Aseptic necrosis of the femoral headThe disease, called aseptic necrosis of the femoral head, occurs quite often. Women suffer from them several times less often than men. It is characteristic that 2/3 of the patients are young people 20-45 years old. It is a rapidly progressing disease.
In the absence of proper treatment threatens with violation of the functions of the joint and, as a result, disability.
That's why it's important not to miss the first symptoms of the disease.
The main causes of the disease
The head of the femur is a closed compartment that is sensitive to circulatory disorders that alter the architectonics of the bone.
Blood supply to the head is through three small arteries. When one of them stops( violates) the supply of blood, necrosis( ischemia, necrosis) occurs in the area of the head that was supplied by the damaged artery.
The essence of asthenic necrosis is a violation of microcirculation and further necrosis of the bone tissue zone in the head of the hip bone. As a result, the integrity of the cartilage covering this area is disturbed and a secondary deforming arthrosis develops.
Vascular causes of
Common causes of discontinuance of artery supply with blood from the head of the hip bone:
- compression or twisting of the artery in trauma,
- its occlusion by small thrombus,
- venous congestion,
- prolonged vasospasm,
- increase in blood viscosity,
- disturbed venous outflow.
Vascular disorders increase intraosseous pressure, resulting in mechanical destruction of bone tissue.
About the mechanical theory of
The "mechanical" theory supplements the vascular theory of causes. According to her, the head of the femur undergoes "fatigue".
Impulses about this are sent to the cerebral cortex.
Back signals lead to spasm of blood vessels or stagnation of blood, disruption of metabolic processes, accumulation of decomposition substances in bone.
As a result, the physico-chemical and structural properties of the bone change, which is gradually destroyed with difficulty in local blood circulation.
Exchange disorders and pathological conditions
Among them leads as the causes of the ailment:
- long-term use of alcoholic beverages;
- long-term use of corticosteroids in high doses;patients with arthritis or bronchial asthma take corticosteroid hormones for a long time( metipred, prednisolone, etc.);
- chronic pancreatitis;
- high doses of radiation irradiation;
- caisson disease;
- sickle-cell anemia and other diseases,
- injury( bruised thigh, hip dislocation, hip bone fracture, etc.).
One of the causes of the ailment is a congenital defect in the form of a hip dislocation( hip dysplasia).
Symptomatics and Diagnosis of
Disease stages of aseptic necrosis of the head of the hip joint with distinctive symptoms:
- Initial. Pain serves as a starting clinical manifestation. It grows to the maximum and becomes intolerable in the first two or three days. Usually appears in the groin, less often in the thigh, knee joint, lower back. The joint fully retains its mobility.
- The second is an impression fracture. At the patient constant strong pains in a joint even in rest. During the period from several days to six months, vascular disorders develop. Possible atrophy of the muscles of the thigh. The aching leg seems to decrease in volume. Movement is limited. Lightness is noted in the gait.
- The third is a secondary arthrosis. For 6-8 months, the bone beams are destroyed, the femoral head is deformed. In the joint, severe pain is noted. Movement is limited in three directions. When walking, there is a starting pain, an average limp, a desire for support.
- Fourth .When the disease lasts more than 8 months, there is complete destruction of the head. Constant pains in the joints of the hip and knee, in the lower back. Movement is severely limited. Atrophy of the muscles of the buttocks and thighs is strongly pronounced. The aching leg becomes shorter, according to a more severe variant, it lengthens.
The widely used methods for diagnosis of include:
- MRI .The early stage is detected by magnetic resonance imaging or computed tomography. This method of diagnosis almost 100% reveals the disease, when the X-ray does not "see" it. Therefore, during the first weeks of the disease, diagnosis with MRI is a priority.
- Radiography .Aseptic necrosis on the X-ray is made visible only in 2-3 stages of the disease. When the disease has an "experience" of more than a year, its signs are very clearly manifested in the pictures. At this stage, the tomogram is not needed.
- Radioisotope scanning .This method shows the unequal absorption of the radioactive preparation by pathological and normal bone tissues. The administered dose of the drug serves as a "mark" for the abnormal zone in the bone. The result is a two-dimensional image where the affected areas of the bone are visible.
X-ray patterns of patients with different stages of aseptic necrosis of the femoral head: from a - the initial stage, to d - complete destruction of the bone.
Treatment and pain relief with conservative methods
The main groups of medicines used to treat the disease include:
- Anti-inflammatory non-steroid preparations , for example, diclofenac, indometacin, piroxicam, butadione, etc. They contribute to reducing pain in the thighand groin. This group of drugs does not cure the disease. But due to anesthetic action, prevention of reflex spasm of muscles occurs with pain. These drugs are especially effective in the first six months of the disease.
- Drug vasodilator , for example, trental, theonikor. They eliminate stagnation in the circulation. As a result, the arterial blood flow is activated and the spasms of small vessels are removed. Decreased vascular night pains in the affected joint. Effective in the first 6-8 months of ailment.
- Bone Restorers .To stimulate the recovery process help with vitamin D( calcium D3 fort, oxide oxidation, napokal D3, etc.).These drugs contribute to the accumulation of calcium in the head of the affected bone of the thigh.
- Calcitonins effectively stimulate bone formation and eliminate bone pain. These include miacalcic, sibacalcin, alostin, and others.
- Chondroprotectors ( chondroitin sulfate and glucosamine) provide cartilaginous tissue and restore the structure of the destroyed cartilage. Treatment gives an effect in the period of the disease from 8 months.
Therapeutic gymnastics and massageOne of the most important treatments for necrosis of the femoral head is the therapeutic gymnastics .Without it, it is impossible to overcome the progressive deterioration of blood circulation in the region of the femoral head and the growing atrophy of the hip muscles.
It is necessary to choose exercises to strengthen the muscles and ligaments of the sore leg. And there should be no pressure on the head of the hip bone without active flexion-extension of the legs.
An example of a static exercise is a small lifting of a straight leg in a position on the back of a prone. The leg is supported by weight. There will be fatigue, although the joints do not work. A set of exercises should be carefully thought through with the doctor.
Therapeutic massage is used as an additional method of treatment. But if you do it correctly, without rough pressure, it will bring real benefits. With massage of the femoral muscles and back, blood circulation improves.Pains in the hip joint can talk about the development of arthrosis. How to properly treat coxarthrosis read in our stelye. Chto do, if you have a suspicion of deforming arthrosis of the ankle joint? The measures that need to be taken first look here.
Orthopedic rulesIt is very important to observe the orthopedic regime. Many experts oppose the prolonged use of crutches and bed rest at the onset of the disease.
In their opinion, this threatens:
- progressive muscle hypertrophy,
- by the formation of pain resistant syndrome,
- by violation of motor stereotypes.
For to facilitate the flow and reduce the duration of the disease you need:
- walking up to 20 min.average pace,
- walking up the steps,
- exercise on the stationary bike,
- using canes in the first weeks and with long walks,
- fighting overweight.
It is necessary to exclude inertial loads on the joint in the form of lifting weights, jumps, jogging.
Surgical treatment of the disease
Surgical intervention is resorted to when conservative drugs are ineffective.
Decompression of the femoral head
The operational method of decompression is to drill a channel into the femoral head region with no blood flow. The drill passes along a large trochanter and neck of the hip bone.
- increase in blood supply of this area due to the growth of new vessels in the formed channel( puncture),
- decrease in intraosseous pressure in the head of the thigh.
By reducing the pressure in 70% of patients reduce pain.
Transplant of autograft from fibula
Unlike decompression, a fragment of fibula, located on the vascular pedicle, is transplanted into the drilled cavity. Such a transplant from your own body gives an improvement in blood flow and strengthening of the neck of the thigh.
Endoprosthetics of the hip joint
It consists in the complete replacement of the damaged hip joint by an artificial one. A titanium pin( or zirconium) with an artificial head on the edge of the joint is inserted into the formed cavity of the hip bone and fixed.
Simultaneously, the second articulating part of the joint is operated, inserting a concave bed to rotate a new head in it. Correctly done surgery removes pain and restores joint mobility.The timely and well-conducted treatment of the head of the hip joint in most patients gives an improvement in the course of several months of therapy.
In another part of the patients the condition stabilizes, which does not bring them to surgical measures.
Video: What systemic diseases can provoke the development of necrosis of the GDK
Treatment of ANGBK( aseptic necrosis of the femoral head) in the Orthopedics clinic in Moscow
Special attention in the Orthopedics clinic in Moscow is given to the treatment of aseptic necrosis of the bones of the femoral head. The specialists of the institution have accumulated unique experience in combating this disease and offer conservative methods of recovery.Effective methods of sutava treatment. We improve blood supply and nutrition of joints. We advise free of charge when treating us
Perthes disease what is it?
Hip joint infarction( also called Perthes disease( Legga-Calvet) or avascular necrosis of the head of the femur) - hip joint damage, which is associated with impaired blood flow in the head of the thigh and a deterioration in the nutrition of its cartilage, usually leading to necrosis.
The photo shows a joint with Perthes disease.
Symptoms of ANGBK
The following symptoms are seen with aseptic necrosis of the femoral head:
- Soft tissue atrophy on the aching leg is manifested.
- Pain localized in the area of the affected joint. As a rule, it arises very sharply, it can give to the knee, the lumbosacral and the inguinal region.
- The functionality of the joint is reduced.
- Transfer part of the load to a healthy leg.
It is worth noting that ANGBC is not an age-related disease and in case of the first symptoms of Perthes disease in children, it is necessary to urgently consult a doctor.
Perthes disease stages
Four main stages of the disease are distinguished:
Aseptic necrosis of the femoral head |femurhead.ru
Aseptic necrosis of the head of the femur is a serious degenerative-dystrophic bone disease due to a violation of the structure of bone tissue, microcirculation and fatty degeneration of the bone marrow.
There are 4 stages in its development:
- I stage - the patient does not yet know about the onset of the disease. Microscopic changes in bone structure are not detected by all diagnostic methods. A subchondral osteonecrosis develops, in which the spongy substance of the femoral head is affected with unchanged cartilage. The zone of structural changes is no more than 10%.
- II stage - perhaps a feeling of slight discomfort in the affected area. There is an impression fracture, in which the surface of the head of the femur has cracks like a "cracked shell".In the loading zone, trabeculae, thin bone plates, have irregularly formed cracks or microcollapse foci. The zone of structural changes is no more than 10-30%.
- III stage - when moving there are pains that do not disappear at rest. This is the stage of fragmentation, which is characterized by uneven contours of the head of the femur, a slight degree of collapse, the emergence of several foci of compaction or cystic degeneration. The articular space narrows or expands. The zone of structural changes is no more than 30-50%.
- IV stage - acute pain even in the lying position, the joint is devoid of functionality. There is a dislocation or subluxation. The head is completely destroyed. The structure of the trabeculae is dissolved or compacted, irregularly shaped cracks. Internal or external edges of the acetabulum are displaced. The articular space is narrowed or has disappeared. The zone of structural changes is 50-80%.
According to the observations conducted in our center, we noted the duration of each stage: the first stage lasts 6 months, the second stage - 6 months, the third stage - 3-6 months with the subsequent transition to the IV stage.
ANGBK is caused by various factors. If you are exposed to one of the listed effects, you are at risk:
- Diseases( osteopenia, osteoporosis, lupus erythematosus, Bechterew's disease, rheumatoid arthritis, sickle cell anemia, ischemic heart disease, hypertension, hypercholesterolemia, osteosynthesis,screws, etc.);
- The toxic effect of such drugs as glucocorticoids, steroids and cytotoxic agents, antibiotics;Alcohol intoxication, smoking.
We have compiled a detailed description of the symptoms of ANGMK in order to disseminate information to as many of our readers as possible, because the sooner you contact our center, the sooner we can help. People who are at risk should also know and undergo ANGBC diagnosis, which allows to identify the disease in the preclinical stage and, thus, prevent serious cases of the disease.
Symptoms of aseptic necrosis of the femoral head
At this time, aseptic necrosis of the head of the femur is a fairly common disease. This is due to a significant change in lifestyle and nutrition. Also, the expansion of the diagnostic capabilities of modern equipment( MRI, CT, heart function analyzer) allows us to identify the early stages of ANGBC, which previously could not be diagnosed. In modern conditions, it is necessary to inform the population about the symptoms of ANGBC, which is at risk.
As a rule, the doctor only calls for stage III or IV of the disease, when to improve the patient's condition, it will take much more effort and time than when seeking help at the initial stage.
Be attentive to your joints and consult a doctor immediately if you find the following symptoms of aseptic necrosis:
- You have a short, episodic pain in the hip joint region, the groin area. The pain can irradiate into the knee, sacrum, waist.
- Appearance of "starting" pain at the beginning of movement, lifting from the bed.
In the future, the symptoms appear avalanche-like:
- You feel a constant pain in the hip joint area. The pain does not leave you in a state of movement: when walking, squatting or climbing and practically does not leave you even at rest. In especially severe cases, pain does not even allow you to fall asleep.
- It is difficult for you to step on the aching leg, as a result, there is lameness.
- The leg loses its mobility: it is difficult to bend it or move it to the side.
- On the aching leg muscle is atrophied quite quickly, which creates the effect of losing weight limbs separately from the rest of the body.
- If the body is lying flat, you can see that the sick leg has become shorter than the healthy leg.
If you observe the described symptoms of ANGBC, do not self-medicate and wait until the disease reaches its climax - the joint will change its shape, movement will become possible only with additional support, help from other people. Contact our Center, and we will conduct a professional diagnosis that will identify the stage of the disease, we will select individual treatment and give hope for the restoration of the joint.
Early diagnosis of aseptic necrosis of the head of the femur - the ability to prevent serious disease
A doctor's appointment with aseptic necrosis usually occurs already in the late stages, when pain is present and the limb functionality is reduced. The first stages often go unnoticed, which is why our specialists carry out an extensive examination to identify early stages of aseptic necrosis of the femoral head with the slightest discomfort in the hip.
To date, the advanced approach is a comprehensive diagnosis. We disseminate information about the causes of the occurrence of ANGBC and suggest that patients at risk should undergo a preventive comprehensive examination aimed at preventing the development of the disease and providing treatment at the initial stage. The components of the complex diagnostics are: examination on the Scriphax screening analyzer, review radiography with the subsequent study of the images in the Analiser + program, ultrasound densitometry, x-ray dual-energy densitometry, three-phase soft tissue and skeleton scintigraphy, study of microcirculation at the hip joint locilocalization), traditional and in-depth studies of blood and urine.
Basic diagnostic methods for ANGBK
Diagnosis of aseptic necrosis of the femoral head includes the following most common methods:
- Radiographic survey of pelvic bones in three projections( on the back, on the abdomen, laying on Launstein).This is the oldest, most common method.
- Magnetic resonance imaging. This method allows to see the appearance of aseptic necrosis in the initial stages( edema of the bone marrow).
- Three-phase scintigraphy of soft tissues and the skeleton serves to assess blood flow, changes in bone tissue and to exclude the presence of malignant formations or metastasis.
Additional diagnostic methods of ANGBK
After the initial determination of the patient's condition, the problem arises of choosing the necessary method of treatment, and the following diagnostic methods are required:
- X-ray dual-energy densitometry of the femoral head allows to determine the density of bone tissue. This is especially true for patients taking glucocorticoids or suffering from a decrease in the function of the sexual glands.
- Ultrasonic densitometry serves to determine the state of bone tissue in terms of the velocity of ultrasonic waves passing through it and the degree of their absorption by tissue. The method is absolutely safe, since it has no radiation effect on the body.
- The processing of X-ray images in the "Analizer +" program gives an opportunity to see the initial signs of the disease, when the changes in the bone tissue are just beginning.
- Express diagnostics of diseases and changes in internal organs at the screening analyzer "Screening" The basis for the theory of information function of the heart and technology for the analysis of electrocardiograms, allows to identify diseases that can affect the development of joint diseases. Thus, it is possible to identify coronary heart disease, hypertension, diabetes mellitus, cholelithiasis, urolithiasis and peptic ulcer disease, chronic gastritis( gastroduodenitis), chronic cholecystitis and latent oncological processes. The special value of the diagnostic system "Screening" - in the possibility of detecting hidden processes of cell degeneration in the patient's body, and indicating their localization. In our Center, a special signal was also identified, which corresponds to ANGBC at the preclinical stage.
- Traditional and in-depth blood tests give an idea of the overall health and associated diseases: a general blood test with a leukocyte formula;determination of the blood group and Rh factor, "hospital complex";biochemical blood test and determination of the level of creatinine, total cholesterol, LDL, HDL, VLDL and glucose;complex blood test for the content of vitamin D and metabolites of vitamin D, total and ionized calcium( Ca ++), magnesium, inorganic phosphorus, anti-streptolysin-O( ASLO), C-reactive protein, rheumatoid factor, uric acid, homocysteine, procalcitonin, parathyroid hormone, calcitonin, osteocalcitonin B-cross laps, prothrombin time, prothrombin index;serological examination of blood for the detection of antigens and antibodies to chlamydia, mycoplasmas, ureaplasmas, toxoplasma, cytomegalovirus, herpes simplex virus, Epstein-Barr virus, systemic lupus erythematosus, genetic determinants.
- Urinalysis provides an additional study of the concentration of calcium in daily urine and DPID in a single urine.
Non-surgical method for the treatment of aseptic necrosis of the femoral head
We use a unique non-surgical method based on progressive discoveries in the field of medicine. Not so long ago, a unique feature of the bone was discovered, thanks to which it is the only organ, if damaged, replacing its defects with a non-connective-woven scar, and with a new full bone tissue. It has also been found that the head of the femur has a great capacity for regeneration and plasticity. In addition, in their medical practices, we rely on Wolff's law, according to which a change in the functional load on the bone causes its internal restructuring, which is adaptive in nature. This means that the bone is able to recover without surgery with properly organized treatment, thus, it is possible to restore the functionality of the joint.
The treatment activities at our center include the following:
- Redistribution of the load from the necrosis-affected sector of the GAB and compliance with the orthopedic regime with crutches. Reducing the load makes it possible not to injure the site affected by necrosis, and to start recovery processes in bone tissue.
- Ingestion of medications. Medicines for each patient are selected individually, according to the peculiarities of his condition.
- Electrostimulation of acupuncture points via phytoapplicators using therapeutic apparatus NS-5, Osteon-1.Therapeutic apparatuses have two electrodes that supply an electrical signal with a predetermined frequency and amplitude, providing compensation for the deficit of the external load. The device for the treatment of necrosis of the head of the femur is a medical device specially designed for the complex treatment of this disease. Due to modern technical design, the device creates various electrical signals - low-frequency pulses and six types of special frequencies of medium frequency. At the same time, through the acupuncture points, active ingredients from the skin applicators are passed into the human body, which pass through the skin and reach the locus of the disease, carrying out the original treatment.
- Segmental and periosteal massage. Individual parts of the body are massaged, and also point impact on certain parts of the bone.
- Fitovannye at a temperature of 37-38 ° C.They serve as a fortifying and beneficial agent for the nervous system.
- Daily exercise sessions. Exercises are conducted according to the author's method and are selected individually.
An internal electrochemical environment is created in the head of the femur in the process of treatment of ANGBC, which contributes to the restoration of impaired microcirculation and the active removal of metabolic products of the diseased tissues, stimulates the division and differentiation of bone cells gradually replacing the bone defect. All the needs of the joint in the necessary mineral and nutrients for the regeneration of bone tissue are satisfied by their constant inflow through the skin, provided with the help of special devices and applicators with biologically active substances, and also by ingesting highly effective drugs and full nutrition.
Already in the first stages of therapy, the patient notes improvement in overall health, loss of pain and increased movement in the hip joint. The first successes inspire optimism and give the necessary positive impulse to recovery. Gradual restoration of the joint, its adaptation to the load, improvement of the motor function contribute to the return of the normal gait and the former muscle strength, the social activation of the patient.
The effectiveness of treatment is assessed by the disappearance of subjective symptoms of the disease and by objective research methods. Every three months, a control radiograph of the hip joint and an analysis of changes in the structure of the head of the femur are carried out. If necessary, blood and urine tests are also performed to assess the dynamics of mineral, carbohydrate, fat metabolism, bone formation and resorption parameters.
It is not yet clear whether pathogens of these diseases provoke the development of a heart attack, whether the reason is the adoption of antibiotics and hormonal drugs, which are often prescribed in the treatment of these diseases.
An undoubted factor in the development of aseptic necrosis is any disorder in the circulation. That is why there is a risk for its occurrence in everyone who suffers from cardiovascular diseases( for example, who have suffered a stroke and myocardial infarction), as well as divers, miners and climbers who experience sharp changes in atmospheric pressure during their work.
Manifestations at different stages of
The first stage of aseptic necrosis is characterized by a pronounced pain symptom
. Specialists distinguish five stages of development of aseptic bone marrow infarction and / or bone marrow:
|Stage||Symptoms of Avascular or Aseptic Necrosis||Diagnosis of Avascular or Aseptic Necrosis|
|Stage 1||10%||Aseptic infarction has non-vaguely expressed symptoms: it is usually manifested by restriction of movements, as well as pains in the hip, with a return to the groin or kneejoint.||X-ray examination does not give any definite results, since the head of the femur did not change its shape and bone structure.|
|2nd stage||30%||Symptoms become more pronounced: pain intensifies after physical exertion, but does not pass at rest. There may be swelling. The thigh of the sore leg becomes smaller.||X-ray signs are quite pronounced. The picture will show multiple microscopic fractures of the femoral head, as well as necrosis of the spongy substance of the head and its bone marrow. It becomes noticeable homogeneous darkening of the head of the femur.|
|3 stage||50%||The pain manifests itself at the slightest load, and there is a pronounced lameness. Swelling becomes more. To the symptom of muscle atrophy, atrophy of the calf muscle is added.||X-ray studies show that the head already completely loses its shape and consists simply of various unstructured isolated fragments of irregular shape. The neck of the femoral head is shortened and thickened. There is a resorption, or sequestration, the head of the femur and its bone marrow.|
|4 stage||80%||Extremely severe atrophy of the limb. Pain is aggravated by movement. It can pass from the limb to the lumbosacral spine.||The restoration of the spongy substance of the femoral head begins - this is the so-called reparation, when the shadow of the femoral head is already depicted on the X-ray photographs, but the head itself is not yet visible.|
|5 stage||100%||Continuous severe pain in the hip, thigh muscles and buttocks atrophied, movements in the joint are almost completely limited.||The shape of the neck and the head of the femur is greatly changed: it becomes shorter and wider, and the congruence of the surfaces is significantly impaired.|
The duration of each stage of aseptic necrosis of tissue and bone marrow of the thigh is individual, as much depends on the characteristics of the body, the impact of external factors, timely treatment and the presence of concomitant diseases.
Conservative therapy and operations
How successful treatment will be and how it will be depends on a number of factors:
- degree of disease;
- early diagnosis;
- prevalence of bone necrosis - the degree of damage to tissues and bone marrow.
As a rule, the treatment is complex, it can be either operational or conservative. Conservative treatment is conducted with the following objectives:
- withdrawal of symptoms, in particular pain syndrome;
- slowing the progression of the disease;
- with contraindications to surgical treatment.
Conservative treatment includes the use of medicines, physiotherapeutic procedures, exercise therapy aimed at relieving pain and swelling, improving blood supply, etc.
In the third and fourth stages, the bone structure of the femoral head is clearly visible.
Medical treatment of aseptic necrosis is carried out by means of the following:
- Non-steroidal anti-inflammatory drugs - relieve edema, reduce pain.
- Vasodilators - stimulate blood circulation around the hip joint, prevent the formation of thrombi, relieve swelling.
- Diphosphonates - regulate calcium metabolism, restore bone tissue.
- Calcium preparations - increase the strength of bones.
- Chondroprotectors are responsible for removing edema from cartilage, bone, tendons and ligaments.
If the drug treatment of aseptic necrosis did not work - the pain and swelling remained, the necrosis continues to develop, then an operation is prescribed. The type of surgical treatment is directly dependent on the stage of the process:
- Infarction( necrosis) of the hip joint of 1-2 stages - tunneling. The head of the femur is drilled to form additional holes in the bone. This is necessary to reduce intraosseous pressure. The success of the operation is in 80-90% of cases. After 3-4 months after the operation, pains occur, the edema subsides, signs of bone tissue reconstruction are noted on the x-ray.
- Infarction of a joint of 2-3 stages - intertrochanteric osteotomy. The femur is dissected at a certain angle, and the bone fragments are placed in the desired position and fixed with special screws. The operation removes the load from the damaged area - bone tissue begins to recover. After the operation, a plaster bandage is applied to the patient for six months.
- Infarction of a joint of 2-3 stages - artoplasty. The lost part of the bone tissue is removed, and a gasket is applied in its place, which will perform the cartilage function. The result of the operation is an increase in the volume of movements, a reduction in pain, and elimination of lameness.
- Heart attack of the joint of 4-5 stages - endothesis. The surgeon replaces the hip joint with an artificial prosthesis. Materials from which prostheses are made are absolutely compatible with human tissues - rejection occurs in 2 cases out of 100. Edema and pain after surgery are rapid. Restoration lasts a couple of months.
Necrosis, in which the tissue and brain of the femur are damaged is a serious disease. Of course, the effectiveness of his treatment depends on how quickly it is detected. It is only at the initial stage that necrosis can be diagnosed only in 15%( the difficulty is that it is not visible on the x-ray, and such symptoms as pain, swelling, lameness may indicate other diseases).In later stages, necrosis can be cured, but only the process will be protracted, and complete restoration of the functioning of the damaged limb will not be achieved - a minimal degree of restricted movement in the joint, and in more complex cases, disability will be put.
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 joint
The main danger of the disease is 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 feature of the first is suddenness and rapid progression of the disease, which does not happen in weeks, but even in days.
Usually there are four stages of development of the disease with characteristic symptoms:
- , in the first stage, up to 10% of bone tissue is affected, 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, which is caused by the appearance of cracks in 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, as well as secondary arthrosis, severe persistent pain and the inability to walk for a long time;
- 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 is shortening of the patient's 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 is 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 reduce the dosage of drugs that lower blood pressure);
- complexes that stimulate 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 at 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 blood microcirculation, and also relieves spasms, but there are a lot of contraindications to its use in necrosis, and it is important to familiarize with them;
- physiotherapy is considered to be ineffective due to the deep anatomical location of the hip joint, but still such procedures are used - 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 can 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.