Necrosis of the head of the hip joint: treatment, consequences

Aseptic necrosis of the hip joint: treatment, consequences, symptoms

In medicine, under necrosis is understood a disease that leads to the withering away of the tissues of the organ. The reason for this is a violation of the blood supply and, as a consequence, insufficient supply of nutrients to the joint.

A fairly common disease is aseptic necrosis of the hip joint. And this disease is more common in men than in women. More than half of cases of aseptic necrosis are observed in men aged 25-45 years.

Aseptic necrosis is a rapidly progressive disease. At its first signs it is necessary to address to the doctor as otherwise untimely treatment can lead to complete loss of ability to work, infection of blood and loss of the affected extremities.

Symptoms of aseptic necrosis

Necrosis affects the head of the hip bone. The head of this bone represents a kind of closed compartment, the functioning of which depends on the quality of the blood supply. P

In violation of the blood supply, changes occur with the architectonics of the bone.

The head is supplied with nutrients through three arteries of small diameter. When the blood on one of them stops coming to the head, the process of dying of the bone tissue begins.

Causes of development of vascular necrosis

Doctors distinguish the most common causes of blood flow disorders in the arteries of the head of the hip bone:

• trauma, which led to squeezing or twisting of the arteries;
• formation of thrombi in the artery;
• violation of venous blood flow;
• spasmodic vessels for a long time;
• increased blood viscosity;
• a bad outflow of venous blood.

Disturbance of blood flow leads to increased pressure inside the bone and destruction of bone tissue.

The mechanical causes of necrosis

Aseptic necrosis causes not only the causes associated with blood flow disorders, but also a number of "mechanical" causes. There is a theory according to which doctors admit that over time the head of the femur begins to experience "fatigue".

Signals of "overwork" are sent to the brain. The consequence of the return signal is vasospasm and blood stasis, which leads to a disruption in the supply of blood and nutrients to the body.

Metabolic and pathological disorders

Among the most likely causes of necrosis due to metabolic disorders are:

1. alcohol abuse for a long time;
2. taking medications based on corticosteroids, non-compliance with doses of drugs;
3. pancreatitis of a chronic nature;
4. reception of a large dose of radioactive irradiation;
5. frequent pressure drops, for example, in miners or divers;
6. blood diseases and other diseases;
7. bruises, fractures and other injuries of the joints and bones.

Separately, among the causes can be identified congenital defects of hip development - dysplasia of the hip joint.

Symptoms and diagnosis of necrosis

Aseptic necrosis is characterized by 4 stages of development, each of which has distinctive symptoms:

• 1 st or the initial stage. The first sign of the disease is the occurrence of unexpected pain. The focus of pain is in the pelvic region. Painful sensations are present in the groin, knees, and lower back. Increasing pain occurs every day and already for 3-4 days from the moment of its occurrence it becomes unbearable. In this case, the joint does not lose its mobility.
• The second stage is an impression fracture. The patient complains of unceasing pain, even when the joint is immovable. The second stage can last one week to six months. During this period, the patient has vascular disorders, an initial process of muscle atrophy is observed. The sick limb becomes smaller than the healthy one. There is limited movement, the appearance of lameness.
• The third stage is secondary arthrosis. For 6-8 months from the onset of the disease, bone destruction and deformation of the joint head occurs. Pain in the joint is worse. Movement is significantly limited. It is difficult for a patient to start moving. There is severe lameness when walking.
• 4th stage. If the disease occurs more than 8 months without proper treatment, the bone head completely collapses. The patient is accompanied by persistent severe joint pains that are felt in the hips, knees and lower back. Movement is almost completely limited. Noticeable is the atrophy of the muscles, especially the gluteal and thigh muscles.

Methods of diagnosing the disease

Depending on the stage of the disease, various methods of its diagnosis are used. Methods of diagnosis include:

Magnetic resonance imaging. The method of MRI of the hip joint is used to detect the disease at the initial stage. When using this method of diagnosis, the probability of error is minimal.

Roentgen of the joints. Aseptic necrosis of 2-3 stages is visible on the X-ray. The severity of the disease and the degree of joint damage will be visible in the pictures. In this case, the use of MRI is not necessary.

Scanning with radioisotopes. The effect of this method is based on the different absorption of radioisotopes by healthy and diseased bone.

Treatment of aseptic necrosis

Medication

The following medicines are used to treat aseptic necrosis:

1. medicines that remove inflammations of non-steroidal nature. These include diclofenac, indomethacin, piroxicam. These drugs reduce the pain that accompanies both necrosis of the knee joint and necrosis of the head of the femur. Their use is aimed only at reducing pain, but not on the treatment of the disease. However, the use of this group of drugs helps to remove reflex spasm of muscles and improve the motor activity of the patient;
2. vasodilator preparations. To improve blood circulation and eliminate stagnant phenomena in the vessels can be used, for example, trental or theonikor. The use of these drugs can reduce the pain associated with blood flow disorders of the joint, especially at night.
3. Medicines, whose action is directed to the restoration of bone tissue. The purpose of taking such drugs is to stimulate bone repair. The main active agent of such drugs is calcium and vitamin D, for example, oxide oxidation, napekel D3.
4. Chondroprotectors. These include chondroitin sulfate and glucosamine. Their action is aimed at the enhanced nutrition of the cartilage and the restoration of its structure. The effect of chondroprotectors is effective even at the last stage of the disease.

Non-pharmacotherapy: physical education and massage

An effective way to reduce pain, as well as the treatment of necrosis of the head of the hip bone, the performance of exercise physical therapy. Its action is aimed at reducing the symptoms of the disease, such as muscle atrophy, worsening of the circulation of the joint head.

Effective exercises are those that strengthen the ligaments and muscles of the injured limb. To ensure that the head does not deteriorate, it is necessary to select exercises taking into account the lack of pressure on it.

To improve blood circulation and the supply of nutrients to the aching limb will help massage.

Rules for compliance with the orthopedic regime

Aseptic necrosis entails compliance with certain orthopedic rules. Doctors do not advise completely to exclude the movement of the joint, to use crutches, especially at the initial stage of the disease.

The consequences, in their opinion, can be as follows:

• atrophy of muscle tissue at a rapid pace;
• acquiring a patient with a persistent pain syndrome;
• loss of motor skills.

In order to alleviate the symptoms and course of the disease to some extent, it is recommended:

• walks for 20-25 minutes at an average pace;
• walking on the steps;
• swimming pool;
• riding a bicycle or exercising on a stationary bike;
• use cane instead of crutches;
• struggle against excess weight.

Treatment of the disease operatively

Aseptic necrosis can be cured by resorting to surgical intervention. This is the last resort, which is used in case of ineffectiveness of other methods of treatment.

Decompression of the femoral head

During this operation, special tools drill a channel into the head of bone, affected by necrosis. As a result, the operation reduces the pressure in the bone and improves blood supply, in connection with the formation of new blood vessels. The efficiency of the operation is about 70%.

Bone segment transplantation

To reduce the symptoms of the disease, they practice transplanting the patient instead of a damaged bone with a fragment of his own healthy bone.

This operation affects the intensity of the blood flow and strengthens the neck of the thigh.

The transplantation of the patient's bone gives a high probability of survival of this part of the bone.

Endoprosthetics of the joint

During this operation, a complete replacement of the joint affected by the disease occurs on the artificial joint. With a positive outcome of the operation, the patient fully restores the motor ability of the joint and the pain sensations disappear.

Despite the fact that most of the performed operations give a positive result, doctors advise using them as an extreme measure. In time, the treatment will help to get rid of necrosis and avoid surgical intervention.

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Surgery to replace the joint with aseptic necrosis of the head of the hip joint

Aseptic necrosis is called necrosis, followed by destruction of the subchondral portion of the bone tissue, that is, located just below the articular cartilage. This site has good blood supply and innervation, which is the reason for its frequent defeat.

The disease almost always leads to persistent and severe disability. That is why it is important to identify it in a timely manner and begin a full-fledged treatment.

As the name implies, the pathological process does not involve an infectious agent, in contrast to septic necrosis of the bone.

The main reason for the formation of aseptic necrosis of the head of the femur (ANGBK) is a violation of blood circulation in this area. Such violations can occur due to:

1. Injuries (bruise, fracture, etc.) of the hip joint.
2. The use of steroid hormones, for example, corticosteroids for a long time.
3. Prolonged and frequent use of alcohol.
4. Actions of ionizing radiation.
5. The presence of other diseases, for example, sickle-cell anemia, etc.

There is also a theory of hereditary predisposition to the development of such pathology.

This theory is based on congenital disorders of the metabolism (metabolism) of bone tissue, which can cause circulatory disorders in it.

Therefore, under the influence of some provoking factors (for example, hypothermia, microtrauma, etc.), aseptic necrosis of the hip joint can develop in children.

How to identify the ANGCC?

Most common are both hip joints. Even if the pathological process is initially unilateral, in almost 90% of cases, the second joint is affected for one or two years.

Symptoms

The main manifestation of ANGBC is pain. First, it worries only when making movements in it, for example, walking and extending to the entire lower limb. Subsequently, the pain is localized in the region of the hip joint, and can often spread to the knee.

Pathological processes occurring in the joint, eventually cause a shortening of the limb.

Outwardly this is manifested by lameness and frequent disruption of the function of the entire leg.

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Due to the restriction of all movements in the affected lower limb, atrophy of the femoral and gluteal muscles occurs. They decrease in size, "dry up".

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Unfortunately, the early manifestations of ANGBC are not specific, which is the cause of diagnostic errors. Also, patients can ignore the discomfort and even pain in the hip joint. This clearly does not contribute to the identification of the disease in the early stages.

Diagnostics

The main diagnostic methods are X-ray and magnetic resonance imaging (MRI). In the early stages of ANGBC, it is especially important to carry out MRI, because on radiographs it is not always possible to identify initial pathological changes.

According to the generally accepted classification, five stages of X-ray changes are distinguished with aseptic necrosis of the femoral head. The tactics of treatment are different for each of them. In addition, radioisotope scanning, ultrasonography, measurement of pressure inside the bone, etc., are sometimes used.

Treatment

In the treatment of aseptic necrosis of the head of the femur, the early onset of it is very important. In this case, there is much more chance of success of therapy. All methods of treatment of ANGBC are divided into conservative and surgical.

Conservative treatment

Such treatment often takes several years. An integrated approach to such therapy is used, which consists of several components. We will discuss them below.

Orthopedic treatment

The basis of conservative therapy is the mechanical prevention of deformation of the head of the femur. To remove the load on it, the following methods are used:

• Bed rest.
• Different methods of stretching - cuff, adhesive tape, etc.
• Gypsum dressings and tires.
• Special orthopedic devices (Atlanta, SRH, MHE, etc.).

The type of unloading, as well as the duration of immobilization (fixation) of the joint is determined by the doctor in direct proportion to the degree of injury and progress in treatment. This type of treatment usually ranges from a few months to a year and a half. A combination of unloading with physiotherapy and physiotherapy is essential.

Excess weight creates an additional burden on the hip joint. Therefore, it is necessary to achieve weight reduction in the body in such cases.

Medication

In the initial stages of ANGBC, medications are prescribed to improve microcirculation in the affected joint.

This achieves a reduction in ischemia (bleeding) in the affected areas of the bone, as well as a decrease in blood viscosity and the tendency to excessive thrombosis.

To stimulate the regeneration (recovery) of bone tissue, various biogenic stimulators are used, for example, the vitreous in combination with the vitamins of group B. To improve the condition of articular cartilage, chondroprotectors are prescribed.

Physiotherapy

It is used in practically all patients with ANHBK in combination with other methods of treatment.

Usually, electrophoresis with various drugs is used. For example, electrophoresis with procaine or lidocaine can significantly reduce pain. Affects the area of ​​the affected hip, lower thoracic and upper lumbar spine.

As the pathological manifestations abate, treatment is provided in specialized balneological and mud cure sanatoriums. It is obligatory to conduct exercises of therapeutic physical training - exercise therapy. This is worth considering in more detail.

Physiotherapy

LFK is appointed from the moment of diagnosis. The complex of exercises is developed strictly individually for each patient, taking into account the degree of defeat of the head of the femur.

LFK exercises are conducted daily under the guidance of a certified instructor. The ultimate goal of such exercises is to restore the normal volume of movements in the affected hip joint. And also - prevention of contractures (stiffness) in other limb joints.

Surgery

According to statistics, approximately 5-15% of ANGBC patients are conducted. The main indication for the operation is the apparent ineffectiveness of conservative treatment and the progression of the disease with the development of complications.

To date, there are several types of operations that are used for aseptic necrosis of the head of the femur. The choice of a specific type of surgery is determined by the doctor, taking into account all indications and contraindications to such treatment.

Decompression of the femoral head

Another name for this operation is tunnelization. It is used in severe pain syndrome to reduce intraosseous pressure.

The principle of the operation is to drill one or more channels in the head of the femur with a special instrument. Often this procedure is combined with the maintenance of bone preparations that improve blood circulation.

Autograft transplantation

Transplantation of an autograft from the fibula is a fairly technically complicated operation.

Its essence consists in transplanting a part of the fibular bone of the patient together with the vessel.

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This provides two effects at once: strengthening the affected bone tissue of the femur and improving its blood supply.

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Unfortunately, sometimes thrombi appear in the transplanted vessel, which makes such an operation ineffective.

Osteotomy

There are many varieties of this operation with ANGBC. Interstitial osteotomy is most commonly used. At the same time, a part of the femur is excised at the level of its skewers. In the new position, the bone is fixed by various devices - screws, plates, etc.

After such an operation, the area of ​​articular surfaces increases, and the focus of necrosis is shifted to the less loaded zone of the joint. This allows you to create conditions for its regeneration (recovery).

Arthroplasty

The essence of the operation is the creation of new articular surfaces in the hip joint. The principle of such an operation depends on the type and area of ​​the pathological changes that have occurred.

The aim of such an operation is to increase the normal volume of movements in the hip joint, reduce lameness and intensity of pain.

Atrodesis

The most often performed in patients who for some reason are contraindicated endoprosthetics. The essence of such an operation is the creation of artificial immobility (adhesion) of the joint in order to eliminate the expressed pain syndrome.

Artrodes is used in a small part of patients. It is a "crippling" operation, since later on such patients develop an obvious skewing of the pelvis and curvature of the lumbar spine sideways with the corresponding neurological symptoms.

Endoprosthetics of the femoral head

It is most often used in the later stages of ANGBC. Especially shown with the development of its complications, for example, osteoarthrosis. Is, perhaps, the most common operation in this pathology.

In carrying out such a surgical procedure, the head of the femur is replaced (prosthetically). The prosthesis is made of materials that are fully compatible with human tissues - titanium, zirconium,

Consequences of aseptic necrosis

With timely diagnosis and started treatment, even in the early stages of the disease, it is possible to achieve a noticeable improvement in the patient's condition. And the younger the patient, the greater the likelihood of almost complete cure.

Progression of the disease significantly worsens the quality of life of the patient and usually leads to disability due to the development of deforming osteoarthritis of the hip joint (coxarthrosis). This complication is characterized by the development of contractures (stiffness) in the joint. And in combination with a fairly pronounced pain syndrome, it significantly complicates the life of a sick person.

That's why do not ignore even minor discomfort in the joints and immediately seek medical help.

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Aseptic necrosis of the head of the hip joint

Aseptic necrosis of the head of the hip joint is a dangerous disease. If untimely detection can lead to dangerous complications. Treatment of this illness should be carried out with the help of qualified specialists.

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The hip joint is considered one of the most important and complex parts of the human musculoskeletal system. The head is a spherical protrusion that connects to the femur by means of the neck of the thigh.

The head is connected to the acetabulum, located on the hip bone. Together they form the hip joint.

It is important because it takes about 40% of all human movements and it is on him that the pressure of the upper body is. For this reason, the joint is often subjected to various injuries and diseases.

One of these diseases is aseptic necrosis of the hip joint. This is the name of the disease, which leads to the necrosis of the tissues.

A feature of aseptic necrosis is the absence of infection of the affected area. With this disease, there is a violation of the microcirculation of the joint with the subsequent death of bone tissue.

According to statistics, this disease affects mainly the male population aged 25 to 45 years.

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Causes of the disease

Necrosis of tissues arises from the violation of their blood supply. To tissues stops to arrive oxygen and nutrients in sufficient volume. Most often this occurs in those areas, whose blood supply is limited.

Causes of insufficient blood supply to the hip joint can be as follows:

1. Mechanical injuries, such as fractures, dislocations, joint bruises, can lead to squeezing of arterial vessels or the formation of blood clots.
2. The intake of hormonal drugs for a long time narrows the blood vessels and disrupts the blood flow.
3. Excessive use of alcohol disrupts metabolism, promotes the deposition of cholesterol. Because of cholesterol, the walls of the vessels thicken and lose their elasticity.
4. Necrosis often occurs against the background of other diseases. Also the influence is exerted by stress, overwork, nervous tension.
5. Obesity leads to additional stress on the musculoskeletal system.

Often the combination of several causes leads to the development of this disease.

Certain risk groups should also be considered:

• Miners, divers and other professions associated with high pressure;
• presence of cardiovascular diseases in the patient;
• people suffering from anemia, pancreatitis, Caisson's disease.

In some cases (about 30%), the cause of the disease remains undetected. Then necrosis is called idiopathic, that is causeless.

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Characteristic symptomatology of the disease

Symptoms of aseptic necrosis directly depend on the stage of the course of the disease. Depending on the degree of disease, these or other symptoms manifest themselves. At the first manifestations of the disease, the patient has painful sensations.

The pain concentrates in the pelvic region, but can spread throughout the extremity, in the groin and lower back. The first stage of aseptic necrosis of the head of the hip joint lasts up to six months.

The patient is not limited in movement, however, when walking and running, the pain syndrome increases. In a state of rest, the pain sensations do not stop and continue to disturb the patient.

The patient has lameness, since the load on the joint during movement is largely due to a healthy leg. There is limited movement of the joint, an attempt to move one's foot to the side causes severe pain.

At the third stage (sequestration), the muscles continue to atrophy. The injured leg is shortened, and decreases in volume in the region of the shin. Lame is pronounced, mobility is significantly limited.

Pain syndrome is very strong. The state of rest brings only a slight relief. At the fourth stage (reparation), the pain sensations do not stop.

Atrophy of the muscles of the diseased limb and buttock is clearly pronounced. The volume decreases on average by 5 - 8 cm.

You can identify common symptoms that characterize the presence of joint disease:

• pain in the thigh;
• amyotrophy;
• limitation of joint mobility;
• lameness, shortening of the damaged limb.

All these symptoms increase with the course of the disease.

It is important to understand that when the first signs of the disease appear, you should immediately contact a qualified specialist.

Timely treatment of the disease will help to avoid undesirable consequences.

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Stages of development of the disease

Necrosis can affect different parts of the head of the hip joint.

Depending on the location of the damage, it is customary to distinguish the following forms of the disease:

• peripheral - the external part of the head under the articular cartilage is affected;
• central - the central part is affected;
• segmental - necrosis in the upper part of the head;
• the head is completely affected.

As noted above, aseptic necrosis of the joint head undergoes four stages of the disease.

At the initial stage of the development of the disease, the bone head retains its original integrity, the bone beads become necrotic (the spongy substance is destroyed). Their micro-fractures are observed, the subchondral region is compacted.

The second stage is characterized by the presence of cracks and multiple fractures of bone beams. This is due to the resorption of dead tissue around intact bone sites.

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The healthy bone becomes weakened and does not cope with the imposed load. The areas of damage grow.

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At the stage of sequestration, the resorption of damaged bone fragments continues. The connective tissue begins to expand, filling the cavities in the joint, bone growths are formed.

This gives an opportunity for the growth of new vessels. Simultaneously with these processes, the joint deforms, which leads to a shortening of the limb. This stage lasts about a year and a half.

The restoration of the spongy substance begins. The duration of each stage is strictly individual for each patient and depends on the level of progression of the disease.

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Methods of instrumental diagnostics

The disease is difficult to diagnose at the initial stage of leakage. In addition, the symptoms of necrosis are in many respects similar to some other diseases of the human musculoskeletal system.

Only a qualified doctor can diagnose an accurate diagnosis. In the diagnosis of necrosis of the femoral head, instrumental methods of investigation play a huge role.

At the first stage of diagnosis, radiography is used. She gives information about the changes in bone tissue. At an early stage of the course of the disease, the radiograph is ineffective, since the joint structure has not yet been changed.

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With an impression fracture, it is already possible to mark areas of necrosis and cracks in the joint head. At the third stage of the disease, the deformation of the femoral neck is clearly visible, and the contours of the bones are modified. During the repair, the shape of the acetabulum and the femoral head changes.

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To diagnose the disease at the first (dorotgenological) stage, computer (CT) and magnetic resonance imaging (MRI) are used. These methods help determine the changes in the structure of bone, cartilage and soft tissue.

The resulting images will clearly see the impression (crushing) of bone fragments. To diagnose the state of blood vessels, a special contrast agent is injected into the patient's body.

Magnetic resonance imaging is considered to be the most effective and informative method of investigation at an early stage of the disease course.

With MRI, it is possible to detect even minor changes in the structure of the head of the femur, the swelling inside the bone and the inflammatory processes that occur in the affected area of ​​the joint.

As with CT, the condition of the vessels is determined by the introduction of a contrast medium intravenously into the patient's body.

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Changes in laboratory analyzes

Laboratory methods of research are widely used to diagnose the death of bone tissue along with instrumental. To identify necrosis, the patient's blood and urine are examined.

In the blood, the level of mineral substances and the presence of certain substances, the presence of which characterizes the resorption of bone tissue, is studied.

In the study of blood, special attention is paid to changes in the level of calcium, phosphorus and magnesium, since these elements are fundamental in the formation of bones. If the patient has necrosis, the level of these minerals decreases.

Specific substances of decay of bone tissues (markers) in patients with aseptic necrosis are found both in the blood and in the urine of the patient. The presence of these substances is due to the destruction of the collagen protein responsible for the strength of bones.

Laboratory tests also help to detect new bone tissue. In this case, the blood level increases the level of the substance - osteocalcin.

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Effective medication

It is important to understand that the scheme of treatment largely depends on the early diagnosis of the disease. Non-surgical treatment of aseptic necrosis of the head of the hip joint is possible only at an early stage of the disease.

Therapeutic treatment of the early stage of development of necrosis, first of all, is aimed at restoring normal blood circulation of the joint, removing edema and pain syndrome. For these purposes, various medications are used.

First, the patient is prescribed drugs of vasodilator action. They stimulate blood circulation in the damaged joint and prevent the formation of blood clots.

The purpose of anti-inflammatory drugs allows you to remove swelling and reduce pain.

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Diphosphonates and preparations containing calcium help restore bone tissue and increase its strength.

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In addition to drug treatment, the patient is prescribed physiotherapy and therapeutic gymnastics. At the beginning of treatment, the patient is recommended to reduce the load on the damaged joint as much as possible, increasing it gradually.

Therapeutic gymnastics is appointed by the doctor taking into account the individual characteristics of the patient. It is aimed at preventing muscle atrophy and restoring the motor function of the leg.

Physiotherapy includes electrophoresis, UHF therapy, paraffin wrap, massage, balneotherapy. Electrophoresis is aimed at vasodilation, increasing blood flow and reducing pain.

The action of ultrahigh frequencies generates heat in the affected areas. This increases blood flow and promotes the formation of blood vessels. The essence of balneotherapy is the adoption of therapeutic baths, which have a therapeutic effect on the human body as a whole.

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Operation with aseptic necrosis and its variety

Surgical intervention is required for the patient if conservative treatment methods are ineffective. As practice shows, operation with aseptic necrosis of the head of the hip joint is required in 80% of cases.

There are several methods of performing surgical treatment, which depend on the degree of damage to the joint.

With necrosis of the first and second stages, it is recommended to perform tunneling. The purpose of this procedure is to reduce intraosseous pressure.

In the second and third stages of the course of the disease, artoplastic or interstitial osteotomy is used. Interstitial osteotomy is the dissection of the hip bone and the fixation of bone debris with screws.

For some time after the operation, it is recommended to limit joint mobility, for this purpose, a plaster bandage is applied. With artoplasty, damaged areas are replaced with special gaskets.

These pads serve as a cartilaginous tissue. At the fourth stage of the disease, endothetics are performed, in which the damaged joint is completely replaced by an artificial prosthesis.

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Possible consequences of the disease

To avoid the undesirable consequences of such a serious disease as an aseptic necrosis, it is necessary, when the first symptoms appear, to go to a medical institution.

An expert in the diagnosis and treatment of the human musculoskeletal system is an orthopedist or surgeon.

As already mentioned above, the effectiveness of treatment largely depends on the timely treatment of the patient to the doctor and accurate diagnosis of the disease.

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Treatment of the disease at the very beginning of its development helps to minimize the occurrence of undesirable consequences.

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Untimely treatment and ignoring the patient's recommendations of the doctor, as a rule, leads to a significant or complete restriction of mobility of the joint.

Another possible outcome is disability and, as a consequence, a decrease in the quality of life of the patient. The optimal option for the patient is to prevent the disease and minimize the risk of its occurrence.

To do this, you must follow the following rules:

1. Control your own weight, avoid obesity.
2. Eat balanced, restrict the consumption of fat, enter the diet foods rich in calcium, magnesium, phosphorus.
3. Avoid excessive physical exertion on the joint, which can lead to injury.
4. Refuse bad habits (smoking, drinking alcohol).
5. Monitor the health of the body as a whole. Remember the effect on the functioning of joints of other diseases.

In case of a favorable outcome of treatment, the progression of the disease stops or the condition of the joint improves.

The motor function of the joint is restored almost completely, although the pain syndrome continues to periodically disturb the patient.

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Timely treatment of necrosis of the head of the hip joint

Recommendations of orthopedist and rheumatologist ...

information for reading

Necrotic lesion of the largest joint in the body occurs against a background of circulatory disorders. Many pathologies and temporary phenomena can lead to this.

In another way, this disease is called avascular necrosis of the joint head, and its clinical manifestations are similar in many respects to the inflammatory process in the organ.

Already at the beginning of the disease there are severe pains in the hip joint

Symptoms of tissue death:

• severe pain during movement, as the disease progresses, this symptom is also manifested in a state of rest;
• It is impossible to stand on one foot on the part of the diseased organ, when walking, a person limps;
• the inability to move one's foot to the side while sitting;
• active muscle atrophy, reduction of hip volume from the affected side;
• shortening limb, why also there is lameness.

All these manifestations are already visible at the beginning of the pathological process. Without therapy, there are unpleasant consequences of necrosis of the head, the treatment of which can not do without surgical intervention.

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Dependent on the degree of organ damage, four stages of necrosis are distinguished:

1. In the first stageaseptic osteonecrosis, soreness is observed during exercise, there is already a small limitation of mobility, and pain in the groin area is also felt.
2. In the second stageX-rays indicate the presence of a crack, which occupies about 25% of the surface of the organ, tenderness and discomfort intensify.
3. In the third stageyou can see extensive damage to the head of the organ, other processes join, and unpleasant consequences can occur if treatment is not started.
4. At the last stagethe patient has almost no mobility of the limb from the patient side, the pain does not stop even when taking strong analgesics.

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The following factors can provoke a dangerous pathology:

• traumatic injury or chronic trauma in the pelvic region;
• focus of the inflammatory process, infections in the body;
• drug intoxication, intake of hormonal and antibacterial agents;
• alcohol dependence, alcohol poisoning;
• vein thrombosis and blood poisoning, sepsis;
• excessive physical activity, heavy weight.

Diagnosed more often bilateral osteonecrosis, which further complicates the treatment. This form of pathology is extremely dangerous, because without adequate and timely treatment the patient can remain without legs.

The group with an increased risk of developing necrotic lesions of bone and cartilaginous tissue is people with congenital anomalies.

The diseases that have been transferred to childhood also play a role, since violations in the period of development are already felt by a fully formed person, when the organs must work together.

Diagnosis of pathology

Confirm the diagnosis will allow the following activities:

• standard radiography and magnetic resonance imaging:
• cytological examination of pathological material;
• a common blood and urine test.

The doctor also sees the changes visually: one limb is shorter, the thigh is more thin from the patient side, the person is limping. Complaints about the pain and severity of the movement are taken into account.

Left - X-ray of a healthy hip joint, on the right - affected by osteonecrosis

How is the treatment performed?

Elimination of osteonecrosis and its consequences can be carried out conservatively or surgically, depending on the degree of tissue damage.Drug therapy can not completely eliminate the death of tissues, because more often doctors are inclined to surgery.

The local impact on pathology is also required, therefore, various physiotherapeutic procedures are carried out. This is electrophoresis, stretching, physiotherapy exercises, massage. All this is necessary to improve local circulation and increase the organ's mobility.

Hip replacement

Medications for osteonecrosis

From medicamentous agents the following groups of preparations are appointed:

• non-steroidal anti-inflammatory drugs;
• strong analgesic drugs;
• vasodilator tablets;
• sedatives and antidepressants;
• drugs to stimulate microcirculation;
• immunomodulating and vitamin complexes.

These same medicines are also prescribed after a surgical operation to remove the pathological focus. Therapy with folk remedies can only be carried out under the supervision of a specialist and as an additional method of maintaining the condition.

Operative treatment

The operation is carried out with the appearance of unpleasant consequences. Its essence lies in the complete removal of the necrotic focus and part of healthy tissues in order to avoid re-infection. The indication will also be a change in the position of the joint head when it is deformed in order to increase strength.

Implant for the treatment of the hip joint

Complications and consequences

The most serious complication is the transition of necrosis to muscle tissue and the gradual death of limbs.

In this case, it will not be possible to save the leg, it will be necessary to amputate it.

No less dangerous consequence will be sepsis, blood infection, which without timely medical assistance can lead to death.

Prophylaxis and prognosis

Primary prevention consists in observing the regime of physical activity.

Hard work or physical inactivity can become decisive in the appearance of ailment.

Secondary prevention includes the use of anti-inflammatory drugs, immunomodulators, in order to prevent the effects of osteonecrosis.

Disease of the largest joint in the human body is extremely dangerous, and when anxious signs urgently need to see a doctor for diagnosis and course.

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A source: http://SustavInfo.com/travmy/lechenie-nekroza-goloi-tazobedrennogo-sustava/