Avascular necrosis of head of femur.pptx
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This document discusses avascular necrosis of the hip. It begins by defining avascular necrosis as the death of bone tissue due to interrupted blood supply. It then lists numerous risk factors that can lead to this condition, such as corticosteroid use, alcohol abuse, and blood disorders. The document goes on to describe the pathogenesis and various classification systems used. It details methods for diagnosing avascular necrosis, including x-rays, MRI, and bone scanning. Both non-operative and operative treatment options are outlined, such as core decompression surgery and hip replacement for more advanced cases.
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Avascular necrosis of the femoral head, also known as osteonecrosis, results from interrupted blood supply to the bone and leads to bone cell death. It has traumatic causes like hip fractures or dislocations and non-traumatic causes like corticosteroid use, alcoholism, or blood disorders. MRI is the most accurate imaging test and stages the disease from pre-collapse to complete joint destruction. Early stages are treated with non-surgical options like protected weight bearing or core decompression surgery, while later stages may require joint replacement. The goal of treatment is to delay or prevent femoral head collapse through reducing pressure and promoting revascularization.
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This document discusses avascular necrosis of the femoral head. It begins by defining avascular necrosis as bone death associated with disrupted blood flow, often caused by corticosteroid use or alcoholism. It then covers the pathogenesis, classifications based on radiographic findings, diagnosis using MRI and CT scans, and various treatment approaches. For pre-collapse cases, core decompression and bone grafting are discussed. Total hip arthroplasty is the treatment for advanced collapse or cartilage damage. The document provides details on advantages and disadvantages of different surgical techniques.
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This document provides information on avascular necrosis of the femoral head, including its epidemiology, pathophysiology, clinical features, investigations, staging, and management. It begins by defining avascular necrosis as the death of bone tissue in the femoral head due to interrupted blood supply. It then discusses the typical patient demographic of men aged 30-50, common causes including trauma, steroid use, and alcoholism. The document outlines the pathophysiology involving compromise of the blood supply to the femoral head. It describes the clinical signs and symptoms, investigative tools including x-ray, MRI, and bone scan, and provides the University of Pennsylvania staging system. Finally, it discusses non-operative and operative management strategies depending on the stage of necrosis
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- 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
- 6. CLASSIFICATION: FICAT AND ARLET CLASSIFICATION
- 8. ARCOS
- 10. CRESENT SIGN
- 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