Femoral head avascular necrosis is a very serious health problem in young adults between the ages of 20-40. This disease, which mostly occurs in individuals of active and productive age, not only negatively affects the life of the person, but also imposes a heavy burden on society. Although total hip arthroplasty performed in the advanced stages of the disease is a very successful surgery, it does not allow an active lifestyle and requires repeated surgeries at older ages due to wear and loosening problems. Therefore, it is of great importance to protect the hip joint with interventions in the early stages of the disease.
Causes of Femoral Head Avascular Necrosis
Femoral head osteonecrosis is associated with various risk factors. has been associated. Among these, cortisone use, alcoholism and autoimmune diseases come first. In addition, fractures/dislocations, pregnancy, thalassemia, myeloproliferative diseases, radiotherapy, chemotherapy, organ transplantation, thrombophilia, smoking, AIDS, and Caisson disease are also risk factors for osteonecrosis. There may be a genetic predisposition.
The most important cause of the disease is circulatory disorder. This may be due to intravascular causes such as thrombophilia and sickle cell anemia, or it may be due to structures around the vessel and vasoconstriction, as in cortisone and alcohol use. Increased compartment pressure with circulatory dysfunction leads to cell death and collapse in the necrotic area. After collapse, arthrotic changes occur on both the femoral and acetabular sides. After this stage, the success of hip joint-preserving surgeries is very low and arthroplasty becomes inevitable.
Diagnosis and Stages of Femoral Head Avascular Necrosis
Femoral head osteonecrosis goes through increasingly severe stages. The disease first begins with a deep and throbbing groin pain, and the pain gradually gets worse. First, internal rotation movement is restricted. Pain gradually increases, and sometimes mechanical complaints such as tripping occur. In the last stage, findings of arthrosis and collapse such as shortness and contracture manifest themselves.
The most commonly used methods in diagnosis are direct radiographs and magnetic resonance imaging (MRI).
Radiological o Ficat-Arlet Staging, which is the most commonly used staging, is important for planning the treatment.
Stage 1: Direct radiographs are normal, MRI shows avascular necrosis
Stage 2: Sclerosis and cysts are also present on direct radiographs
Stage 3: Subchondral fracture occurs in the necrotic area, there is a crescent sign
Stage 4: Femoral head collapse and arthrosis
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