Q. Apart from surgery what are the treatment options for AVN of hip?

Answered by
Dr. Chirag Ashok Berry
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 10, 2018 and last reviewed on: Jul 26, 2019

Hi doctor,

I have pain in thighs, hip joints and legs for more than a year. Reports indicate avascular necrosis stage 3. Doctor has recommended me hip replacement. I am really scared of this. Because I did a lot of research on internet about this. I got to know a lot of restriction and risk of dislocation after surgery. What if I somehow avoid the surgery? Is there any chance of natural healing in long term of two to three years?

#

Hi,

Welcome to icliniq.com.

Thank you for using this platform.

From the information you provided, it seems like you have stage 3 avascular necrosis (AVN). While there are numerous causes for AVN and often there is no identifiable cause, the prognosis is not very favorable once you reach stage 3.

This stage is said to have been reached when the femoral head collapses and loses its round spherical shape.

Due to the incongruency with the hip socket, there is undue friction during hip movements, and eventually the joint surfaces start getting eroded. Once this happens, it is said to be in stage 4 of osteoarthritis.

It may be helpful if you could share your x-ray and MRI (magnetic resonance imaging) images with us.

Also, has the cause of your AVN been diagnosed? How does the opposite hip look like?

Often, the opposite hip may have early AVN and may be amenable to certain procedures to prevent it from reaching an irreversible state like your painful hip.

I understand your worries with hip replacement. You are only 25 years old and any hip prosthesis has a limited life of its own with a high likelihood of needing a revision at some point.

It may be best to postpone hip replacement for as many years as you can, so long as your hip pain does not prevent you from doing activities of daily living.

For further information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Hi doctor,

Even now, I have to struggle a lot especially when sitting down or standing up. I cannot sit or stand up instantly. If I keep on doing the activities or keep on walking then it feels little fine. Is there any way to postpone the surgery or temporary relief or natural healing? Also I want to know, what is the risk of dislocation after surgery? And what are the restrictions?

#

Hi,

Welcome back to icliniq.com.

  • Thanks for uploading the images (attachment removed to protect patient identity). From what I can see is it appears that you may have stage 3 avascular necrosis in your right hip and stage 2 in your left hip.
  • This means that your right femoral head has shown some collapse and is no longer completely round or spherical, while your left femoral head shows some early changes like crescent sign, but there has been no collapse yet.
  • Most of the treatment modalities in AVN are dependent on whether collapse has occurred or not. These modalities include some non-operative methods (medications), some operative methods other than hip replacement, and finally hip replacement.
  • The non-operative and operative methods that do not involve hip replacement are known to be less successful in those hips that have collapsed, and are usually advised only in precollapse stages. This means that if you were to be treated by any of these methods, you are likely to get good results for your left hip, but not so good in your right hip.
  • The non-operative method that has been most often studied and has published results is use of medications called Bisphosphonates. While Alendronate is the only Bisphosphonate that has been studied extensively with AVN, there are newer examples as well.
  • Alendronate is usually taken orally daily, while the newer examples may need to be taken weekly or monthly and some of which may be via injections. These have shown to reduce pain, slow down collapse and delay the need for hip replacement.
  • The goal of delaying hip replacement can also be achieved by certain surgical procedures that involve drilling of your femoral head (core decompression) with or without filling the cavity with bone graft.
  • The major disadvantage of this surgery is that you will need to use crutches for six weeks and not put weight on the operated side.
  • The possible advantage of reversing the changes in your left hip (healing) and possible prevention of need of hip replacement outweigh the disadvantage. These procedures can be done in many different ways depending on your surgeon's preference.
  • I would sincerely recommend consulting an orthopedic surgeon with special expertise in hip surgeries in person to evaluate all these options for you.

Probable diagnosis:

Osteonecrosis (AVN) of both hips - stage 3 right and stage 2 left with unknown etiology.

Treatment plan:

1. Bisphosphonates.
2. Core decompression or other surgical modalities to delay hip replacement as much as possible

Regarding follow up:

For further information consult an orthopaedician and traumatologist online.--->https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


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