Bones are living living tissues; Most living tissues feed on blood vessels from many directions. Some bones in our body provide their nutrition through a limited number of veins. Some bones in our body provide their nutrition through a limited number of veins. The head of the femur is one of them. Whole feeding of the head of the femur; Femur, which combines the body of the femur with the head, happens with veins extending from the neck. When femur head nutrition deteriorates, the bone structure loses vitality and robustness, and over time the bone structure begins to collapse. The head of the femur collapses and loses its roundness, its contours begin to deteriorate. The fact that the hip joint is under load is the cause of this structure deterioration. This mismatch in the joint initiates the osteoarthritis process, ingring out pain and limping.
Etiology: Avascular necrosis can have many causes. Any event that disrupts femur head blood loss can lead to avascular necrosis. Avascular necrosis is also a condition that can be seen in patients with bleeding and clotting problems. Traumas around the hip joint, such as femur neck fractures and hip joint disseouts; damage to blood vessels. Some drugs may lead to avascular necrosis. Corticosteroids are the drug best known to cause avascular necrosis. It is a problem that may arise in patients who need regular cortisone every day, such as patients with advanced stage arthritis or organ transplantation. There is a clear link between avascular necrosis and alcoholism.. Excessive alcohol intake causes blood vessel damage and avascular necrosis. Divers and miners working under high pressure have a high risk of blood vessel damage and avascular development.
Clinical: The first symptom of avascular necrosis is pain in the hip when it is under load. Pain can be felt in the groin area, behind the hips or on the front of the thigh. As the problem progresses; limping while walking and stiffness in the hip, limited movements occur. At the last stage, pain begins even during rest or sleep.
Diagnosis: Information received from the patient and physical examination. The patient’s work, history of illness and medications are learned. Alcohol intake is questioned. Avascular necrosis may not be detected in direct X-rays despite pain in the patient in the early stages. If no direct radiography findings can be detected in early stage avascular necrosis, bone synonymography and magnetic resonance imaging (MRI) method can be used for diagnosis. The most important feature of MRI is its success in revealing early stage avascular necrosis.
Treatment: Treatment options in avascular necrosis are determined by the severity of the patient’s symptoms and the duration of the disease. Painkiller and anti-inflammatory treatment; may reduce disease-related symptoms, but cannot restore femur head nutrition and return avascular necrosis. Its important feature is its success in revealing early stage avascular necrosis. It can help to relieve the hip joint, which is painful in early stage avascular necrosis, from the load with a cane or crutch. Physiotherapy is recommended to prevent reduced hip range of motion. Anti-inflammatory, pain relievers and prostaglandin inhibitors can be used for medical treatment. All of these treatments can help delay surgical treatment, but they have little success in affecting the course of the disease. All of these treatments can help delay surgical treatment, but they have little success in affecting the course of the disease. If the femoral head starts to collapse and deteriorate; Surgical methods are preferred to increase the blood circulation of the femoral head. Femoral head decompression (forage) surgery is an intervention aimed at increasing blood supply by reducing the pressure in that area by carving the femoral head where the collapse and cystic area are intense. Grafting and supporting the femoral head with fibular autograft with or without vessels can also be used as another surgical option to increase blood supply in that area. Advanced stage avascular necrosis is treated like hip joint osteoarthritis. Hip circumference osteotomies and arthroplasty operations are recommended for patients at this stage. However, the most satisfactory results in patients who come to the last stage are obtained with prosthetic surgery.
