Indications for hip arthroscopy: Osteonecrosis of the femur head
Avascular necrosis of the femur head is caused by impaired blood supply to the femur head. The condition usually covers the area transferring large loads, which leads to collapse (distortion) of the femur head and progressive degeneration of the joint. Symptoms of the disease include: exercise pains, constant pain in the groin area or nonspecific back pain, and progressive limitation of the hip motion. The first symptoms of the condition are not visible on a radiological image. At this stage, the disease is often unrecognised or sometimes misdiagnosed as spinal pain syndrome or gluteal muscle pathology. Unfortunately, treatment during this "radio-silence" period is the most effective in the majority of patients. The most sensitive imaging modalities allowing for diagnosing necrosis are magnetic resonance imaging and scintigraphy. However, there are no clear guidelines as to surgical treatments.
Osteonecrosis of the femur head
Our experience shows that in the absence of subchondral collapse of the femur head the following procedures are beneficial;
- femur drilling
- boring and supporting the subchondral with bone grafts
- during the remodelling of bone necrosis it may be beneficial to use growth factors
Do not forget that the most important treatment is offloading (prohibition of succession) the affected limbs.
In the case of deformation (distortion and degradation) of the femur head and persisting pain, the treatment of choice is hip replacement surgery.
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