OSTEONECROSIS OF THE FEMORAL HEAD
with appropriate care.
L'osteonecrosis of the femoral head, Avascular necrosis of the femoral head, also known as avascular necrosis of the femoral head, is a condition affecting the bone due to reduced blood supply. It can cause pain, limited mobility, or collapse of the femoral head, but it does not always lead to the need for a prosthesis.
The goal of treatment is first to understand the origin of the symptoms, then to choose solutions that preserve natural movement and joint function for as long as possible.
UNDERSTANDING OSTEONECROSIS OF THE FEMORAL HEAD
cam morphology pinching morphology-
Normally, the head of the femur is perfectly round and extends into a thinner neck. Here, the junction between the head and the neck has a bony prominence. During significant flexion or rotation, this prominence impinges against the rim of the acetabulum.
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Normally, the acetabulum covers the femoral head just enough. Here, its rim is too prominent or too covering. In certain positions, it touches the femoral neck earlier than intended and pinches the joint.
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The acetabulum is the socket in the pelvis that receives the femoral head. Normally, its depth and orientation allow the hip to move freely. When it is too deep or incorrectly oriented, it covers the head too much: this is the origin of the "pinching" morphology.
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This fibrocartilaginous ring borders the acetabulum and seals the hip joint. When the bones repeatedly rub against each other, it can become trapped and may become irritated or crack. However, damage to this ring can have other possible causes.
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Repeated contact gradually wears down the cartilage, which normally ensures the smooth gliding of the joint. Over time, this wear can contribute to osteoarthritis. However, a cambered or pinched joint does not always cause pain or injury.
RECOGNIZING THE SYMPTOMS
L'osteonecrosis of the femoral head It can cause deep pain in the groin, thigh, or buttock. Symptoms may appear gradually, and their intensity does not always reflect the extent of the injury.
- Pain in the groin: often present when walking, climbing stairs or moving from a sitting to a standing position.
- Pain in the thigh or buttock: Hip pain can radiate to the thigh, buttock, or sometimes the knee.
- Progressive stiffness: Some movements become more difficult, including hip rotation, putting on shoes, or getting into a car.
- Limping or reduced weight-bearing: When the pain increases, walking may become asymmetrical and putting weight on it more difficult.
Symptoms may be mild at first, then worsen if the femoral head loses its shape or if secondary osteoarthritis develops. Persistent groin pain or new difficulty bearing weight warrants a medical evaluation.
WHY DOES OSTEONECROSIS OF THE FEMORAL HEAD OCCUR?
Osteonecrosis occurs when the blood supply to the femoral head becomes insufficient. It can have a traumatic origin, be associated with certain treatments or diseases, or occur without a clearly identified cause.
HIP TRAUMA
A fracture of the femoral neck or a dislocation of the hip can damage the vessels that contribute to the vascularization of the femoral head and lead to secondary osteonecrosis.
PROLONGED CORTICOSTEROID THERAPY
High doses of corticosteroids, or corticosteroid therapy administered for a long period, are associated with an increased risk. This factor must be interpreted according to the dose, duration, and medical context.
DISEASE OR ASSOCIATED TREATMENT
Certain inflammatory or hematological diseases, coagulation disorders, oncological treatments or a history of transplantation may also be associated with osteonecrosis.
ORIGIN UNKNOWN
In some situations, no single cause is found. The condition may be bilateral; therefore, both hips must be evaluated according to the context and imaging results.
MAKE THE RIGHT DIAGNOSIS
The diagnosis combines symptoms, examination of the hip, and appropriate imaging. It allows for determining the size and location of the lesion, checking for subsidence, and assessing the condition of the other hip.
01 – CLINICAL EXAMINATION
The location of the pain, hip mobility, rotations, weight-bearing pain, and gait quality are assessed. A history of trauma, corticosteroid therapy, or associated disease is also investigated.
02 – X-RAYS
X-rays of the pelvis and hip can be used to look for changes in the shape of the femoral head, a fracture line, subsidence, or signs of secondary osteoarthritis. However, they may be normal initially.
03 – MRI AND ADDITIONAL EXAMINATIONS
An MRI can detect early osteonecrosis, determine the extent of the affected area, and look for damage to the other hip. Further tests may be performed depending on the suspected cause and the patient's overall health.
A normal X-ray is not always sufficient to rule out early osteonecrosis of the femoral head.
Relieve hip pain without surgery
The management of’osteonecrosis of the femoral head The treatment depends on the stage and extent of the injury, as well as the condition of the articular surface. Non-surgical measures aim to reduce stress, relieve pain, and preserve mobility when the femoral head retains a satisfactory shape.
ADAPTATION OF SUPPORTS
When weight-bearing is painful or the lesion appears to be subjected to stress, high-impact activities may be temporarily reduced. Walking aids may be recommended if clinical examination and imaging warrant them.
PHYSICAL ACTIVITY AND PHYSIOTHERAPY
Physiotherapy helps maintain mobility, preserve muscle strength, and limit compensatory walking patterns. Exercises are tailored to the stage of the injury and should not increase stress on the affected area.
DRUG TREATMENTS
Pain relievers or anti-inflammatory treatments may be discussed depending on the patient's health status, usual treatments, and contraindications. They alleviate symptoms but cannot, on their own, eliminate the osteonecrotic area.
JOINT MONITORING
When the lesion is limited, minimally symptomatic, or without collapse, clinical and radiological monitoring may be recommended. This allows for checking the evolution of the femoral head and adapting the treatment strategy if pain or mobility changes.
Preserving the femoral head and maintaining mobility remain the primary objectives when non-surgical management is possible.
WHEN TO CONSIDER SURGERY?
Intervention may be considered when the lesion presents a risk of collapse, when the femoral head has already become deformed, or when pain remains significant despite appropriate management.
PRESERVE: DECOMPRESSION OF THE FEMORAL HEAD
When the femoral head retains a satisfactory shape and the articular surface is not collapsed, decompression can sometimes be considered. This involves creating a channel within the bone to reach the affected area and reduce local pressure.
TREATING AN EARLY INJURY
In certain cases, decompression may be combined with bone grafting or bone marrow transplantation. These options are evaluated on a case-by-case basis and are not suitable for all injuries.
REPLACE: TOTAL HIP REPLACEMENT
When the femoral head has collapsed, the joint surface is irregular, or secondary osteoarthritis causes debilitating pain, a total hip replacement may be considered.
→ Understanding the indications and procedure for a total hip replacement
KEEP MOVING AND RECOVERING
Osteonecrosis of the femoral head does not necessarily mean that all activity must be stopped. Movements and exercises are adapted to the stage of the injury, the pain level, and the quality of weight-bearing.
When the hip is still relatively unaffected, low-impact activities are recommended. Adapted walking, gentle cycling, water exercises, or muscle strengthening are all suitable options, depending on individual tolerance and medical advice.
After an intervention, the resumption of walking and exercises is done gradually, depending on the movement performed, the condition of the hip and the recovery of each patient.
Progress is measured by the quality of movement and hip tolerance, not by an identical schedule for everyone.
A CARE APPROACH TAILORED TO EACH PATIENT
Osteonecrosis of the femoral head can have very different causes, stages, and progressions. A consultation allows the doctor to correlate symptoms, clinical examination, medical history, and imaging results.
Management may involve weight-bearing adjustments, physiotherapy, symptomatic treatment, and monitoring. When the femoral head is still intact, femoral-sparing surgery may be considered in certain situations.
When the bone has collapsed or the joint is severely damaged, a prosthesis may become the most appropriate solution. The decision depends on the pain, mobility, impact on daily life, and the patient's goals.
«"Preserve the hip whenever possible, then intervene when the condition of the joint truly makes it necessary."»
FREQUENTLY ASKED QUESTIONS
DO YOU WANT TO BETTER UNDERSTAND YOUR PAIN?
A clinical evaluation and appropriate examinations will help to identify the source of the pain and discuss treatment options for your hip.
