Aseptic necrosis of the head of the femur.
Aseptic necrosis of the head of the thigh 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 the 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:
- Hip joint trauma( 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 the "aching" 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 hip joint necrosis
For 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 neck 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.
Aseptic necrosis of the femoral head: causes and treatment
The hip joint is formed by the femoral head and a special depression in the pelvic bones called the acetabulum. Normally the head of the femur is inserted into the acetabulum and fixed in it by ligaments.
The articular surface of the head is hemispherical, the acetabulum is a recess with smooth rounded walls in the shape of a bowl. This form of contiguous surfaces allows the foot to make large amplitude movements in different directions.
Aseptic necrosis of the head of the hip joint - severe degenerative-dystrophic( associated with impaired blood circulation and metabolic processes) disease. Characterized by aseptic necrosis of the hip joint is the necrosis of the bone substance of the head of the femur in places where the greatest load is applied to it.
Gradually, the femoral head collapses, bone formations( osteophytes) form at its edges, the structure of the acetabulum changes and the deforming arthrosis of the hip joint is formed. Movement in the joint is severely limited until complete immobilization.
Necrosis is the process of necrosis of tissues, which can be caused by a variety of causes. The term "aseptic" means that necrosis in this disease occurs in sterile conditions, that is, without the participation of microorganisms.
The causes that can cause aseptic necrosis of the head of the hip joint can be divided into four large groups:
- Vascular : change in microcirculation( blood flow through the smallest vessels - the capillaries) and hemocoagulation( the ability of the blood to change the viscosity and coagulation).In this case, two options for the development of aseptic necrosis of the head of the hip joint are possible:
- In the first variant, blood circulation is disturbed in the bone tissue of the femoral head and immediately leads to the development of foci of necrosis.
- In the second variant, circulatory disturbance leads to a disruption of cartilage nutrition. The cartilage at the same time loses its elastic properties and ceases to protect the underlying bone from excessive loads. The bone is damaged and foci of necrosis form in it.
- Mechano-functional , that is, associated with excessive load on the joint. Excessive loads can be connected both with the profession( electric and gas welders, parquet makers, drivers of heavy vehicles, etc.) and with displacement of the center of gravity when walking and performing work for a number of diseases such as osteochondrosis of the spine, for example, or dysplasia of the hipThe cause of excessive loads on the joint can also become overweight.
- Associated with metabolic disorders .
- Genetic factors of , such as sex, age, intensity of metabolic processes, rate of destruction of bone tissue and its neoplasms. Evidence of participation in the development of the disease may be that most often aseptic necrosis of the hip joint develops in men of working age.
It has now been established that none of the causes individually can cause disease. Only a certain combination of several causes and conditions can provoke necrosis of the head of the hip joint. Namely, local disturbance of microcirculation leads to a decrease in the ability of the articular cartilage and the underlying bone to repair. Their density and ability to withstand the load are reduced.
In such conditions, any damage to the cartilage or bones of the joint as a result of the load or external trauma aggravates their condition and provokes the appearance or progression of the process of necrosis of the bone tissue in the femoral head.
Symptoms of the disease
The course of the disease has certain stages, depending on the degree of damage to the structures of the hip joint. For each stage, almost the same symptoms are characteristic, but the nature of the symptoms and the degree of their expression varies.
Symptoms of aseptic necrosis of the hip joint are as follows :
- Reduction of the amplitude of movements in the joint;
- Reduces the burden on the diseased leg and transfers most of the body weight to the leg healthy.
And now let's look at how the symptoms increase depending on the stage of the disease:
In the initial period of , the main symptom of the disease is pain. They appear suddenly. Some patients can remember not only the day, but also the hour of their first appearance. Localized pain in the region of the hip joint, can spread to the groin, the knee joint and the lumbosacral spine.
For the first few days, most patients can neither sit nor walk because of pain. Then there is some improvement in the condition: the pain appears periodically during physical exertion and disappears at rest. Then gradually their intensity and duration increase, there are pains at night.
The amplitude of the movements is preserved. There may be a slight atrophy( decrease) in the muscles of the thigh. Lameness is not present, the patient distributes weight of a body on two legs practically fifty-fifty.
In the second stage of the , the pain becomes permanent and intensified after physical exertion. The amplitude of movements in the diseased joint is slightly reduced. Atrophy of the muscles of the thigh is significant( the thigh decreases in circumference as compared to a healthy leg by 3-4 cm).The patient begins to take care of the aching legs and transfers most of the body to a healthy leg.
The third stage of pains are significant and intensified at the slightest load. The amplitude of movement in the patient joint sharply decreases, marked lameness is observed. Atrophy of the muscles of the hip is significant, the atrophy of the muscles of the shin begins. There may be a slight shortening of the sore leg.
The fourth stage of shows pain. The gait is broken. The atrophy of the muscles of the thigh and lower leg is pronounced.
To diagnose and determine the stage of the disease, a variety of methods are used: X-ray examination, measurement of walking and support parameters, subgraphy, measurement of intraosseous pressure, MRI( magnetic resonance imaging) and others. The main diagnostic method is X-ray.
- At the initial stage on the roentgenogram, areas of compaction or deflation of the bone tissue of the femoral head in places of necrosis are visible.
- In the second stage, a flattening or a step-like deformation of the head appears in the pictures. This is due to the fact that the necrotic areas of the bone are squeezed and fail. The joint gap widened.
- In the third stage on the roentgenogram, the contours of the femoral head become more and more uneven due to the progressive destruction of the bone, and due to the formation of marginal bone growths - osteophytes.
- In the fourth stage, changes in the shape of the acetabulum are added to the described changes.
Treatment of hip joint necrosis can be conservative( without surgery) and prompt.
Conservative treatment of hip joint necrosis is aimed at:
- preventing or slowing the progression of the disease;
- reduction or withdrawal of pain syndrome;
- improved joint function.
Conservative treatment includes:
- use of non-steroidal anti-inflammatory drugs and corticosteroids for pain relief, reduction of inflammation in the joint and normalization of metabolic processes;
- therapeutic exercise;
- physiotherapy: electrophoresis with novocaine, paraffin, ozocerite, ultrasound, diadynamic currents, balneotherapy, etc.
- orthopedic treatment: orthopedic laying for the prevention of contractures etc;
- massage to increase the contractile function of the muscles and restore their functions.
Surgical treatment of hip joint necrosis varies depending on the stage of the disease.
At the initial stage, the main objectives of the operation are:
- restoration of blood circulation in the tissues of the hip joint;
- elimination of venous stasis.
In the second stage, the objectives of the operation are different:
- changing the position of the femoral head in relation to the acetabulum so as to remove the most damaged portion of the head from under the load;
- improved blood supply to the joint and decreased intraosseous blood pressure;
- increase the mechanical strength of damaged sections of the head.
In the late stages of the disease, the replacement of the fractured joint with a prosthesis is used to restore the function of the lower limb.
Aseptic necrosis of the head of the femur |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 upcoming 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.
ENGBK is caused by various factors. If you are exposed to one of the listed exposures, you are at risk:
- Diseases( osteopenia, osteoporosis, lupus erythematosus, Bechterew's disease, rheumatoid arthritis, sickle cell anemia, coronary heart disease, hypertension, hypercholesterolemia, osteosynthesis,screws, etc.);
- The toxic effects of such drugs as glucocorticoids, steroids and cytotoxic agents, antibiotics;Alcohol intoxication, smoking.
We have compiled a detailed description of the symptoms of ANGBC with the aim of disseminating information to as many of our readers as possible, because the sooner you contact our center, the faster 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 for the improvement of 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 a painful 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 weight loss of the limb apart 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, 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 ANGBK
Diagnosis of aseptic necrosis of the femoral head includes the following most common methods:
- Radiographic examination of pelvic bones in three projections( on the back, on the abdomen, laying according to 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 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 bone density. 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 speed of passage through it of ultrasonic waves and the degree of their absorption by tissue. The method is absolutely safe, since it has no radiation effect on the body.
- Processing of X-ray images in the "Analizer +" program gives the opportunity to see the initial signs of the disease, when the changes in bone tissue are just beginning.
- Express diagnostics of diseases and changes in internal organs at the screening analyzer "Screening" is based on the theory of information function of the heart and technology of 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 body of the patient, 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, calcium and ionized( 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 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 conducted in our center include the following:
- Redistribution of the load from the necrosis-affected sector of the GAB and compliance with the orthopedic regimen 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 course of treatment of ANGBC, which contributes to the restoration of impaired microcirculation and the active removal of metabolic products of the tissues destroyed by the disease, 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 an improvement in overall health, the disappearance of pain and an increase in the volume of movements 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.
The hip joint externally has the shape of a large spherical joint, into which the head of the hip bone and the articular cavity enter. This is one of the most complex mechanisms of the entire human body, which contributes to the exercise of the body's ability to keep in balance, as well as the ability to walk and sit. Blood supply of the head occurs due to one artery, which passes through the neck of the femur. In case of disturbance of blood flow along the artery, necrosis of the hip joint develops.
If necrosis of cells occurs without the participation of microorganisms, that is under sterile conditions, then aseptic necrosis occurs. The process of bone tissue death can last about three years, when the patient will experience severe pain while walking, being silenced only with the help of medicines. But their action will be fleeting in nature, and severe pain will force the patient to increase doses all the time.
One of the severe complications of necrosis of the head of the hip joint is gangrene, resulting in infection of the blood and further amputation of the limb. Therefore, it is necessary to recognize the disease as early as possible on the first symptoms. And with severe pain, you need to see a doctor who, after examining, analyzing and collecting an anamnesis, will help determine the cause of the illness and prescribe a timely treatment.
Aseptic necrosis occurs in the hip region, in half the cases affects the head immediately on two legs. Among the factors contributing to the onset of the disease, there are several main causes:
- hip joint injuries, such as a dislocation directly to the joint or fracture of the neck of the hip;
- long-term alcohol abuse;
- frequent and excessive loads and the occurrence due to this microcracks;
- drug overdose, for example, antibiotics, cytotoxic drugs or hormonal agents;
- periodic effects on the body pressure drops, which can lead to the formation of air bubbles in the blood, clogging the vessels( typical for divers or miners);
- are some kinds of diseases that are systemic in nature, for example, arthritis, lupus erythematosus or Bekhterev's disease;
- diseases in which endothelial dysfunction occurs( cold and inflammation).
It has also been established that aseptic necrosis of the joint head can not be caused by just one cause alone. The combination of several causes and certain conditions contributes to the emergence of necrosis of the hip joint. So, due to the violation of microcirculation of blood there is a decrease in the ability of the cartilage or bones of the joint to regenerate.
This leads to a constant decrease in their density and, consequently, the ability to transfer loads. Later, due to the slightest damage, the process of bone necrosis in the head of the hip joint can be provoked.
Symptoms of the disease
Necrosis of the head of the hip joint has several stages of development, which differ from each other in the degree of damage to the structures. For each of the stages, the symptoms are the same, which differ only in their degree of expression and in the nature of the manifestations, increasing with the development of the disease.
Aseptic necrosis of the head has several main symptoms:
- pain of the hip joint, arising when walking or standing with an emphasis on the aching leg;
- changing gait by transferring the load from the affected leg to a healthy one;
- atrophic processes occurring in the soft tissues of the hip lead to the drying of the muscles of the diseased leg and it becomes visually thinner than the healthy leg;
- decrease in the amplitude of movements that lead to impaired mobility;
- there is a shortening of the leg.
In this case, aseptic necrosis of the joint head largely resembles its symptoms with arthrosis of the hip joint. But if the latter develops slowly, then with pain necrosis pain can reach its maximum in a few days.
Stages of development of
Like any disease, necrosis has several stages of the development of the disease, which are characterized by an increase in pain syndrome and damage to bone structures.
The initial period of necrosis of the joint head is characterized by the appearance of pain sensations that occur suddenly and, localizing in the region of the hip joint, gradually spread to the knee joint, groin and lumbosacral spine. Pain occurs when walking or standing for a long time in a standing position. After rest, the pain disappears. In this case, there is no restriction of movements in the joint and lameness is not observed.
Gradually, the pain becomes permanent, radiates into the inguinal area, and is especially strengthened after physical exertion. There is a limitation of mobility of the joint, the burdo begins to decrease in the girth compared to the healthy leg. Because of the desire to save a sick leg, the patient transfers the weight of the body to a healthy one.
Painful sensations become strong and constant, arise at the slightest burden on the aching leg, and pronounced lameness begins to manifest. The amplitude of the movement of the joint sharply narrows. There is not only atrophy of the muscles of the thigh, but also the lower leg. There may be a slight shortening of the patient's leg in comparison with the healthy one.
The last stage of the development of the disease is characterized by severe pain that occurs in the region of the hip joint. The patient is completely broken gait. The muscles of the buttocks and thighs are atrophied. The head of the bone is destroyed. The amplitude of motion of the joint is reduced to almost zero.
At the first sign of necrosis of the hip joint, it is necessary to consult a doctor as soon as possible, since the direction, effectiveness of the treatment, and the chances for a full recovery directly depend on when the disease is detected.
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