Features of treatment of hip joint necrosis
In the affected joint, the cartilage and bone tissue die
Necrosis - the death of some tissues of the damaged organ. There is an ailment as a result of a violation of blood supply, insufficient supply of essential nutrients to the joint. With necrosis of the hip joint, the bone head is mostly damaged.
The most dangerous complication of osteonecrosis is gangrene, often leading to blood infection or limb amputation. Therefore, if you have pain in the hip or knee joint, and after getting injuries, you should immediately contact a specialist and conduct a survey. Timely diagnosis will help to find out the nature of pain and avoid the risk of developing serious illnesses.
Causes and Symptoms of the Disease
Aseptic necrosis of the hip joint can develop for the following reasons:
- dislocation or fracture;
- frequent minor tissue damage and excessive loads( especially with regular sports activities);
- arterial thrombosis;
- transferred inflammatory diseases;
- taking certain medications( antibiotics and hormones in large doses and for a long time);
- pressure drops( for miners and divers);
- alcohol abuse.
In 80% of cases, osteonecrosis is bilateral. In addition to the head of the hip joint, it often progresses in the knees, shoulder, elbows and ankles. Osteonecrosis may occur several months or even years after the injury or pathological conditions that provoked it.
Joint type at different stages of the disease
The course of the disease is divided in stages depending on the degree of destruction of the hip or knee joint tissues. Each stage is characterized by the same symptoms, but the intensity of their manifestation is different.
The main symptoms of the disease:
- atrophic changes of soft tissues of the thigh or knee( if the patient has necrosis of the knee joint);
- reduction in the amplitude of joint movements;
- relocation of the body load to a healthy leg.
At the initial stage, the main sign of asthenic necrosis is pain, which appears spontaneously. It concentrates in the region of the hip joint and gives in the groin, the area of the knee joint, waist and sacrum. Pain can stop walking and sitting. Gradually they become more intense and prolonged, especially at night. The possibility of joint motion does not change. The body weight is distributed evenly to both extremities.
Stage 2 osteonecrosis is characterized by persistent pain, especially after physical exertion. The amplitude of movement of joints decreases slightly. There is a significant death of the femoral muscles( the girth of the affected thigh is less than healthy).The load of body weight is gradually transferred to a healthy leg.
With the 3rd stage of the disease, even a minimal load causes a significant increase in pain. Movement of the joint is limited. Muscles are significantly atrophied. The leg may become somewhat shorter.
Osteonecrosis of the 4th stage is characterized by the appearance of soreness, which is most pronounced. There is a violation of gait. Muscular atrophy is clearly pronounced. The amplitude of the motions is zero.
Diagnosis and treatment of osteonecrosis
Complication of the disease led to a fracture of the femoral neck
The earlier avascular necrosis is detected, the easier it is to treat the disease. Often, x-rays are prescribed for diagnosis, but in the initial stages aseptic necrosis of the hip with the help of this method is almost impossible to determine. The lesion of the joint on the X-ray will be noticeable only at 2 or 3 stages of the disease. Ultrasound and laboratory tests for the diagnosis of necrosis are also ineffective. To detect the disease at the beginning of its development is possible only with the help of computer tomography and MRI.
Treatment can be traditional and operative. Aseptic necrosis of the knee and the head of the hip joint, revealed at the initial stage of development, lends itself to conservative therapy. The purpose of such treatment is to prevent or slow the development of the disease, to relieve or reduce pain, to improve the mobility of the affected joint.Traditional treatment includes:
- reception of analgesic, anti-inflammatory drugs( corticosteroids, non-steroid drugs);
- exercise therapy;
- physiotherapy procedures( electrophoresis with novocaine, ozocerite, ultrasound methods, use of diadynamic currents, etc.);
- massage, enhancing the functionality of muscle tissue;
- use of orthopedic prophylactic orthoses.
The main requirement for all treatment methods is that they should be applied before the biomechanical collapse of the head of the hip joint. The evidence of collapse is a symptom of a crescent moon, which can be identified during diagnosis.
Features of surgical methods of therapy
To determine which treatment should be prescribed, should a competent specialist. The choice of methods depends on how far the process of development of the disease has gone, from the age of a person and the characteristics of his organism. Today there are no drugs that can restore blood circulation in the damaged joint. In general, aseptic necrosis of the head of the femur is treated by surgical methods.
In the early stages, the main tasks of the operation are restoration of blood supply in articular tissues and elimination of stagnation of venous blood. If the 2nd stage of the disease is diagnosed, the surgical intervention tasks are as follows:
- to change the position of the head of the hip joint with respect to the acetabulum so as to eliminate the burden on the most affected part of the head;
- improve blood flow in the joint and reduce blood pressure inside the bone;
- to increase the mechanical strength of the affected parts of the head.
Several surgical methods are used to treat necrosis of the hip bone. Often shown to perform operations that restore blood flow in the joints:
- decompression of the focus of osteonecrosis;
- osteotomy( intervertebral and prone);
- unvascularized osseous plastic;
- Vascularized osseous plastic.
Osteonecrosis of the talus is treated with chondroplasty - surgery to replace the destroyed portion of the tibia. The tunneling method is also used( drilling of the affected area).
Endoprosthetics of the hip and knee joint are performed in 90% of patients with a diagnosis of "aseptic necrosis of the hip joint" if an operation is prescribed. This is the process of replacing a damaged joint with a transplant. With effective prosthetics, the patient's pain disappears and the amplitude of limb movement is fully restored. But there are some risks of complications and infection. In addition, if the surgeon incorrectly adjusted the prosthesis, he can quickly loose his tongue, and then a second operation is inevitable. With the correct operation, the implant replacement will take 12-15 years.
The main thing is to diagnose aseptic necrosis of the head of the hip joint or other joints as early as possible in order to do without surgical intervention. Conservative treatment, started in time and under the strict supervision of a specialist, gives good results. Any operation carries new problems and complications and requires a long rehabilitation.
A careless attitude towards one's health and untimely action in the presence of symptoms of a disease reduces the chances of recovery. It will take more effort and financial cost in order to restore the working capacity of the joints.
Necrosis of the head of the hip joint: treatment, consequences, operation
Aseptic necrosis is called necrosis, followed by destruction of the subchondral bone tissue, that is, located just below the articular cartilage. This site has good blood supply and innervation, which is the reason for its frequent defeat.
The hip joint is most commonly affected, in particular, the femoral head. More often men are young and middle-aged.
The disease almost always leads to a persistent and severe disability. That is why it is important to identify it in a timely manner and begin a full-fledged treatment.
As the name suggests, the pathological process does not involve an infectious agent, in contrast to septic bone necrosis.
The main reason for the formation of aseptic necrosis of the head of the femur( ANGBK) is a violation of blood circulation in this area. Such violations can occur as a result of:
- Injuries( bruise, fracture, etc.) of the hip joint.
- The use of steroid hormones, for example, corticosteroids for a long time.
- Prolonged and frequent use of alcohol.
- Actions of ionizing radiation.
- Presence of other diseases, for example, sickle cell anemia, etc.
There is also a theory of hereditary predisposition to the development of such pathology. This theory is based on congenital disorders of the metabolism( metabolism) of bone tissue, which can cause circulatory disorders in it. Therefore, under the influence of some provoking factors( for example, hypothermia, microtrauma, etc.), aseptic necrosis of the hip joint can develop in children.
How to identify ANGBC?
Most common are both hip joints. Even if the pathological process is initially unilateral, in almost 90% of cases, the second joint is affected for one or two years.
The main manifestation of ANGBC is pain. First, it worries only when making movements in it, for example, walking and extending to the entire lower limb. Subsequently, the pain is localized in the region of the hip joint, and can often spread to the knee.
Severity of pain increases during the progression of the disease.
Pathological processes occurring in the joint, eventually cause a limb shortening. Outwardly this is manifested by lameness and frequent disruption of the function of the entire leg. Due to the restriction of all movements in the affected lower limb, atrophy of the femoral and gluteal muscles arises. They decrease in size, "dry up".
Unfortunately, the early manifestations of ANGBC are not specific, which is the cause of diagnostic errors. Also, patients can ignore the discomfort and even pain in the hip joint. This clearly does not contribute to the identification of the disease in the early stages.
The main diagnostic methods are X-ray and magnetic-nuclear tomography( MRI).In the early stages of ANGBC, it is especially important to carry out MRI, because on radiographs it is not always possible to identify initial pathological changes.
According to the generally accepted classification, five stages of X-ray changes are distinguished with aseptic necrosis of the femoral head. The tactics of treatment are different for each of them. In addition, radioisotope scanning, ultrasonography, pressure measurement inside the bone, etc. are sometimes used, etc.
In the treatment of aseptic necrosis of the head of the femur, the early onset of it is very important. In this case, there is much more chance of success of therapy. All methods of treatment of ANGBC are divided into conservative and surgical.
Conservative treatment of
Such treatment often takes several years. An integrated approach to such therapy is used, which consists of several components. We will discuss them below.
The basis of conservative therapy is the mechanical prevention of deformity development of the head of the femur. To remove the load on it, the following methods are used:
- Bed rest.
- Different stretching techniques - cuff, adhesive tape, etc.
- Plaster casts and tires.
- Special orthopedic devices( Atlanta, SRH, MHE, etc.).
The type of discharge, as well as the duration of immobilization( fixation) of the joint is determined by the doctor in direct proportion to the degree of injury and progress in treatment. This type of treatment usually ranges from a few months to a year and a half. A combination of unloading with physiotherapy and physiotherapy is essential.
Overweight creates an additional burden on the hip joint. Therefore, it is necessary to achieve weight reduction in the body in such cases.
In the initial stages of ANGBC, medications are prescribed to improve microcirculation in the affected joint. This achieves a reduction in ischemia( bleeding) in the affected areas of the bone, as well as a decrease in blood viscosity and the tendency to excessive thrombosis.
To this end, various vasodilators are used - nose-pa, nicotinic acid, etc. Antiplatelet agents - dipyridamole and pentoxifylline - have been widely used.
It is mandatory to prescribe drugs that correct phosphoric-calcium metabolism. To this end, it is prescribed, for example, preparations of etidronic acid in combination with preparations of vitamin D and calcium.
To stimulate the regeneration( recovery) of bone tissue, various biogenic stimulants are used, for example, the vitreous in combination with vitamins of group B. Chondroprotectors are prescribed to improve the condition of articular cartilage.
It is used in practically all patients with ANHBK in combination with other methods of treatment.
Electrophoresis with various drugs is usually used. For example, electrophoresis with procaine or lidocaine can significantly reduce pain. Affects the area of the affected hip, lower thoracic and upper lumbar spine.
The treatment of UHF, magnetic and laser therapy, electromyostimulation, etc. is also prescribed. Procedures are applied for the massage of the lumbar region and the affected limb.
As the pathological manifestations abate, treatment is carried out in specialized balneological and mud cure sanatoriums. It is obligatory to conduct exercises of therapeutic physical training - exercise therapy. This is worth considering in more detail.
Therapeutic physical training
is prescribed from the moment of diagnosis. The complex of exercises is developed strictly individually for each patient, taking into account the degree of defeat of the head of the femur.
LFK exercises are conducted daily under the guidance of a certified instructor. The ultimate goal of such exercises is to restore the normal volume of movements in the affected hip joint. And also - prevention of contractures( stiffness) in other limb joints.
According to statistics, approximately 5-15% of ANGBC patients are performed. The main indication for the operation is the apparent ineffectiveness of conservative treatment and the progression of the disease with the development of complications.
However, at present, given the variety of methods of surgical treatment of ANGBC, some operations are carried out in conjunction with conservative therapy and are in addition to it.
To date, there are several types of operations that are used for aseptic necrosis of the head of the femur. The choice of a specific type of surgery is determined by the doctor, taking into account all indications and contraindications to such treatment.
Decompression of femoral head
Another name for this operation is tunnelization. It is used in severe pain syndrome to reduce intraosseous pressure.
The principle of the operation is to drill one or more channels in the femoral head with a special tool. Often this procedure is combined with the maintenance of bone preparations that improve blood circulation.
Transplantation of an autograft from the fibula is a technically complicated operation. Its essence consists in transplanting a part of the fibular bone of the patient together with the vessel. This provides two effects at once: strengthening the affected bone tissue of the femur and improving its blood supply.
Unfortunately, sometimes thrombi appear in the transplanted vessel, which makes such an operation ineffective.
There are many varieties of this operation with ANGBC.Interstitial osteotomy is most commonly used. At the same time, a part of the femur is excised at the level of its skewers. In the new position, the bone is fixed by various devices - screws, plates, etc.
After this operation, the area of articular surfaces increases, and the focus of necrosis is shifted to the less loaded zone of the joint. This allows you to create conditions for its regeneration( recovery).
The essence of the operation is to create new articular surfaces in the hip joint. The principle of such an operation depends on the type and area of the pathological changes that have occurred.
The aim of such an operation is to increase the normal volume of movements in the hip joint, reduce lameness and intensity of pain.
Most often performed in patients who for some reason are contraindicated endoprosthetics. The essence of such an operation is the creation of artificial immobility( adhesion) of the joint in order to eliminate the expressed pain syndrome.
After removal of the affected bone tissue in the joint, the femoral head is tightly aligned with the acetabulum and in this position is fixed with screws, rods or other devices.
Arthrodesis is used in a small number of patients. It is a "crippling" operation, since later on such patients develop an obvious skewing of the pelvis and curvature of the lumbar spine sideways with the corresponding neurological symptoms.
Endoprosthetics of the femoral head
The most commonly used in the later stages of ANGBC.Especially shown with the development of its complications, for example, osteoarthrosis. Is, perhaps, the most common operation in this pathology.
When performing such surgery, the head of the femur is replaced( prosthetically).The prosthesis is made of materials that are fully compatible with human tissues - titanium, zirconium, etc.
After a successful operation, the volume of normal movements in the joint is restored and the pain syndrome is eliminated.
Consequences of aseptic necrosis
With timely diagnosis and treatment initiated, it is possible to achieve a significant improvement in the patient's condition even in the early stages of the disease. And the younger the patient, the greater the likelihood of almost complete cure.
Progression of the disease significantly worsens the quality of life of the patient and usually leads to disability due to the development of deforming osteoarthritis of the hip joint( coxarthrosis).This complication is characterized by the development of contractures( stiffness) in the joint. And in combination with a fairly pronounced pain syndrome, it significantly complicates the life of a sick person.
That's why do not ignore even minor discomfort in the joints and immediately seek medical help.
Aseptic necrosis of the head of the femur.
Aseptic necrosis of the head of the femur is a very serious disease of the hip joint. It is the necrosis of the bone tissue of the femoral head. The necrosis occurs due to impaired blood circulation in the head of the femur.
Normally, bones always break down and regenerate bone blocks. When the blood flow is disturbed, inflow of oxygen and nutrients is disturbed. This causes disturbances in the recovery processes and their complete cessation. Bone tissue of the femoral head begins to degrade. Its mechanical properties gradually decrease. Under the influence of the load on the joint, the bone collapses( collapses) in places of necrotic areas. Over time, the head of the femur is flattened. Normal joint work is difficult. At the final stage of aseptic necrosis of the femoral head develops osteoarthrosis of the hip joint.
Causes of aseptic bone necrosis
The main factors contributing to the development of aseptic necrosis of the femoral head include:
- Injuries of the hip joint( hip fracture, hip dislocation, etc.);
- Systematic small microtraumas and hip joint overloads( usually in athletes);
- Effects of drugs( cytostatics, certain antibiotics and hormonal drugs for prolonged use);
- Alcohol abuse;
- Some diseases( systemic lupus erythematosus, Bechterew's disease, osteopenia, osteoporosis, rheumatoid arthritis, etc.);
- Diseases accompanied by endothelial dysfunction( colds, inflammations).
- Exposure to high pressure( from divers, miners).With improper decompression in the blood can form air bubbles, causing a blockage of blood vessels.
Stages of development of aseptic necrosis of the femoral head
I stage ( 6 months).The structure of the bone is changed insignificantly - no more than 10% is affected. Movement in the joint is not limited. Periodic pains arise that radiate into the inguinal region.
II stage ( 6 months).The stage of impression fracture. Cracks are observed on the surface of the femoral head. Foci of microcollapse or a crack in the trabecula zone are visible. It is struck 10-30%.Limited mobility of the joint( withdrawal and rotation).The pain is strong, permanent, irradiruyut in the groin.
III stage ( 3-6 months).Secondary arthrosis develops, the acetabulum is involved in the pathological process. The defeat of tissue increases to 30-50%.The mobility of the joint is sharply reduced. At this stage, the pain in the joint is strong and permanent.
IV stage .Complete destruction of the head of the femur. Constant pains in the region of the hip joint, muscles of the thigh and buttocks are atrophied, movements in the joint are minimal. The vicious thigh settings are formed.
Symptoms of aseptic bone necrosis
The main symptom is the pain in the hip joint area that occurs when walking, standing on a "sick" leg. With the development of aseptic necrosis, lameness appears, the mobility of the joint is impaired. In the late stages of pain is constant.
Diagnosis of the head of the hip joint
To verify the diagnosis, use an X-ray. But it allows you to accurately distinguish changes only if the duration of the disease is long enough. Most often, a magnetic resonance imaging( MRI) is used to diagnose aseptic necrosis. It allows you to detect even the smallest changes in the early stages of necrosis of the head of the femur.
Treatment of femoral head necrosis
The choice of method of treatment depends on the specific case. Depending on the stage of the disease, age and other physiological characteristics of the patient. To date, there are no drugs that can restore blood flow in the head of the hip. Most often, with aseptic necrosis of the head of the femur, surgical methods of treatment are used.
Surgical treatment is of several types:
1. Operations to restore blood flow.
- Femoral decompression. Through the neck of the hip, one or more channels are drilled into the head, where the blood flow is disturbed. Inside the canal, vessels begin to grow, which improves blood flow. The second positive effect is a decrease in intraosseous pressure and a reduction in pain in the joint.
- Transplantation of an autograft from the fibula. Unlike the first operation, a segment of the fibula on the vascular pedicle is transplanted into the drilled hole. The transplant improves blood flow and strengthens the neck of the hip. This is a very complex and rare operation.
2. Endoprosthetics. Endoprosthetics is used in the late stages of necrosis of the head of the hip joint. A defective joint is replaced by a mechanical structure.
Stages of development of necrosis of the hip joint
Aseptic necrosis of the hip joint, i.e.occurring not through the fault of infection, is often also called avascular necrosis or a heart attack of the femur. This disease is due to a violation of blood flow, resulting in some parts of the bone marrow begin to break down. According to statistics, two-thirds of patients are young people under the age of 45, mostly men, who have an incidence of 7 times more often than women. In addition, in 60% of cases, the lesion is localized in one leg, and in 40% - spreads immediately to both, which requires skilled and immediate treatment.
Stages of development of necrosis of the head of the hip
The main danger of the disease lies in its suddenness, and the development of some symptoms is possible in just a few weeks. And in the presence of concomitant pathologies of the vascular system, pathological processes can proceed even faster. If with coxarthrosis atrophy of the femoral muscles develops in a few years, then with necrosis it takes quite a few months, or even weeks, and the appearance of motor limitation occurs in the first days of the disease.
Symptomatic aseptic necrosis is very difficult to distinguish from arthrosis, although the main sign of the first is the suddenness and rapid progression of the ailment, which occurs not that weeks, but even days.
Usually, there are four stages of development of the disease with characteristic symptoms:
- in the first stage is affected to 10% of bone tissue, and the patient does not feel any motor limitations, although sometimes light short-term pains are given in the groin;
- , the second stage is characterized by the appearance of constant pain in the joint and groin area, which is caused by the appearance of cracks on the head of the bone, and since 10-30% of the tissue is already affected, the first signs of motor limitation appear;
- in the third stage( up to 50% of the bone is affected), the acetabulum is already involved in the pathological process, and secondary arthrosis, strong persistent pain and the inability to walk for a long time are characteristic;
- the fourth stage assumes almost complete absence of movements, which is caused not only by destruction of the head of the femur, but also atrophy of the gluteal and femoral muscles.
In addition, the patient has a shortening of the aching leg, which causes lameness. But in rare cases( less than 10%), when the disease takes a very severe form, limb lengthening is possible.
Medical treatment of aseptic necrosis of the hip joint
Almost at all stages of necrosis treatment is the same, and only the degree of physical activity and dosage of drugs are chosen. Drug therapy usually provides courses of such medications:
- NSAIDs - have a good analgesic and anti-inflammatory effect, but do not treat necrosis;
- vasodilators - are mandatory in all cases, since they eliminate the main cause of necrosis and eliminate stagnation of blood circulation( hypertensive patients during this course are recommended to lower the dosage of drugs that lower blood pressure);
- complexes stimulating the generation of bone tissue - calcitonins and vitamin D - reduce the amount of calcium in the blood, contributing to its entry into the bone tissue;
- chondroprotectors are usually prescribed in stage III of the disease, and contribute to the restoration of the joint tissue.
The course of chondroprotectors usually lasts from 3 months to 3 years, but such treatment is very effective.
Additional medical measures
However, it is impossible to cure with tablets alone, so doctors recommend to resort to such additional procedures:
- hirudotherapy - helps to strengthen immunity and remove from the affected organs stagnant blood;
- therapeutic massage - improves microcirculation of blood, and also relieves spasms, however there are a lot of contraindications to its use with necrosis, and it is important to familiarize with them;
- physiotherapy - is considered not very effective due to the deep anatomical location of the hip joint, but still apply such procedures - laser therapy, paraffin and mud therapy;
- decompression of the head of the bone, which helps reduce intraosseous pressure, and, as a result, pain syndrome.
In rare cases, if necrosis of the joint is caused by a pinch, manual therapy may be indicated. However, all the same without medical treatment, these measures will not help to cope with necrosis, and sometimes not without surgical intervention, and endoprosthetics, in particular.
Treatment of avascular necrosis of the hip
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What causes avascular necrosis of the hip joint?
Avascular necrosis occurs when blood flow to the bone is interrupted. Loss of blood flow can be the result of joint trauma, constricted or blocked blood vessels( from fat or sickle cell anemia), or from excessive pressure inside the bone( caused by conditions such as Legg-Calve-Perthes disease or Gaucher's disease).
What is it that is felt during avascular necrosis of the hip joint?
Avascular necrosis is characterized by constant pain and stiffness in the affected joint, as well as a reduced range of motion.
When the bones of the hip joint die, the pain extends from the hip joint in the groin, down the thigh, and into the knee.
In some cases, the symptoms develop slowly, for several months. However, the symptoms may appear suddenly after an injury. Some patients do not experience any symptoms at all.
How do I know if I have a medical condition?
The physician may prescribe a visualization examination such as X-ray, magnetic resonance imaging( MRI), or bone scanning to examine necrotic bone and determine the diagnosis.
How is avascular necrosis of the hip treated?
The treatment that you will receive depends on the amount of bone loss you have already suffered and the methods of treatment are aimed at preventing further loss of bone mass. Treatment can consist of a combination of drugs, therapy and surgical procedures.
- Medications. Anti-inflammatory drugs such as aspirin or ibuprofen are often prescribed to alleviate the pain and inflammation commonly associated with avascular necrosis. In addition, biophosphates, or preparations against osteoporosis, are often prescribed to slow the progression of the disease.
- Physiotherapy. Physiotherapy exercises can help improve the range of motion in the affected joint. Meanwhile, the restriction of certain physical actions leads to a decrease in weight pressure on the bone, reducing symptoms.
- Surgery .As a rule, progressive cases of avascular necrosis require surgical intervention. The most common procedures are: Internal decompression. During this procedure, part of the inner layer of the bone is removed. This helps reduce pain symptoms by reducing the pressure inside the bone. Thanks to the new space, the bone has a place for the formation of new blood vessels, which stimulate the growth of a new bone. Bone transplantation. In a bone graft, a healthy bone is transplanted from another part of the body to the area affected by avascular necrosis. This procedure is often carried out in conjunction with internal decompression. Osteotomy. This bone reshaping operation reduces the amount of load on the area affected by avascular necrosis. Recovery may take up to a year. Total hip replacement. This operation is performed if other methods of treatment do not work, or if the diseased bone is already destroyed. The operation for the total replacement of the hip joint replaces your joint with an artificial one. Recovery may take several months, and requires the patient to know how to use the new joint.
If surgical intervention is necessary, you and your doctor will work together to determine which method is best for you.© Authors and Reviewers: Editorial team of the health portal "On health!".All rights reserved.
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Treatment of Aseptic necrosis of the femoral head should be complex and differentiated depending on the stage and clinical manifestation of the disease, and the disease prognosis depends on the early diagnosis of the disease, the prevalence of osteonecrosis and adequate treatment tactics. The possibility of bilateral hip joint damage in most patients should be considered.
Despite the success of surgical treatment( overturned rotational osteotomy, the prevention of collapse of the femoral head in 95% of cases, developed by Sugioka( Japan), subchondral autoplasty of the femoral head, proposed by Imamaliev AS, Zorya MV), ANGBC is primarilythe problem of outpatient orthopedics. Duration of the disease( from 1.5 to 2 years), requires the doctor and patient to have a lot of patience and perform the necessary complex of medical rehabilitation, taking into account the staged nature of the process and the orthopedic situation. Complete restoration of the joint usually does not occur( we observed single cases of complete restoration of bone structure without head collapse in patients with central necrosis of the femoral head).However, in most cases, it is possible to achieve a completely acceptable outcome of the disease: preventing the contralateral joint injury;reduction of destructive processes in the head of the thigh and secondary coxarthrosis;pendulous thigh settings in the position of flexion, reduction and excessive rotation;minimum limitation of the volume of movements in the hip joint;a good functional state of the muscles and a poorly expressed pain syndrome. Since we did not meet in the literature the temporal characteristics of the duration of each stage of the disease, we indicate them below on the basis of our own observations( Table 5).
The complex of medical rehabilitation for Aseptic necrosis of the head of the femur includes:
Adherence to the optimal orthopedic regimen and therapeutic gymnastics;
Decompression tunneling and prolonged intraosseous blockades;
Intra-articular injection therapy;
Correction of walking, including with the use of multichannel electromyostimulation;
Physiotherapy( EHF therapy, laser therapy, magnetotherapy).