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Aseptic Necrosis of the Hip

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Condition Detail

(Osteonecrosis; Avascular Necrosis; Ischemic Necrosis; Osteochondritis Dissecans)

Definition

Aseptic necrosis of the hip is the death of bone tissue in the head of the femur due to an inadequate blood supply.

Certain bones have a fragile blood supply. The head of the femur in the hip joint is the most likely to suffer loss of blood supply. This can cause tissue death.

The Hip Joint

Causes

Any event or condition that damages the arteries that feed the head of the femur raises the risk of aseptic necrosis. The most common events are fractures in the upper femur and dislocations of the hip, especially developmental dysplasia of the hip. Other causes reduce the blood supply by closing off or compressing the blood vessels.

There is a specific type of aseptic necrosis of the hip called Legg-Calvé-Perthes disease that affects the growth plate at the upper end of the femur in children. It most commonly affects boys aged 5-10 years old.

Risk Factors

Factors that increase your chance of developing aseptic necrosis of the hip include:

Femoral neck fractures
Hip trauma
Dislocation of the hip
Radiation therapy
Prolonged or repeated use of cortisone-like drugs
Decompression sickness
Sickle cell disease
Gaucher disease
Cushing disease
Excessive alcohol use
Systemic lupus erythematosus (SLE) —especially if SLE is being treated with corticosteroids
Chronic renal failure or renal transplantation
HIV infection

Symptoms

The few symptoms of aseptic necrosis of the hip are nonspecific and may be caused by other, less serious health conditions. Symptoms include:

Groin pain, especially with weight-bearing actions
Hip pain or limited hip motion
Buttock, thigh, and knee pain
Limping

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. If the diagnosis is suspected, you will be referred to an orthopedic surgeon.

Images may need to be taken of your internal structures, especially your bones. This can be done with:

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Conservative Treatment

Taking nonsteroidal and other pain relievers and performing non-weight-bearing exercises may prevent or minimize disease progression.

Surgery

There are several surgical procedures used to treat aseptic necrosis of the hip. The choice depends on the extent of disease and the age and health status of the patient. Bone grafts, decompression of the inside of the bone, realignment of the bone, femoral head resurfacing, and prosthetic hip replacement are all available.

Prevention

To help reduce your chances of getting aseptic necrosis of the hip, take the following steps:

Minimize the dose and duration of cortisone-like drugs
Avoid decompression disease when diving underwater

RESOURCES

Johns Hopkins University Medical School http://www.hopkinsmedicine.org

Penn State Milton S. Hershey Medical Center http://www.pennstatehershey.org

CANADIAN RESOURCES

HealthLink BC http://www.healthlinkbc.ca

Health Canada http://www.hc-sc.gc.ca

References

Abeles M, Urman JD, Rothfield NF. Aseptic necrosis of bone in systemic lupus erythematosus. Relationship to glucocorticoid therapy. Arch Intern Med . 1978;138:750.

Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology (Oxford) . 2005;44:352.

Osteonecrosis of the hip in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Accessed January 16, 2013. Accessed May 3, 2013.

Avascular necrosis. The Merck Manual . 17th ed. West Point, PA: Merck and Co; 1999.

Martin K, Lawson-Ayayi S, Miremont-Salame G, et al. Symptomatic bone disorders in HIV-infected patients: incidence in the Aquitaine cohort (1999-2002). HIV Med . 2004;5:421.

Matsuo K, Hirohata T, Sugioka Y, et al. Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop . 1988;234:115.

Metselaar HJ, van Steenberge EJ, Bijnen AB. Incidence of osteonecrosis after renal transplantation. Acta Orthop Scand . 1985;56:413.

Revision Information

Reviewer: John C. Keel, MD; Michael Woods, MD
Review Date: 05/2013 -
Update Date: 05/03/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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