Contents
In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
Aseptic necrosis of the femoral head is a local, chronic, and self-healing ischemic disorder whose cause and formation are not fully understood. It may affect only part or all of the femoral head. Perthes disease occurs five times more often in boys than in girls, and it starts on average around the age of 7.
What is sterile femoral head necrosis?
It is an ailment resulting from disturbances in the blood supply to the epiphyses of long bones, including the femur. It is characterized by the death of bone tissue. Aseptic necrosis usually occurs in children and adolescents, then we are talking about the childhood-adolescent form, which consists of many disease entities that differ from each other in their clinical significance, location and age of occurrence. The common feature of these ailments is a similar course and picture of lesions. In adults, however, aseptic necrosis of the femoral head is different.
Aseptic necrosis of the femoral head – symptoms
The first symptoms are not characteristic. This is pain in the buttock and thigh that usually gets worse with exertion. A less common symptom is morning stiffness which lasts for up to an hour. Children complain of limping while walking and pain in the front of the thigh or in the knee. Hip movement is restricted, especially Abduction and Internal Rotation. In more advanced cases, contracture in the hip joint may be attacked. In conventional radiological examination at the earliest stage of the disease, sometimes no radiological changes are revealed. In the event of persistent symptoms, the following tests are helpful for diagnosis:
- scintigraphy,
- nuclear magnetic resonance (MRI). which allows not only the early diagnosis of necrosis of the head, but also shows changes in the articular cartilage of the femoral head.
Aseptic necrosis of the femoral head – causes
The death of bone tissue occurs without the involvement of external factors. Especially in children, the disease begins for no apparent reason. In adults, however, most cases of aseptic femoral head necrosis occur as a result of:
- trauma, e.g. displaced fracture;
- taking glucocorticosteroids,
- excessive alcohol consumption,
- sickle cell anemia (rare),
- connective tissue ailments,
- the presence of multiple myeloma (about 9% of cases).
Another (often forgotten) cause of this disease is the effect of high pressure, e.g. during diving.
Aseptic necrosis of the femoral head – diagnosis
Pathological changes occurring in the disease are usually diagnosed with the help of imaging tests. Most often, computed tomography, radiological examinations and magnetic resonance imaging are performed. However, the most important method is resonance. Sometimes it happens that early diagnosis and treatment is impossible, if the changes do not affect the articular surfaces and do not give symptoms.
Treatment of sterile femoral head necrosis
Treatment of aseptic femoral head necrosis aims to reduce inflammatory symptoms in the hip area, maintain good range of joint motion, prevent distortion of the femoral head and its secondary subluxation, and maintain a spherical head shape.
The essence of the treatment of this disease, which lasts about two years, is to keep the femoral head in the acetabulum throughout the disease in order to maintain its shape, especially when the disease has occurred in children aged six and over and is located in the lateral part of the femoral head. A variety of support devices or plaster dressings are used in the treatment. Currently, surgical treatment is increasingly used, which, according to recent reports, provides the best long-term results regarding the spherical shape of the femoral head.
Physiotherapy
It is a method of treatment that aims to prevent deformities of the femoral head, muscle wasting and cramps. The usual treatments include positioning, such as flexion, abduction, external rotation of the thigh, and passive and active exercises (e.g. in water). Physical treatments are also performed.
What’s the prognosis?
The most important factor in prognosis is the extent of the necrotic lesions. If the necrotic lesions also include the growth cartilage, the prognosis is worse because limb growth may be stunted.
Can I prevent aseptic femoral head necrosis?
In most cases, it is impossible to prevent this ailment. Disease development is difficult to predict, but there are some occupations that increase the risk of developing aseptic necrosis. People who want to work under high pressure conditions can be subjected to radiographic examination of the bones and regular health checks during work. As a result, disturbing changes can be detected relatively early.
The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website.