According to abbreviationfinder, femoral head necrosis, also known as femur necrosis , is a serious disease of the hip bone. Severe circulatory disorders lead to bone tissue dying off. Consequences for the avascular, i.e. no longer supplied with blood, and necrotic femoral head are possible collapses in the further course of development, hip arthrosis up to stiffening of the hip joint and, in the worst case, disability.
What is femoral head necrosis?
The further the femoral head necrosis progresses, the more immobile and stiff the hip joint becomes and it hurts even at rest.
Femoral head necrosis generally belongs to osteonecrosis, ie death of the bone substance as a result of circulatory disorders. One of the most common types of osteonecrosis is hip head necrosis or femoral head necrosis, in which the bone cells in the hip joint die off.
The painful disease often occurs in middle-aged adults and is often associated with stabbing pain in the affected hip joint area and restricted movement even in the early stages. With progressive femoral head necrosis, the disease leads to a collapse of the femoral head or the articular surfaces. This results in arthrosis, ie premature wear and tear of the hip joint.
Characteristic and the cause of femoral head necrosis, which is one of the aseptic bone necrosis, is a circulatory disorder, which then results in necrosis of the bone tissue. In the case of femoral head necrosis, a distinction must be made between the post-traumatic form, eg after an injury such as a femoral neck fracture, and spontaneous femoral head necrosis.
In post-traumatic femoral head necrosis, the injury suddenly leads to an acute circulatory disorder, whereas spontaneous femoral head necrosis is characterized by chronic, recurring circulatory disorders. In very rare cases, femoral head necrosis occurs in childhood, the so-called Perthes disease.
Causes
Femoral head necrosis can have many causes. In the case of post-traumatic, ie accident-related femoral head necrosis, the trauma is clearly recognizable as the cause of the circulatory disturbance. Here the vessels are damaged as a result of an accident or acute injury, which leads to a severe circulatory disorder in the hip area.
These include, for example, a fracture of the femur, a femoral neck fracture, a serious injury in the joint or in the course of a hip dislocation. In the case of spontaneous femoral head necrosis, on the other hand, there are many possible causes. One of the most common risks and possible causal factors is the lipid metabolism disorder, which can be identified or suspected in around half of the cases of femoral head necrosis.
However, the causal connection has not been clearly proven, just as with other influencing factors that are observed in connection with femoral head necrosis: These include the intake of corticoids (e.g. medicinally in the form of cortisone or also as steroid doping), excessive alcohol consumption, nicotine consumption, Coagulation disorders, but also diving accidents that lead to decompression sickness. In many cases of femoral head necrosis, however, the exact cause remains unknown.
Typical Symptoms & Signs
- hip pain
- movement restrictions
- osteoarthritis of the hip
Diagnosis & History
In the case of femoral head necrosis, patients usually only consult a doctor relatively late in the course of the disease due to pain in the hip joint. At this stage, these symptoms are mostly load-dependent, and in the further course a leg length discrepancy can even be detected due to femoral head necrosis.
Magnetic resonance tomography, which is particularly effective in the early stages, is available as a diagnostic method and can visualize (intrabony) edema formation in the bone. As the disease progresses, an X-ray shows the progressive deformation and “unrounding” of the femoral head. The course of femoral head necrosis takes place in several stages, initially there is no pain, later increasing after exertion and often in a sudden and stabbing form.
The further the femoral head necrosis progresses, the more immobile and stiff the hip joint becomes and it hurts even at rest. Later in the course of necrosis of the femoral head, the hip joint can collapse and lose its original shape, which can result in severe joint damage and hip joint wear. The result is a considerable reduction in quality of life and mobility, which can even lead to disability.
Another diagnostic possibility to recognize the stage of femoral head necrosis in a more differentiated manner is hip arthroscopy, which, as an operative reflection of the hip joint, helps to better assess the cartilage conditions and the condition of the bone, among other things.
Complications
As a rule, femoral head necrosis leads to the death of the bone tissue and thus to a severe circulatory disorder. Furthermore, the patient experiences severe pain and restricted movement, which often also causes psychological problems and depression. The hip hurts relatively badly and can also be affected by rest pain.
Pain at rest can also lead to insomnia and thus extremely reduce the patient’s quality of life. Furthermore, without treatment, a leg length discrepancy can develop, which leads to significant limitations in the patient’s ability to walk and stand. The bone tissue continues to recede and so-called joint wear and tear can occur.
In the worst case, the person affected is then dependent on a walking aid or a wheelchair if they can no longer move on their own. Femoral head necrosis can be treated relatively well without further complications. Drugs, therapies and surgical interventions are used. The course of the disease is always positive and the affected person can usually resume their usual activities after treatment. Life expectancy is usually not affected by femoral head necrosis.
When should you go to the doctor?
If hip pain occurs during exertion, a doctor’s visit is indicated. Femoral head necrosis manifests itself at the beginning of the disease through non-specific symptoms that need to be clarified, for example restricted movement and a feeling of pressure in the hip area. If these symptoms are noticed, the family doctor or an orthopedist should be consulted. Medical advice is required at the latest when the hip pain also occurs during a rest phase. Increasing movement restrictions are another warning sign that requires immediate clarification by a doctor. If there are complications such as severe pain at rest or a stiffening of the hip, the person concerned must be taken to the nearest hospital.
If further problems arise or the person concerned suffers a fall, it is best to call an ambulance. In the case of psychological complaints, the doctor can put you in contact with a therapist. This is necessary above all in the case of long-term illnesses that have been burdening the patient for some time. People who notice signs of femoral head necrosis after a femur fracture, joint injury, or hip dislocation should speak to their healthcare professional. Alcohol consumption, coagulation disorders and taking certain medications are also risk factors that need to be clarified.
Treatment & Therapy
The doctor treating you has a wide range of possible therapies to choose from. Above all, the respective stage of the disease is decisive, because the further course of femoral head necrosis can be estimated, among other things, from the shape of the femoral head, the extent of the femoral head necrosis (i.e. the dead area) as well as from the specific head changes and whether and to what extent the hip socket is already intact is involved.
Basically, a strict relief of the hip joint by means of externally applied aids (ortheses) as well as an adapted movement therapy can be considered as therapy. As far as drug treatment is concerned, the drug of choice can be administered to improve blood circulation, iloprost, but bone-building preparations (such as bisphosphonates) are also administered. In an early stage of the disease, so-called hyperbaric oxygen therapy and shock wave therapy are sometimes helpful and successful.
Drilling into the femoral head in an early stage of femoral head necrosis can also be considered as a therapeutic option: Here there is the possibility of carrying out the so-called marrow cavity decompression as a measure to increase blood flow. Drilling into the diseased femoral head bone supports the formation and growth of new blood vessels in order to heal or at least significantly improve the femoral head necrosis. If the cartilage condition is stable, it can also be filled with bone substitute, which is known as retrograde cancellous bone transplantation.
In advanced stages and in the case of a collapsed femoral head and cartilage damage, only total hip replacement can help as a joint replacement. However, especially in young patients, prostheses that are specially adapted to the extent of the necrosis are being used more and more frequently instead of the standard prostheses.
For example, there is a button-shaped prosthesis that acts as a femoral head surface replacement. These surface replacement prostheses can be used as “bone-saving” as possible, which is of particular benefit to the younger sufferers. The following also applies to femoral head necrosis: The earlier a clear diagnosis is made, the more favorably the course can be influenced therapeutically.
Prevention
According to the current state of knowledge, a generally active, conscious and healthy lifestyle can be recommended as a preventive measure. The permanent reduction of obesity is certainly one of the best measures to prevent femoral head necrosis.
But it is also advisable to consume stimulants such as alcohol and cigarettes as sparingly as possible, as they are also possible risk factors for this disease. One should also be warned of excessive use of cortisone and steroids in connection with femoral head necrosis, because these are considered to be extremely “encouraging” in terms of the development of osteonecrosis in general and femoral head necrosis in particular.
In addition, if there is even the slightest pain in the hip area, a medical and differential diagnostic clarification should be carried out in order to be able to recognize a possibly existing femoral head necrosis at the earliest possible stage and to be able to treat it optimally.
Aftercare
In most cases, the aftercare measures for femoral head necrosis are severely limited or are not available to the person concerned. This disease should therefore be diagnosed very early on so that the symptoms do not get worse. As a rule, self-healing cannot occur in the case of femoral head necrosis, so that the person affected should ideally see a doctor as soon as the first complaints and symptoms appear.
Most of those affected are dependent on physiotherapy and physiotherapy in order to relieve the symptoms permanently. Many of the exercises from these therapies can also be carried out at home, so that the treatment is accelerated. Furthermore, the support and care of one’s own family and friends has a positive effect on the further course of the disease.
Depressive moods or other psychological complaints can also be prevented. The further course of femoral head necrosis depends very much on the time of diagnosis, so that a general prediction is not possible. However, the disease usually does not reduce the life expectancy of those affected.
You can do that yourself
Patients with femoral head necrosis suffer in particular from pain and limited mobility that impair everyday life. The pain emanating from the affected hip joint occurs both during movement and in phases of inactivity as pain at rest. For many of those affected, the relief of pain is an important aspect in order to increase the quality of life. Every patient has to find the right way to deal with the pain and appropriate measures to relieve it. In general, it is important to determine the right balance between stressful and non-stressful activities.
Overexertion of the affected hip should be avoided in any case, but reducing physical activity to a minimum is not recommended. Physical activity should be coordinated with the attending physician and physiotherapist and will help maintain a certain level of fitness and mobility.
Patients with femoral head necrosis often undergo various medical procedures aimed at slowing the progression of the disease or reducing pain. Before and after these interventions, those affected must strictly follow the instructions of the doctors and, for example, change their diet or adhere to scheduled rest periods. The independent implementation of medically prescribed physiotherapy at home supports the well-being of the patient.
