collapse of the bone in the femoral head. Avascular necrosis avn of the femoral head is a common cause of hip disability that may progress to collapse of the femoral head and hip osteoarthritis in up to 80% of patients if left untreated. Avascular necrosis of femoral head blood supply to femoral head ball of hip joint is interrupted by 1. Threedimensional assessment of femoral head coverage in. The postoperative rehabilitation protocol for this procedure includes 10 weeks of. Open left femoral head articular upper leg bone, hip fracture. When a patient is suffering from necrosis of the femoral head, for objective and subjective reasons, delaying the start of treatment, this inevitably leads to a complication of the disease, and there is a collapse or hip stiffness in the femoral head. The french orthopedic surgeon paul rp ficat 19171986 4 in association with professor jacques arlet devised a system of staging idiopathic avascular necrosis of femoral head in the late. A series of cases from north wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented. The femoral sheath is contained within the femoral triangle. Osteonecrosis of the femoral head, also referred to as avascular necrosis, is a pathological state with multiple possible etiologies that causes decreased vascular supply to the subchondral bone of the femoral head, resulting in osteocyte death and collapse of the articular surface.
Avn has a wide variety of causes and can affect nearly any bone in the body. Pincer type fai is caused by overcoverage of the femoral head by the acetabulum. Avascular necrosis of the femoral head radiology case. When adverse events happen in orthopaedics an interdisciplinary approach to reducing length of stay in joint replacement patients. A femoral head ostectomy is a surgical operation to remove the head and neck from the femur. Frontal cortical erosive destruction and sclerosis within the weight bearing portion of the left femoral head. Avascular necrosis of the hip avascular necrosis avn of the hip can be caused by a variety of things. The vascularisation of the femoral head and of the upper extremity of the femur depends on the age. It is performed to alleviate pain, and is a salvage procedure, reserved for condition where pain can not be alleviated in any other way. Risk factors of avascular necrosis of the femoral head in patients with systemic lupus erythematosus under highdose corticosteroid therapy.
Surgical procedure all surgical procedures were performed by one of the. Pizzolatto on avascular necrosis of the hip in children. Avascular necrosis of the femoral head anfh is a degenerative condition which causes the upper ends of the thigh bones femurs to break down due to a disrupted blood supply and poor bone repair. Femoral head avascular necrosis clinical presentation. A predictive method for subsequent avascular necrosis of the femoral head avnfh by observation of bleeding from the cannulated screw used for fixation of. Avascular necrosis of the femoral head presents with groin pain. The offending agent causes a decrease in essential blood flow to the femoral head the ball portion in the hip socket. Femoral nerve block a guide for medical students and. An analysis of radial ct reconstructions in adolescents.
Doctor answers on symptoms, diagnosis, treatment, and more. We report a case of a 27yearold man with pigmented villonodular synovitis of the hip joint with coincident osteonecrosis of the femoral head. The natural history of onfh is a progression to subchondral fracture leading to femoral head collapse and secondary osteoarthritis. Recently, various femoral head fixation devices hfds for trochanteric fractures have. Risk factors for pincer fai include acetabular retroversion46 or an. Hip dislocations and femoral head fractures orthopaedic trauma. Bony avulsion of the femoral head has been associated with tears of ligamentum teres, but this is a very unusual finding 67.
Intraosseous pressure and oxygen tension in avascular necrosis and osteoarthritis of the hip. Familial avascular necrosis of the femoral head genetic. Use of eswt in avascular necrosis of bilateral femoral. Avascular necrosis of the femoral head pelvic pain. Although it can occur following fixation of unstable 3part or 4part. The development of anfh is associated with steroid use, alcohol use, smoking, autoimmune disorders. Avascular necrosis of hip avn hip linkedin slideshare. Bone is living tissue loss of blood supply bone death if bone death progresses leads to bone collapse 5. Excision of the femoral head and neck produces more favorable results than conservative treatment with rest and analgesics.
Radiographic findings mimicked those of other disorders such as. According to the literature, about 5%12% of hip arthroplasties are performed for the treatment of this condition per annum. Treatment of collapsed traumatic osteonecrosis of the femoral head. Pdf osteonecrosis of the femoral head diagnosis and. Features consistent of bilateral femoral head avascular necrosis. Using the head impactor, engage the head with several gentle taps until it is firmly set. The femoral sheath crural sheath is formed by a prolongation downward, behind the inguinal ligament, of the abdominal fascia, the transverse fascia being continued down in front of the femoral vessels and the iliac fascia behind them. Rapidly destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population.
The femur neck femoral neck or neck of the femur is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward. Avascular necrosis of the hip in children doctor answers. Osteoarthritis usually in older individuals, may occur in younger individuals in the setting of previous trauma fracture usually secondary to osteoporosis in older individuals less common diagnoses. Osteonecrosis on or avascular necrosis of the femoral head is a condition characterized by the death of osteocytes and bone marrow. Doctors give unbiased, trusted information on the use of magnetic resonance imaging for avascular necrosis. Avascular necrosis of femoral head association of surgical.
Avascular necrosis is a condition involving disruption of the vascular supply to the subchondral bone of the femoral head, resulting in articular surface collapse with eventual articular degeneration and osteoarthritis. Does fluoroscopy improve acetabular component placement. Osteonecrosis of the femoral head onfh usually affects young adults in the third and fourth decades of life. Six experienced hip arthroscopists were instructed in the zone and clockface. For the anthology stem system, it is important to template for proximal. Alternatively, if the femoral head and neck are securely anchored in strong cancellous bone, resorption of bone at the fracture site effectively leads to a. Introduction avascular necrosis is condition in which there is loss of blood supply to the bone. Taper fit stem, reduced standard offset high offset 6 catalog number description 11063001. The instance and distribution of these various procedures may give some insight into the practicing communitys understanding of the efficacy of these treatments. Presence of bone marrow edema, increased fat content in the proximal femur and joint. Avascular necrosis avn is a disease that may affect several different bones as a result of temporary or permanent loss of the blood supply to these bones. There is almost no literature regarding the mr appearance of tears of the ligamentum teres 68.
202 361 89 563 527 160 523 403 970 998 223 1145 544 1445 1447 426 154 1101 400 1425 267 7 205 975 1091 413 918 240 1177 902 839 320 566 1484 433 390 135 508 437 240 270 1271