A brief presentation on AVN femoral head

1. AVASCULAR NECROSIS OF HIP
MODERATOR : DR B. BORTHAKUR
(PROF & HOD,DEPT OF ORTHOPAEDICS,LMCH)
PRESENTER : DR DIBASHJYOTI DUTTA (PGT)

2. INTRODUCTION
• Term osteonecrosis is now preferred ,means ‘dead
bone’
• Result of loss of circulation from numerous potential
causes
• Affects patients in the 3rd through 5th decades of life.

3. BLOOD SUPPLY

4. RISK FACTORS
• Trauma
• Corticosteroid use
• Alcohol abuse
• Smoking
• Hemoglobinopathies e.g. sickle
cell anemia
• Coagulation disorders
• Myeloproliferative disorders
(Gaucher disease)
• Hyperbaric decompression
• Hyperlipidemia
• Chronic kidney disease
• Autoimmune diseases
• Human immunodeficiency virus
infection

5. PATHOGENESIS OF OSTEONECROSIS

6. CLASSIFICATION: FICAT AND ARLET
CLASSIFICATION

7. STEINBERG CLASSIFICATION

8. ARCOS

9. FEMORAL HEAD SCLEROSIS

10. CRESENT SIGN

11. FEMORAL HEAD FLATTENING

12. JOINT SPACE NARROWING

13. ADVANCED DEGENERATIVE CHANGES

14. COMBINED ANGLE OF ARTICULAR
INVOLVEMENT

15. DIAGNOSIS
• Clinical features
Typically asymptomatic in the early stage
Groin pain on ambulation later stages
Restricted range of movement.

16. XRAY :ANTEROPOSTERIOR AND FROG-LEG
LATERAL
• Normal in early stages
• Increased density or lucency in
femur head
• Cresent sign
• Femoral head collapse
• Severe arthritic changes

17. MRI
• Imaging modality of choice for early stages- stage and extend
of pathological process
• To evaluate asymptomatic hip when radiographs show changes
in one hip only
• Following progression of asymptomatic disease
• Evaluating efficacy of treatment

18. BONE SCANNING
• Patient has contraindication to MR imaging
• Tc 99m uptake decreased in very early stage of disease
• Increased uptake at later stages

19. CONSERVATIVE TREATMENT
• Crutch ambulation or bedrest is ineffective
• Can be placed in crutches in patients whom femoral head
preserving technique is planned to prevent collapse till surgery.

20. NON-OPERATIVE TREATMENT
• Bisphosphonates : inhibition of osteoclastic function of bone
resorption and subsequent reduction of bone turnover.
• Statins : beneficial in early stages of the disease in renal failure
patients
• Hyperbaric oxygen
• Extracorporeal shock wave therapy

21. OPERATIVE TREATMENT
• Core decompression : relieves intraosseous pressure caused by
venous congestion
Improved vascularity
Slowing progression of disease
• Earlier the stage of disease better the results
• Void left after core decompression autologous bone graft
that include marrow cells with or without growth factors

22. PERCUTANEOUS TECHNIQUE FOR CORE
DECOMPRESSION

23. BONE GRAFTING TECHNIQUE
TRAPDOOR LIGHTBULB

24. PROXIMAL FEMORAL OSTEOTOMY
• Move involved necrotic segment of femur head from principal
weight-bearing area

25. ARTHROPLASTY
• Osteonecrosis involving more than 30% of femur head
1. Resurfacing arthroplasty
2. Total hip replacement

27. THANK YOU