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Avascular Necrosis of the Hip

Avascular necrosis of femoral headVarious causes of hip arthritis are age related wear and tear, rheumatoid arthritis, ‘avascular necrosis’ of the hip etc. ‘Avascular necrosis’ means death of the head of femur bone because of loss of blood supply.

Sickle cell disease, alcohol consumption, prolonged treatment with medicines called as steroids, fracture of the hip etc are most common causes of avascular necrosis of the hip joint. Some rare & unknown diseases can cause avascular necrosis of the hip as well.

Even though in India, arthritis of the knees is more common than the arthritis of the hip, in Central India especially around Nagpur region, there is higher prevalence of hip arthritis because of sickle cell disease.

Sickle cell diseaseHIP Arthritis

Hip and knee are the most significant joints that are affected by arthritis. Every time we perform our day to day activities like walking, standing, getting up from a chair or bed etc all our body weight is always transmitted through our hip & knee joints. Therefore in patients with arthritis of hip and knee there is severe pain even in normal day to day activities. There can also be shortening of the lower limb.

steroid medicationsPain leads to restriction of activity and loss of freedom leading to disability (handicap) and dependence. Patients having advanced arthritis cannot do simple activities like walking, sitting, getting up from a seat due to pain. As the disease progresses, they cannot go outside the confines of the four walls of their home even for simple activities like shopping, buying milk or vegetables. In the advanced stages of arthritis even household activities like going to toilet, cleaning, washing, wearing socks or tying shoe laces evoke pain leading to serious disability and dependence on others like spouse, family members, servants or neighbours.

Osteoarthritis of hip jointVarious treatment options available for hip arthritis include pain-killer medications and joint preserving surgeries in the early stages. In the advanced stages only a hip joint replacement can help the patient get relief from pain and regain normal movement. Hip joint replacement is so effective and popular surgery all over the world that, in an online poll hip replacement was voted as the single most significant medical discovery of the 20th century.

patient of sickle cell diseaseSymptoms

Pain, loss of motion, restriction of activity, difficulty in walking, unequal leg lengths. Dependence on others, permanent disability, loss of confidence are other outcomes of this disease process.

Totalk HIP Replacement (THR) when?


  • dotPain not controlled
  • dotStiffness (loss of motion)
  • dotDisability
  • dotRestriction of day to day activities
  • Hip replacement surgery is performed primarily for pain relief and also to regain independence and ability to do day to day work.

    Surgical Procedure

    The hip joint consists of femoral head (ball) inside the acetabulum (socket). In a hip replacement, the femoral head is either resurfaced or removed and replaced with a ball attached to a stem which is inserted into the shaft of the femur (thigh bone). The acetabulum is then enlarged and a new socket inserted.

    There are a variety of bearing surfaces that can be used depending on patient’s age, activity & bone quality.

    Recovery

    The patients are hospitalized for less than 1 week after surgery. Most patients recover quite quickly from surgery. The recovery is much faster in thinner and hard working patients and those who are motivated to participate in active rehabilitation.