Aseptic necrosis of the femoral head

Aseptic necrosis of the femoral head is the death of the bone tissue of the joint due to a lack of blood supply. The disease is also called avascular necrosis or osteonecrosis. This disease can lead to small bone fractures and subsequent joint destruction.

The word “avascular” means “devoid of blood vessels”. That is, in the case of aseptic necrosis, pathogenic microorganisms are not the root cause. In septic necrosis, the cause of the disease is inflammation against the background of a bacterial infection.

Ischemia is a local decrease in blood flow, due to which damage to tissues and organs occurs. Ischemic necrosis leads to irreversible changes in bone tissue.

Avascular necrosis can occur in any joint. Aseptic necrosis of the head of the humerus is much less common than that of the hip. But in any case, the patient experiences significant discomfort with the risk of losing the motor functions of the limb.

Perthes disease is another serious pathology of a non-infectious nature. This is osteochondropathy of the femoral head. The disease is accompanied by the death of the femoral head, which requires joint replacement and immediate therapy.

According to the Mayo Research Clinic, the process of aseptic necrosis of the joint can take from several months to several years. Most often, the disease occurs in people aged 30 to 50 years.

Aseptic necrosis of the femoral head (ANFH) may result from:

• traumatic injuries of the joint;
• complications of coronavirus infection;
• long-term use of glucocorticoid hormones;
• alcohol abuse.

Necrosis of the hip joint most often occurs in children aged 3 to 15 years. Although the exact causes of the disease in children are unknown, doctors are inclined to the presence of genetic defects. Also, circulatory disorders in the joint are often associated with past viral infections. Trauma in the form of a dislocation of the joint can also cause aseptic necrosis in childhood.

Adult patients in most cases experience aseptic necrosis as a complication of another disease. In the past 2 years, this has been caused by COVID-19 infection.

Diseases such as sickle cell anemia and Gaucher disease can also reduce blood flow to the joints.

Violation of blood flow with the subsequent development of the pathology of the femoral head can be triggered by AIDS or systemic lupus erythematosus.

In the early stages of aseptic necrosis of the femoral head, there may be no symptoms. As the condition worsens, the affected joints may hurt only when there is a load on them.

The pain can be moderate or severe and usually gets worse gradually. Over time, discomfort may be concentrated in the groin or buttocks. Further, the pain spreads to the legs, arms, and shoulders.

Patients most often develop avascular necrosis:

• in the right femur;
• in the left femur;
• in one or both knees.

During the initial examination, the orthopedist will feel the joint and check its mobility. This is important for assessing the condition of cartilage and bone. Main methods of hardware diagnostics:

• MRI and CT. These imaging tests provide detailed images that show early signs of bone changes. Structural changes in the joint may indicate ANFH.
  X-ray. This examination helps to identify bone changes that occur in the later stages of the disease. In the early stages, X-rays usually show no abnormalities in the femoral neck.
• To make an accurate diagnosis, it is important to consult a narrow-profile doctor who has experience with aseptic necrosis of the hip joints. Lack of adequate treatment will lead to disability without the ability to restore the motor function of the leg.
• Idiopathic osteonecrosis of the femoral head or ANFH may be misdiagnosed as a result of misdiagnosis. An inexperienced medical professional may confuse this disease with arthritis or another pathology.

If the patient is not sure that it is possible to undergo a full-fledged orthopedic examination at the place of residence, he (she) should immediately contact a foreign clinic. Thanks to modern equipment and accumulated experience, foreign doctors will be able to conduct accurate diagnostics and targeted treatment.

Pelvic X-ray shows the collapse of the femoral head and marked changes involving the acetabulum of the left femur. Photo from NCBI (National Library of Medicine of America).

There are 4 stages of necrosis of the hip joint:

The first stage of the disease is not accompanied by tangible symptoms. At stage 1 of ANFH, subcartilaginous osteonecrosis develops. There is a lesion of the cancellous substance of the femoral head. At the same time, the cartilage itself is unchanged.

The second stage is accompanied by minor pain. ANFH stage 2 is characterized by cracks on the surface of the femoral head.

The third stage is accompanied by pain during movement, which does not immediately go away at rest. At stage 3 of ANFH, there are foci of compaction and cystic neoplasms. It narrows the interarticular space.

The fourth stage of the disease leads to frequent and intense pain, even at rest. At the 4th stage of ANFH, the head of the joint is completely destroyed. This leads to immobilization of the limb.

To treat aseptic necrosis at different stages, doctors use different tactics. Therefore, it is important to accurately diagnose and assess all risks in order to individually select a treatment protocol.

To diagnose Perthes disease, five stages are distinguished:

• stage 1 – aseptic necrosis;
• stage 2 – secondary compression fracture;
• Stage 3 – fragmentation, resorption of areas of dead spongy substance;
• Stage 4 – recovery;
• Stage 5 – stage of secondary changes.

Therapy for avascular necrosis is aimed at alleviating the patient’s condition and reducing symptoms. In the early stages of the disease, the doctor may prescribe the following non-surgical treatment options:

• non-steroidal anti-inflammatory drugs anesthetize and slightly reduce the inflammatory process;
• drugs for osteoporosis slow the progression of avascular necrosis in some cases;
• cholesterol-lowering drugs help prevent blockage of blood vessels;
• medicines that open blood vessels can improve blood circulation in the area of bone damage;
• anticoagulants can prevent the formation of blood clots in the vessels that feed the joints.

The effectiveness of these types of drugs in ANHF is not fully proven, so they are not prescribed universally. Depending on the general condition of the person and the accompanying pathologies of the musculoskeletal system, each patient will have an individual reaction to the drug treatment of aseptic necrosis of the joint.

Treatment of aseptic necrosis of the femoral head abroad will depend on the degree of neglect of the disease. Most often, patients who are diagnosed with stage 3 or 4 of ANFH turn to foreign clinics. In these cases, 2 methods of surgical treatment are used:

• Decompression of the nucleus. An orthopedic surgeon drills small holes in the affected bone to improve blood flow there. This procedure may be combined with stem cell injections to promote healing.
• Hip replacement. The doctor replaces the damaged joint with a quality implant.

According to experts of the Cleveland Research Clinic, hip or knee replacements are 95% effective in relieving pain and possibility of being able to walk on your own.

Stem cells are a natural building material that the body needs to recreate the elements of all tissues. In the case of arthrosis and aseptic necrosis of the joint, stem cells help repair damage to bone and cartilage. To carry out this therapy, it is necessary to contact a medical institution with appropriate laboratory equipment.

After undergoing cell therapy, patients note a decrease in pain. This is evidenced by the reviews of people who received injections of cell preparations into the joint.

The best orthopedists who specialize in surgical treatment and stem cell therapy work in clinics in Turkey, South Korea, Italy, and some other European countries. The best value for money can be found in Turkish medical centers. Academic Hospital in Istanbul is one of them.

A world-famous doctor, Professor Murat Bezer, works in the Turkish Academic Hospital. The doctor has over 19 years of experience in the treatment of orthopedic pathologies, including aseptic necrosis. Professor Bezer grafts the bone, which eliminates the need for a prosthesis.

To clarify the cost of a consultation with Professor Bezer and find out the cost of joint replacement surgery, leave a request on the Experts Medical website. The medical coordinator will provide you with all the information and, if necessary, organize a trip to the Turkish Academic Hospital free of charge.

Murat Bezer is a spinal surgeon, orthopedist, and member of national and international medical associations.

The BIOSS method (metodica BIOSS) is aimed at delaying prosthetics. This treatment can prevent the progression of the disease, remove unpleasant symptoms, and improve the functionality of the joint.

For the treatment of femoral head necrosis, the Italian network of GVM clinics uses the Bioss method. It allows to revascularize, stabilize, and start the process of regeneration of the affected bone.

The technique combines the Core Decompression technique (a treatment that creates a channel to reduce pressure within the bone itself, facilitating blood circulation, with an efficiency of up to 90% in mild/moderate cases and up to 40% in severe cases) and biological treatment (the use of growth factors, mesenchymal cells).

BIOSS consists in the introduction of a special screw having holes on the longitudinal axis. It is attached to the joint. Necrotic tissue is preliminarily removed and blood circulation in the bone is restored. The design of the screw makes it possible to introduce osteoinductive or osteoconductive substances into the bone itself, stimulating regeneration from the inside. The screw becomes a kind of “door”, through which other substances can be reintroduced over time.

Professor R. Giancola specializes in the treatment with the BIOSS method. The doctor has 45 years of experience in the treatment of orthopedic diseases using minimally invasive surgery.

You can undergo innovative treatment of aseptic necrosis at the San Carlo di Nancy Hospital (part of the GVM clinic network) in Rome. To be accepted in an Italian clinic, leave a request to the Experts Medical coordinator and get a free consultation.

If left untreated, ANFH worsens the patient’s condition as a whole. Degenerative-dystrophic damage to the tissues of the joint leads to its complete destruction. In the intermediate stages, avascular necrosis provokes the appearance of severe arthrosis.

Aseptic necrosis affects the elements of the bone marrow in the head of the joint. Tissues stop receiving nutrients. The gradual death of bone and cartilage leads to the destruction of all parts of the joint. In this case, drug treatment will not bring any effect, and the person will be tormented by constant pain.

To reduce the risk of avascular necrosis, it is recommended:

• undergo examinations of the joints in the presence of diseases that can provoke ANFH;
• limit alcohol consumption;
• maintain normal cholesterol levels;
• take steroids with caution.

Any symptoms that may indicate aseptic necrosis of the femoral head require immediate investigation. The complexity of treatment and rehabilitation will depend on the extent of the joint damage.

In order to prevent the complete loss of motor functions in the later stages, it is necessary to timely replace the damaged joint with an artificial one.