Ischemic or avascular necrosis of the hip occurs in young patients and usually affects both hips. It presents with dull pain in the buttock, groin and/or knee. Although it is related to corticosteroid intake and alcoholism, the origin of the disease itself is not known. Diagnosis is difficult, so it is important to detect the disease early and provide adequate treatment.
Ischemic or avascular necrosis of the femoral head (hip) is a disease that occurs in young patients (between 35 and 50 years), males and usually bilaterally in both hips.
Causes of avascular or ischemic necrosis
The most frequent etiology or cause is the intake of corticosteroids and alcoholism. Although many other causes have been described, both traumatic and non-traumatic (arteriosclerosis, Cushing’s disease, diabetes mellitus, hyperlipidemia, dysplasias, etc.). Also, more than one third of patients have an idiopathic etiology, i.e. the origin of the disease is unknown.
The reason why it occurs (its pathogenesis) is still unclear; in fact there are many theories on the subject. There are theories that defend that the reason is an intraosseous infarction, a fat embolism, an increase in cellular stress or a progressive ischemia (lack of blood supply). But what they all agree on is that, for whatever reason, there is an area of bony weakness of the femoral head (hip) that can collapse and cause osteoarthritis.
Symptoms of avascular necrosis of the hip
Clinical symptoms usually begin as a dull or intermittent pain, of gradual onset, referred to the buttock, groin and/or knee. In some cases a sudden, intense pain appears, sometimes with nocturnal onset, followed by this dull pain. It is usually bilateral, although not simultaneous (in 60% of patients). Mobility is usually well preserved, which differentiates it from osteoarthritis.
Diagnosis of avascular necrosis of the hip
The diagnosis should be as early as possible. For this we must have the clinical suspicion, and then confirm the diagnosis with tests such as simple radiography, scintigraphy, CT and, above all, nuclear resonance.
How to treat avascular necrosis of the hip
Treatment varies greatly depending on the patient and the degree of lesion present. It can be an expectant and conservative treatment, based on unloading the joint, or surgical, and in this field the options in traumatology are very varied: drilling, grafts, osteotomies and, finally, hip prostheses.
In conclusion, as the disease is difficult to diagnose initially and it is very important to diagnose it as soon as possible, when a young patient starts with pain in one or both hips, the most important thing is to see a specialist in hip pathology to be diagnosed and treated as soon as possible.