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(Osteonecrosis of the Hip; Avascular Necrosis of the Hip; Ischemic Necrosis of the Hip; Osteochondritis Dissecans of the Hip)

Definition

Aseptic necrosis of the hip is the death of bone tissue in the head of the thigh bone (femur) due to poor blood supply.

Legg-Calvé-Perthes disease is a type of aseptic necrosis in children. It affects the growth plate at the upper end of the thigh bone.

The Hip Joint
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Causes

Aseptic necrosis of the hip is caused by any event or health problem that blocks blood supply to the head of the femur.

Risk Factors

This problem is more common in people who are between 30 and 50 years of age. It is also more common in men. Some things that may raise the risk are:

  • Corticosteroid use
  • Alcohol use disorder
  • Smoking
  • Hip trauma, such as hip fracture, hip dislocation, and prior hip surgery
  • Cushing disease
  • Sickle cell disease
  • Blood clotting disorders, such as thrombophilia
  • Systemic lupus erythematosus (SLE)
  • HIV infection
  • Kidney failure

Symptoms

There may not be symptoms in the early stage. People who do have problems may have:

  • Hip pain
  • Problems moving the hip
  • Groin pain and throbbing that may be worse when bearing weight
  • Buttock, thigh, and knee pain

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Images may be taken of the hip. This can be done with:

Treatment

The goal of treatment is to ease symptoms and stop damage. Treatments may include:

  • Limiting activities that cause pain
  • Using a cane or walker to keep weight off the hip
  • Physical therapy to help with strength, flexibility, and range of motion
  • Avoiding or limiting alcohol and smoking

Other choices are:

Medication

Medicine may be given to:

  • Ease pain
  • Prevent loss of bone mass
  • Prevent blood clots
  • Improve blood flow

Surgery

Some people may need surgery. Some options are:

  • Decompression of the inside of the bone (with or without bone grafts)
  • Hip replacement
  • Hip resurfacing
  • Realigning the bone

Prevention

There are no guidelines to prevent aseptic necrosis.

RESOURCES

Family Doctor—American Academy of Family Physicians  http://www.familydoctor.org 

OrthoInfo—American Academy of Orthopaedic Surgeons  http://orthoinfo.aaos.org 

CANADIAN RESOURCES

HealthLink BC  http://www.healthlinkbc.ca 

Health Canada  https://www.canada.ca 

References

Amanatullah DF, Strauss EJ, et al. Current management options for osteonecrosis of the femoral head: part 1, diagnosis and nonoperative management. Am J Orthop (Belle Mead NJ). 2011 Sep;40(9):E186-192.

Osteonecrosis of the hip in adults. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/osteonecrosis-of-the-hip-in-adults  . Updated December 6, 2017. Accessed May 14, 2020.

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