Lifelong general recommendations after hip replacement. Sports after endoprosthetics Is aseptic necrosis of the femoral head treated?

Content

With aseptic necrosis, the head of the femur is damaged due to a disruption in its oxygen supply. The most serious complication of this disease is gangrene, which will ultimately lead to amputation of the limb. Doctors strongly recommend treating avascular necrosis of the head of the hip joint at the first symptoms. Diagnosis in the early stages of the disease will help avoid the risk of developing many serious illnesses.

Causes and symptoms of avascular necrosis

These are vascular diseases when blood microcirculation changes, which leads to the development of foci of tissue necrosis. The cause of the disease can also be excessive load on the hip joint. This is due not only to a person’s profession (truck drivers, parquet floor workers, gas welders), but also to excess weight and a shift in the center of gravity when walking.

The reasons for the development of necrosis of the hip joint may be associated with metabolic disorders in the human body or with a genetic predisposition. But none of the above factors can independently cause this disease; it develops only as a result of a combination of several conditions.

Depending on the severity of damage to the hip joint, the course of the disease has stages, each of which is characterized by the following symptoms:

At the first stage of the development of the disease, rare pain and minor bone changes are observed. Slight pain radiates to the groin, but mobility in the hip joint remains.
At the second stage, cracks appear on the head of the hip bone, which can occupy up to 30% of its surface. The pain in the affected area intensifies.
At the third stage of the disease, the acetabulum is involved in the process, and up to 50% of the articular tissues are affected. The pain becomes constant and severe, and joint mobility decreases.
Motor function is completely reduced, severe pain never stops, the muscles of the buttock and thigh atrophy.

Types and stages of disease development

The stages of development of aseptic necrosis of the head of the hip joint do not have a clear distinction between each other. The first stage lasts about six months, when pain occurs during exercise or during bad weather, after the disappearance of the provoking factor it goes away. The second stage also lasts about six months. During this period, thinning of the muscles of the buttock and thigh appears.

The third stage takes a longer time - up to 2.5 years, during which the tissue surrounding the necrosis zone resolves. Patients are already beginning to move exclusively with a cane. In the fourth stage, which develops over about 6 months, patients cannot move on their own. However, the duration of development of the disease is individual for each person, depending on concomitant diseases, timely treatment and other factors.

Doctors distinguish four types of necrosis:

Segmental (observed in 48% of patients with this diagnosis). A small area of necrosis appears as a cone on the upper part of the femoral head.
Complete necrosis (diagnosed in 42% of patients). The entire head is affected.
Peripheral (occurs in 8% of patients). The pathology affects the outer part of the head, located under the articular cartilage.
Central (observed in 2% of cases). A zone of necrosis forms in the center of the head of the femur.

Diagnostic methods

If you experience pain in the pelvic area, you should consult a doctor, who, based on the symptoms, will prescribe a diagnostic examination. With early detection of the disease and adequate treatment, patients have a chance to avoid subsequent surgical intervention. The choice of research method depends on the stage of the disease.

Hardware

Mandatory hardware diagnostics of the disease include blood pressure monitoring (to exclude the presence of hypertension), an electrocardiogram (to exclude heart disease) and ultrasound densitometry, when the condition of the patient’s bone tissue is determined by the degree of absorption of ultrasonic waves and the speed of their passage through it. Hardware diagnostic methods are effective both in the early stages of the disease and in later stages, when it is necessary to monitor changes in bone tissue during treatment.

Radiography

To check the condition of the hip bone, the doctor will definitely send the patient for an x-ray. When it is carried out, photographs are taken in two projections: from the side or directly. In the first case, the patient is placed on the table, lying on his back, the leg being examined is bent at the knee and moved to the side by 90 degrees. In the second, the patient lies on his back with straight legs, and the feet are fixed inward using special rollers. If the joint is motionless, then the patient is placed on his stomach, and the opposite side of the pelvis is fixed with bolsters.

Computed tomography

Using CT (computed tomography), the patient's bones and soft tissues are examined layer by layer. X-rays are absorbed by tissues of varying densities as they pass through the body and then hit a sensitive matrix, which transmits the data to a computer. Computed tomography determines the structure of the articular cartilage and the damaged head of the hip bone. During the procedure, the patient is placed on the tomograph table, lying on his back, and the doctor uses a remote control to move the table so that the desired area of study is in the frame of the device.

Magnetic resonance imaging

The principle of this study is to obtain images of the patient’s bones and soft tissues using electromagnetic waves. Magnetic resonance imaging (MRI) helps to identify the focus of changes in the femoral head at a very early stage and detect even small intraosseous edema or inflammation. During the examination, a person is placed in a tomograph flask, in which he must lie motionless for 10-20 minutes. At this time, a series of photographs are taken, and the doctor monitors the patient using a video camera.

Laboratory research

If aseptic necrosis of the head of the femur is suspected, the patient is always referred for urine and blood tests. They are taken to determine mineral levels in the body and identify markers of bone formation. When the disease occurs, natural collagen is destroyed and, breaking down, forms markers that are excreted from the body along with urine. These studies are prescribed both to diagnose the disease and to evaluate the treatment.

Which doctor should I contact?

If mobility in the hip joint is impaired or pain occurs when walking, you should immediately contact a surgeon or rheumatologist. For a more informative diagnosis, one specialist often refers the patient to another for consultation. In multidisciplinary clinics, joints are dealt with by an arthrologist who identifies all types of aseptic necrosis.

Treatment

After a medical examination and diagnosis, the doctor prescribes treatment. The complex of therapeutic measures in the early stages of the disease includes: drug therapy, massage, mud baths in sanatoriums, vitamin therapy, hirudotherapy (treatment with leeches), swimming. However, conservative methods do not lead to a complete cure of the disease, but only inhibit its development, preserving the function of the joint for many years.

No modern medicine can completely destroy the necrotic process. If it is not possible to slow down the development of the disease, then doctors use surgery. This is the only radical treatment for necrosis of the femoral head, which can significantly improve the living conditions of a person with this disease. Surgeries are used at all four stages of the disease.

Medication

The tactics of drug treatment depend on the development of symptoms, the age of the patient and the complete picture of the disease after a thorough diagnostic examination. Medicines that doctors prescribe for this disease:

Non-steroidal anti-inflammatory drugs. They are prescribed to relax the thigh muscles, restore normal blood circulation and relieve pain. The course of treatment is one ampoule intramuscularly daily for a week. Well-known drugs are Naklofen, Diclofenac, Xefocam, Ibuprofen.
Vasodilators. They eliminate blood stagnation and improve arterial blood flow. The dosage regimen depends on the severity of necrosis of the hip joint, but is at least 8 weeks with repeated courses every six months. Popular vascular agents are “Curantil”, “Trental”, “Dipyridamole”, “Xanthinol nicotinate”.
Regulators of calcium metabolism, preventing excessive loss of calcium. They improve the process of bone restoration and reduce collagen destruction. The drugs are used for at least 8 months continuously or at intervals of several weeks. The best drugs are “Calcium D3 nycomed”, “Xidifon”, “Bonviva”, “Fosamax”, “Vitrum”, “Osteomag”, “Osteogenon”, “Alfacalcidol”.
Chondroprotectors. These are the most effective drugs at stage 3 of necrosis of the hip joint, when the cartilage in the head of the femur begins to peel off and destroy. They help restore cartilage tissue by stimulating ligament regeneration. These drugs must be taken in long courses, at least 6 months, with an interval of six months. The most famous chondroprotectors are “Structum”, “Chondroitin sulfate”, “Chondrolone”.
Muscle relaxants. These drugs can relax muscles, thereby inhibiting the transmission of nerve impulses, improving blood circulation. The course of treatment is 15-20 days, one tablet 2 times daily. The best relaxing drugs are “Mydocalm”, “Sirdalud”.

Surgical methods

If drug treatment does not produce results, surgery is performed. In the first stages of aseptic necrosis of the hip joint, it is used for decompression of twisted vessels that do not provide adequate nutrition to the head of the femur, or for transplantation. Types of surgical treatment:

tunneling, when additional holes are formed in the bone to reduce pain and intraosseous pressure;
transplantation of a musculoskeletal graft to increase local blood flow and eliminate pain;
intertrochanteric osteotomy to eliminate the worn part of the femoral head and redistribute the load to other areas;
arthrodesis (artificial fusion) to immobilize the joint to eliminate pain;
arthroplasty to increase range of motion, eliminate lameness, and improve blood supply to the hip joint.

At stage 4 of the disease, endoprosthetics is used, when the destroyed joint is replaced with an artificial one. The duration of use of the prosthesis is about 15 years, after which it requires replacement. All surgical operations are performed under general or epidural (in the lumbar region) anesthesia. The timing, level and scope of rehabilitation depend on the surgical technique and the individual characteristics of the body.

Therapeutic gymnastics and massage

One of the main methods of treating aseptic necrosis is therapeutic exercises. Physical exercise does not require any financial investment. All the patient needs to maintain health is a little free space on the floor and a rug. Instead of active dynamic exercises, you need to do static movements while lying on your back, for example, slowly raising your leg and holding it suspended.

Therapeutic massage can also bring tangible benefits to a sick person, provided that it is done by a professional, and inept treatment will only lead to a worsening of the condition. Proper massage for necrosis of the hip joint is done softly, smoothly, without sudden movements. It should provide the patient with a feeling of warmth and comfort without causing pain or injury.

Medical centers

Conservative and surgical treatment of necrosis of the hip bone is carried out both in Russia and abroad. But prices for services in clinics in Germany, Israel and other countries are an order of magnitude higher than in medical centers in Moscow or St. Petersburg. The quality level of Russian medicine is in no way inferior to foreign clinics. Here are the addresses of leading medical institutions in Russia where effective treatment of aseptic necrosis is carried out, and prices for services:

Procedure name	Price, rub.	Clinic address
Corrective osteotomy of the femur for necrosis of the head of the hip joint		"GrandMed" Moscow, st. Sadovaya, 35
Revision hip replacement (without cost of implants)		"Garant Clinic" Moscow, st. Vavilova, 97
Hip replacement (without consumables and cost of prostheses)		"Central Clinical Hospital of the Customs Service" Moscow, Otkrytoye Shosse, 32
Hip replacement for necrosis of the femoral head (without implant cost)		"Medical Union" St. Petersburg, Grazhdansky Avenue 68 A
A set of procedures for rehabilitation after endoprosthetics		"Pension Baltiysky" St. Petersburg, st. Baltiyskaya, 2/14

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According to statistics, necrosis of the femoral head affects men more often than women. The disease usually affects people 20-50 years old and often leads to disability, so it is very important to diagnose it in the early stages.

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What is aseptic necrosis of the femoral head? Practicing doctors often encounter ANFH. This is a rather severe pathology, which is characterized by a chronic course. The provocateur of this condition is a failure in the local circulatory system. As a result, the bone tissue in the femoral head is subject to destructive effects. According to statistics, it mainly affects the male half of the population. In fifty percent of cases, both lower extremities are affected by the pathology, i.e., initially the process occurs on one leg, and after a short period, about a year, it forms on the other.

Structure and layers of bone tissue

Bone tissue contains different cells, each of them performs specific functions:

Osteoblast - this cell is responsible for creating bone tissue. They are located in those areas of the bone that are growing. On the outside, the cell is surrounded by a matrix; when it hardens, this cell receives a different name.
An osteocyte is a mature bone cell formed from a previous one. The enzymes it synthesizes maintain the mineral concentration of the matrix.
Osteoclast - responsible for removing bone tissue. The need for them is explained by the regular formation of new tissue. Normally, a balance is maintained between destruction and formation.

Age and some other factors have a negative impact, under the influence of which the activity of destructive cells begins to prevail over forming ones. As a result, without having time to renew itself, bone tissue is destroyed. The Haversian system, or osteon, which is a structural unit of bone tissue, has the appearance of a cylinder. It is formed by bone plates, between which there are osteocytes. Osteons are grouped into so-called crossbars, they are also called beams or trabeculae. Their special structure and location allows the bones to be elastic and dense. Depending on how the beams lie, the following layers are distinguished:

the outer one is the periosteum;
internal - spongy bone substance;
medium - compact.

Anatomy of the hip joint and femur

The femur is the thickest and largest bone in humans and is called the long lever of movement. At its proximal or upper end there is a rounded articular head. Using the neck, which is a narrowed section, it connects to the rest of the femur. In the area where the neck communicates with the bone body, there are two tubercles (apophyses). The articular surface covering the head of the femur, through which the head is connected to the socket of the pelvic bone, forms the hip joint. It is located directly under special soft tissues that synthesize a special fluid. It is called articular. It is what contributes to the nutrition of cartilage tissue and the gliding of the joint.

Development of aseptic necrosis

The mechanism of development of necrosis of the head of the hip joint has not yet been fully studied. There are several theories:

Vascular - negative processes occurring in the vessels lead to ischemia. This phenomenon is preceded by blockage or narrowing for a long period, as well as thickening of the blood. As a result, blood circulation at the local level is disrupted, and the bones begin to lose strength. The process of destruction during this period prevails over the formation of new tissue. Fractures of the crossbars are provoked by any load, which results in the formation of venous congestion and blood clots. This condition provokes an increase in intraosseous pressure, and an even greater negative effect on blood flow. Bone tissue dies in the place where there is the greatest load on the femoral head. The first areas of death (necrosis) appear already on the fourth day after the circulatory disturbance. If the unfavorable factor disappears, the blood flow returns to normal and the damaged tissue is restored. Otherwise, the process develops further.
Traumatic - the integrity of the bone tissue is damaged due to dislocation, fracture, etc.
Mechanical - as a result of various factors, bone overwork occurs. Signals entering the brain from the femoral head cause reverse impulses that provoke vasoconstriction. As a result, the exchange processes fail. The blood flows poorly, begins to stagnate and, as a result, decay products begin to accumulate in the bones.

In medicine, there is no clear division between the above theories.

Factors causing avascular necrosis

The causes of aseptic necrosis of the femoral head are as follows:

Long-term use of hormonal drugs for the treatment of chronic pathologies: bronchial asthma, rheumatic diseases, etc. According to doctors, the most common cause of aseptic necrosis of the head of the hip joint is the use of corticosteroids. The negative effect of hormonal drugs is that they constrict blood vessels for a long period, causing disruption of blood flow. In addition, these medications make bones less dense and provoke their destruction, and broken bone bars block the path of blood to the femoral head.
Impacts of any nature that can lead to disruption of the integrity or flow of blood in the head of the femoral bone provoke tissue death.
Traumatic or surgical intervention. Both processes increase the likelihood of blood clot formation or vessel rupture. In the future, this leads to a failure of blood circulation. The disease does not manifest itself immediately, but after some period after the damaging effect. Clinical signs will not be visible until twelve or more months later.
Taking NSAIDs and painkillers. Therapy with these drugs over a long period of time provokes damage to the trabeculae of the bone and causes osteoporosis. As a result, even a slight increase in load or disruption of blood flow to the femoral head provokes the development of the disease.
Autoimmune conditions are also one of the causes of avascular necrosis of the head of the hip joint. The inflammatory process provokes a violation of the elasticity of the vascular wall and local blood flow. And long-term use of hormonal drugs used to treat chronic autoimmune pathologies leads to a severe course of ANFH.
Regular intake of alcoholic drinks. The development of atherosclerosis is provoked by a violation of the metabolism of fat and protein products, as well as the deposition of lipoproteins on the walls of blood vessels. As a result, they thicken, become less elastic, and the femoral head is less well supplied with nutrients from the blood. An acute decrease in its blood supply is observed with a single consumption of alcoholic liquid in a large volume.
Caisson disease. This disease is mainly diagnosed in miners and divers. As a result of an instantaneous decrease in the pressure of the gas mixture that the individual inhales, gas bubbles enter the blood and cause an embolism.
Pathological processes in the spine, especially in the sacrum or lumbar region. Hernias that form between the vertebrae contribute to vascular spasm, disrupting the nutrition of bone tissue.

Unfortunately, in thirty percent of cases, it is not possible to identify the exact cause of the formation of ANFH.

X-ray of the hip joint

X-rays are usually taken in two projections. This test allows the doctor to obtain information about the condition of the bone.

Abnormal signs of aseptic necrosis of the head of the hip joint on x-ray vary according to the stages:

The first is that there are no changes that imply destruction. Visually, the deformation of the shape of the head and the structure of the bone tissue is not visible.
Second, destruction of the crossbars and small areas of necrosis are noticeable.
The third is that the neck is shorter and thicker, the femoral head consists of separate fragments.
Fourth - growths are visible along the edge of the acetabulum, and it itself is flat and irregular in shape.

Such a complex problem as aseptic necrosis of the head of the hip joint is devoted to a large number of webinars on the radiologists’ portal, conducted specifically for specialized specialists. In addition, you can discuss interesting cases, watch, and participate in Internet broadcasts.

Stages and types of aseptic necrosis of the femur

The division into periods is considered conditional; the transition from one to the next is carried out without any clear boundaries. Let's look at the stages of necrosis of the hip joint and the symptoms characteristic of each of them:

Initial signs of the disease. It lasts approximately six months. The head of the femur does not change shape, but the death of the bone beams is present. The symptom of the disease is pain, which at the very beginning occurs only during physical activity or in damp weather. It goes away at rest and under favorable weather conditions. Over time, with aseptic necrosis of the head of the hip joint, pain becomes a constant companion. Periods of rest are replaced by exacerbation in the presence of a provoking factor. Sometimes severe pain can appear unexpectedly. In such a situation, patients are unable to walk or even sit. After some period it subsides and increases again only after any load. Initially, the pain syndrome is concentrated in the hip joint, and is felt in the groin, lower back, buttock or knee. There is no limitation of movement in the affected joint.
Compression or impression fracture. The duration of this stage of aseptic necrosis of the femoral head is approximately six months. In some places, the femoral heads are destroyed, crushed and the bone beams crash into each other. There is a clear pain syndrome that is constantly present and does not go away even at rest. Any physical activity increases the patient's suffering. The muscle fibers on the thigh and buttock on the affected side become thinner. There are difficulties when performing circular movements.
Resorption. Its duration is from one and a half to two and a half years. Intact tissue located around the area of necrosis gradually resolves bone fragments. Islands of connective tissue, as well as cartilage, gradually grow into the head. The individual experiences constant pain and finds it difficult to move. There is a noticeable limp when walking and a cane is required. The lower limb on the injured side becomes shorter. In some patients, on the contrary, it lengthens. Doctors consider this phenomenon to be a bad sign for the prognosis of the disease.
Exodus. This stage of aseptic necrosis of the head of the hip joint takes about six months. The individual develops secondary deforming arthrosis. The spongy substance of the femoral head is revived due to the transformation of overgrown cartilage and connective tissue into bone. In addition, secondary modifications are formed, which are characterized by deformation of the bone structure and its adaptation to new loads and conditions. The acetabulum also undergoes changes and flattening. All these transformations disrupt its contact with the femoral head. In the affected area of the pelvic joint and in the lumbar region, there is a constant pain syndrome that does not disappear even at rest. The muscles of the lower leg and thigh atrophy, movements are limited. The individuals themselves are unable to move. Using a cane doesn't always help.

Above is the approximate duration of each stage, since these processes are individual and depend on timely treatment, concomitant pathologies and some other reasons.

Another systematization of aseptic necrosis of the head of the hip joint is known. The location of the area of necrosis is taken as a basis. The following types are distinguished:

Peripheral- the area of the head located under the articular cartilage is negatively affected.
Segmental- death of bone tissue occurs in the upper or upper outer lobe of the head.
Central- the center of the spherical protrusion is damaged.
Complete defeat- death of the femoral head is observed.

Signs of aseptic necrosis of the femur

Clinical manifestations are not always characteristic of this disease. Symptoms that are inherent in other pathologies may be observed, so it is sometimes difficult for doctors to make a diagnosis of “aseptic necrosis of the head of the hip joint” (ICD-10 - M87). Any disruption of the blood flow to the head significantly irritates the pain receptors. When the joint capsule is involved in this process, inflammation begins. The following stages of pain are distinguished:

The first is that the pain intensifies with exertion, can arise suddenly and stop after a few days.
The second is constant pain. At rest it subsides.
The third is constant pain, which can intensify with low load. Calms down a bit when at rest.
The fourth is severe pain that intensifies with any movement. The pain syndrome extends to the lumbosacral region.

The next symptom of aseptic necrosis of the head of the hip joint is a decrease in muscle volume and thinning, i.e. atrophy. As a result of vasoconstriction and disruption of blood supply, metabolism and nutrition in tissues decreases. The following stages of atrophy are distinguished:

no thinning or reduction in muscle volume;
atrophy of the muscles of the buttock and thigh;
the lower leg muscles are involved in the process;
atrophy spreads and reaches eight centimeters in volume.

Restriction of movement is also a symptom of necrosis of the hip joint, the cause of which lies in the inflammatory process. First of all, the restriction affects circular movements, which are impossible at the last stage of the disease, then - abduction of the body to the sides, and after a while - extension and flexion.

Shortening of the limb occurs as a result of thickening and shortening of the neck, as well as loss of the shape of the femoral head resulting from minor fractures. The gait is disturbed, and the patient begins to limp.

Methods for treating aseptic necrosis of the head of the hip joint

Depending on the clinical picture and stage of the disease, complex treatment is indicated, including surgery and pharmacotherapy. Conservative, i.e., drug treatment is especially effective in the initial stages. For these purposes, the following pharmacotherapeutic agents are indicated:

Calcium-phosphorus metabolism regulators. Taking Osteogenon has a beneficial effect on the strength of bone tissue as a result of its saturation with calcium.
Mineral and vitamin complexes. Eating them promotes more complete absorption of minerals such as calcium and phosphorus from the intestines. “Vitrum Osteomag”, “Calcium D3 Nycomed” are indicated for aseptic necrosis of the head of the hip joint for both therapeutic and prophylactic purposes (courses up to three times a year).
Bisphosphonates - ibandronic acid, sodium alendronate. They retain calcium, preventing it from being washed out. This speeds up the process of bone tissue restoration. They are prescribed for permanent or course appointments.
Medicines containing vitamin D - Alfacalcidol, Oxydevit. Increases the elasticity of bone tissue by activating protein synthesis in bone tissue. Doses and treatment regimens are selected individually.
Chondroprotectors - “Dona”, “Arthra”, “Chondroitin”, “Alflutop”, “Elbona”, “Chondrolon”. Relieves the inflammatory process, stimulates the restoration of ligaments, tendons, bones and cartilage. The course of therapy is prescribed by the doctor depending on the clinical picture of the disease.
Antiplatelet agents and vasodilators - Dipyridamole, Pentoxifylline, Xanthinol nicotinate. Helps thin the blood, increasing its fluidity. They prevent red blood cells from sticking together and fight blood clots. Thanks to the normalization of blood flow from small veins and the expansion of arteries, local blood circulation is improved. Treatment with drugs is a course, long-term. The dosage and regimen are selected individually.
Group B vitamins - “Milgamma”, “Kombilipen”, “Benevron”, “Neurobion”. The drugs help magnesium penetrate bone tissue, improve protein production and the functioning of osteoblasts. Initially, intramuscular injections are indicated, then taking tablet dosage forms.
NSAIDs - Diclofenac, Xefocam, Naklofen, Ibuprofen. Actively fight inflammation and help reduce pain. Drugs are recommended in different dosage forms.
Centrally acting muscle relaxants - Tolperisone, Tizanidine - are especially effective for painful muscle spasms. After a course of treatment, local blood flow improves.

When treating aseptic necrosis with medications, rehabilitation is also indicated:

Walking with a cane for long walks. Moving at a moderate pace for twenty minutes or walking up stairs promotes faster recovery.
Individual or group physical education classes. Exercises selected by a medical instructor are performed.
Electrical muscle stimulation is recommended as a physical therapy. As a result, it not only compensates for the lack of physical activity, but also reduces pain.

How to treat aseptic necrosis of the head of the hip joint surgically? This method is used in the absence of effect from pharmacotherapy. All interventions are performed under general or epidural anesthesia. In the arsenal of doctors there is a fairly large number of different techniques for performing operations for aseptic necrosis:

Tunnelization - additional holes are formed in the bone to reduce pain and intraosseous pressure. In addition, blood flow is restored. Surgery is performed for severe pain in the first and second stages of the disease.
Musculoskeletal graft transplantation. As a result, pain is eliminated, blood flow improves, and the femoral head is strengthened. The indications are the same as with the first method. Among the undesirable consequences of treatment of necrosis of the head of the hip joint, the formation of blood clots in the transplanted vessel should be noted.
Intertrochanteric osteotomy. The worn part of the femoral head is released from the load and redistributed to other areas. Used for second and third degree disease. After surgery, a cast is applied for a month and a half. Next, walking on crutches is allowed, and after x-rays, full weight bearing is allowed. Negative aspects - limited range of motion in the damaged joint; difficulties may arise in moving the damaged area to another area.
Arthrodesis. The purpose of this operation is to relieve pain by artificially fusing the joint. It is used in elderly people with existing contraindications to hip replacement. Next, a plaster cast is applied for three months. Then - another for the same period. Movement is allowed four to six months after surgery. The consequences are curvature of the spine in the lumbar region, immobilization of the joint.
Arthroplasty. How to cure avascular necrosis with this operation? In this case, they achieve a reduction in pain intensity, improvement of local blood supply and increase in range of motion. Several varieties of this method are known; they are used for the second and third degrees of the disease.
Endoprosthetics is the replacement of a joint with a prosthesis. The result of the operation is the restoration of movement and pain relief. This method is indicated for the third and fourth degree of pathology. After the operation, medications are prescribed that prevent blood clots from forming - Fraxiparin, Clexane.

After all types of surgical intervention, rehabilitation is indicated, which is carried out in several stages. What will be the result of the treatment? The prognosis for necrosis of the hip joint is unfavorable, as it is a very serious condition leading to disability. The patient is constantly tormented by severe pain and restrictions of movement in the diseased joint. Detection of pathology in the early stages gives a chance for a successful outcome when using conservative and surgical treatment.

ANGBK in children

In children, this disease most often occurs in boys in the age group of three to ten years. The joint of the right lower limb is mainly affected; aseptic necrosis of the head of the left hip joint is rare in practical medicine. Often it is not possible to determine the cause of the pathology. As in adults, there are four stages of the disease, the duration of which depends on various reasons. For diagnosis, CT, MRI, and radiography are used. Early treatment helps to significantly slow down the progression of the disease. It's quite difficult to make a forecast. In some cases, the destructive process in the head lasts for years, and sometimes rapidly. The choice of tactics for the management and treatment of avascular necrosis of the head of the hip joint in children depends on the duration of the pathology. At the initial stage, it is necessary to restore normal blood flow and relieve pain. In the later stages, installation of an endoprosthesis is the only option. Conservative treatment involves a whole range of measures, such as:

use of medications, including joint injections;
hirudotherapy;
use of orthopedic devices;
physical therapy;
physiotherapy.

It is important to remember that if your baby complains of discomfort in the joints, you should contact a healthcare facility.

A little history

It is known that the very first information about a disease similar to aseptic necrosis of the head of the hip joint (ICD of the tenth revision assigned it code M87) appeared in the distant thirties of the twentieth century. For many years it was compared to the destruction of the femoral head in children, the so-called Perthes disease. However, then clinicians noted that in childhood this disease is much easier, and bone tissue is able to recover while maintaining the shape of the femoral head.

Necrosis of the head of the hip joint was identified as a separate disease only in 1966. According to medical statistics, this disease is becoming a common cause of prosthetics. Unfortunately, this pathology is often detected in young people and individuals of working age. As a result, the quality of life decreases and the person becomes disabled.

The hip joint is a rather complex mechanism, consisting of a socket and a head. With the help of this bone, a person manages to maintain balance, and is also given the opportunity to be in sedentary and move around.

In medicine, necrosis is a pathology that results in tissue death of the affected organ. The reason for this condition is a violation of blood flow, as a result of which there is insufficient supply joint nutrients.

Necrosis of the hip joint is a fairly common disease, and representatives of the stronger sex suffer from it more often than women. More than 50% of cases are men 25−45 years old.

Aseptic necrosis of the femoral head in children and adults

hip joint disease is a rapidly developing disease, so at the first sign of it, you should urgently consult a doctor. Delay and untimely treatment can lead to blood infection, complete loss of ability to work, amputation of the affected limb, and, as a result, disability.

Causes of development of necrosis of the hip joint

As already stated, main cause of necrosis is a violation of the blood supply to the hip joint, as a result of which aseptic damage to the tissues of the head is observed, usually on both sides.

The following factors can provoke the development of the disease:

Venous stasis;
mechanical damage to the joint;
excessive passion for alcoholic beverages;
sickle cell anemia;
embolism;
violation of the integrity of blood vessels;
use of corticosteroids;
pancreatitis;
exposure to ionizing radiation.

Currently, medical experts have several points of view explaining the development of infarction of the head of the hip joint. It is particularly difficult to determine the etiology of non-traumatic necrosis.

There are the following theories of the occurrence of pathology:

Vascular. This theory is based on development of hip ischemia, provoked by arterial embolism. According to experts, embolism causes a break in the blood supply, which leads to the transformation of the vascular network, venous stasis, and an increase in blood viscosity.

Theory of chronic microtrauma. It is based on the accumulation of decay products in the hip joint, which leads to the destruction of the base of the bone and a change in its properties.

If the disease is diagnosed at the initial stage of development, it is possible to use conservative methods of therapy.

Symptoms of the disease

Symptoms of aseptic joint necrosis are determined by the stage of development of the disease, each of which has both general and characteristics specific to this stage.

The very first manifestation of head necrosis The hip joint in both children and adults is a pain syndrome. Pain sensations are concentrated in the pelvic area, but can cover the entire limb, as well as the groin area and lower back.

The first stage of necrosis of the head of the femur can last up to six months.

The second stage of the disease is called an impression fracture. At this stage, the pain becomes intense and pronounced, especially after excessive stress on the affected joint. In addition, there is a decrease in the volume of the lower limb in the hip area. The patient begins to limp, since the main load during movement falls on the healthy leg. There is limited movement of the affected joint, and when trying to abduct a limb unbearable pain appears to the side.

At the third stage, muscle atrophy continues. The damaged limb becomes shorter, and a decrease in the volume of the lower leg is observed. Joint mobility is significantly limited, lameness is clearly expressed. The pain becomes very strong and only a little decreases at rest.

The fourth stage is reparation. Severe pain persists. There is pronounced atrophy of the muscles of the buttocks and the affected limb. The thigh volume decreases by approximately 5-8 cm.

Common symptoms of necrosis of the femoral head include the following:

Limitation of mobility of the diseased joint;
muscle atrophy;
reduction in the length of the injured leg, lameness;
pain in the hip area.

As the disease progresses, all of the above symptoms intensify.

The appearance of the first signs of pathology should be a reason to visit the clinic. Timely treatment will help avoid ь adverse consequences.

Stages of development of necrosis of the head of the hip joint

Various parts of the head of the hip joint may undergo necrosis. Depending on the location of the lesion, the following forms of pathology are distinguished:

Central - the central part of the head is damaged;
peripheral - the lesion is localized under the articular cartilage on the outer part of the head;
segmental - tissue death in the upper section;
and, finally, complete damage to the head.

As mentioned earlier, necrosis of the head of the femur in both children and adults has 4 stages of development.

At the initial stage of the disease, the head of the joint retains its integrity, while destruction of the spongy substance is observed (necrosis of the bone beams). Microfractures and compaction of the subchondral region are noted.

The second stage is characterized by multiple bone fractures x beams and the presence of cracks. This process is caused by the resorption of dead tissue around healthy areas of the hip bone. The intact joint weakens and can no longer cope with the loads placed on it. The affected areas grow.

At the sequestration stage, resorption of the affected bone fragments continues. The process of growth of connective tissue begins, which fills the voids in the affected joint, the formation of bone growths occurs, and new vessels are formed. Simultaneously with the ongoing processes, deformation of the joint is observed, which leads to a decrease in length limbs. This stage of development of aseptic necrosis of the head lasts about 18 months.

During the repair stage, severe destruction (up to 80%) of the joint head is observed. Connective and cartilaginous tissues degenerate into bone. The process of restoration of the spongy substance begins. The duration of each of these stages is determined by the degree of progression of the pathology and depends on the individual characteristics of the organism.

Treatment of necrosis of the head of the hip joint

Therapy for aseptic necrosis of the head of the hip joint is aimed at obtaining the following results:

Restoration of motor function of the joint;
reduction of pain syndrome;
elimination of the inflammatory process in the femur;
maintaining the obtained effect by changing lifestyle.

Traditional medicine involves treating necrosis of the femoral head conservatively (without surgery) and surgically.

Conservative treatment of aseptic necrosis of the head of the hip joint

Conservative methods of therapy for necrosis of the femoral head and neck require quite a lot of time, so treatment can last several years.

Improvement measures are taken first condition of a child or adult. For this purpose, painkillers are prescribed in various forms (plasters, powders, injections, tablets, ointments). Specialists usually prescribe the following medications:

Diclofenac;
nimesulide;
ibuprofen and others.

At the next stage of treatment, measures are taken to improve blood flow in the affected area of the femur. For this, vasodilators are used (vitamin PP, nosh-pa alone or in a complex called Nikoshpan).

Additional nutrition of cartilage and bone tissue is provided by taking chondroprotectors (chondroitin and glucosamine). It must be said that these drugs have a negative effect on the gastric mucosa, so take they should only be done after meals.

An important role in the treatment of pathology without surgery is played by drugs whose action is aimed at regenerating the hip bone (various combinations of vitamin D3 and calcium). In combination with the above drugs, calcitonins are prescribed, which promote the rapid growth of newly formed bone tissue, as well as reduce the intensity of pain.

You should also significantly limit or completely stop hip movements. The following methods are used for this:

Bed rest;
hip immobilization;
splints and plaster casts;
orthopedic devices and hoods.

The choice of method and duration of immobilization is determined by the attending physician.

Experts often prescribe electrophoresis with lidocaine or novocaine, which provides an additional analgesic effect on the spine and legs. At the rehabilitation stage, the doctor can refer the patient to a specialized sanatorium, where the patient will undergo a course of massages, mud wraps and physical therapy. With the help of special exercises You can work out the affected joints, which will make it possible to avoid stiffness.

It is worth noting that conservative treatment only slows down the process of development of pathology and necrosis, but does not guarantee a complete cure. Therefore, such methods of therapy are used only at the initial stages of pathology development.

Surgical treatment of aseptic necrosis of the femoral head

Often surgery for necrosis of the head of the hip joint, it is used in combination with conservative therapy. This depends on the stage of the disease, as well as its neglect. On average, surgery is indicated in 15% of cases.

The specialist may prescribe one of the following types of surgical intervention:

Endoprosthetics of the head of the hip joint;
transplantation of a certain section of the femur;
decompression of the head (tunnelization);
arthrodesis;
arthroplasty, which involves performing such manipulations as restoring the original shape of the damaged joint, removing fibrous or callus, preventing secondary fusion of the femoral bone;
osteotomy.

Treatment of necrosis of the hip joint using traditional methods without surgery

Traditional medicine methods have long been used in the treatment of aseptic necrosis of the head and neck of the hip joint. However, before using traditional recipes, should be consulted with your doctor and think about the consequences. After all, lost time cannot be returned later.

Eggs, cabbage, milk and other ingredients are used for medicinal compresses. In addition, therapy for this pathology can be carried out by rubbing with use of medicinal plants and medications.

In the early stages of the disease, nettle baths showed a good effect. There are also many recipes for preparing all kinds of potions using elderberry flowers, willow bark, parsley root, nettle leaves, etc.

Consequences of aseptic necrosis of the head of the hip joint

Hip infarction accounts for only about 2% of all diseases of the musculoskeletal system, but is considered one of the most difficult to treat. The consequences of this disease are individual for each patient and are determined by the degree of damage to the head of the hip bone. Experts are not always able to guarantee a complete cure for the patient and often use surgical treatment of the disease as the only possible method.

For complete restoration, joint arthrodesis, endoprosthetics, or corrective osteotomy are often used.

Necrosis of the head of the hip joint is a rather serious and dangerous disease that requires long-term and painful treatment. If treatment is not started in time, a significant deterioration in the patient’s life occurs, which in many cases leads to disability. This is the impossibility of independent maintenance, a recumbent lifestyle, at best, restricts the movement of the damaged joint. Therefore, at the slightest suspicion of the development of necrosis of the head of the hip joint, you should immediately contact the clinic. If treatment is started in a timely manner, the prognosis of the disease is more than favorable.

Necrosis of the femoral head is a devastating disease in which the bone and soft tissue around the hip joint die. In parallel with necrosis, osteophytes form on the head of the femur and pelvis. Arthrosis also develops and cartilage tissue is destroyed, which subsequently leads to shortening and immobilization of the diseased limb, and later to disability. The disease develops extremely rapidly and untreated necrosis of the head of the hip joint, after just six months, can lead to irreparable consequences, including blood poisoning and amputation of the affected limb.

Reasons for development

There are quite a few reasons for the occurrence of the disease, but in cases where not a single symptom fits the particular clinical picture, such necrosis is considered to be idiopathic. So, the main reasons for the development of aseptic necrosis of the hip joint are:

Injuries of the hip joint of various types;
Radiation exposure;
Alcoholism and drug addiction;
Metabolic disorders;
Thrombosis;
Bone diseases;
Constant load on the hip joint due to professional activities;
Hereditary factor (manifests in children);
Exceeding the permissible dose of steroids.

Symptoms

The symptoms of necrosis of the head of the hip joint are extremely similar to the symptoms of deforming arthrosis, therefore only a thorough diagnostic examination and a competent doctor can correctly determine the specifics of the disease. This is what happens to a patient during illness:

Severe, sharp and burning pain appears in the joint area;
As the disease progresses, the patient will no longer be able to bend down to put on shoes.
Abduction of the hip to the side becomes impossible;
Painful sensations intensify even when performing standard household activities.
Unlike arthrosis, during necrosis, atrophy of the periarticular muscles occurs in a matter of days.
Shortening of the affected limb occurs, and sometimes, much less frequently, lengthening of the leg occurs due to the proliferation of osteophytes.
Another clear difference between the 2 diseases is that necrosis is much “younger” than arthrosis. It affects patients aged 25 to 45 years, most of whom are men.

Treatment

Treatment of necrosis, like any disease of the musculoskeletal system, is best started in the early stages of the disease. Modern medicine knows 4 degrees of necrosis of the head of the hip joint. The first 2 stages can be treated with conservative methods, however, it is worth noting that neither medications nor concomitant therapy can completely cure the patient of the disease.

Such therapy will only delay degenerative changes in the joint, sometimes for a very long time. Conservative treatment will include a fairly extensive list of medications, as well as: exercise therapy, physiotherapeutic exercises, massages, traction, etc. The consequences of ineffective treatment of aseptic necrosis of the head of the hip joint can be very bad, including loss of a limb.

In the final stages of necrosis, depending on the presence of contraindications, the age and physical health of the patient, the doctor will recommend surgical intervention.

The whole truth about: necrosis of the head of the hip joint and other interesting information about treatment.

Causes and symptoms of avascular necrosis

At the first stage of the development of the disease, rare pain and minor bone changes are observed. Slight pain radiates to the groin, but mobility in the hip joint remains.
At the second stage, cracks appear on the head of the hip bone, which can occupy up to 30% of its surface. The pain in the affected area intensifies.
At the third stage of the disease, the acetabulum is involved in the process, and up to 50% of the articular tissues are affected. The pain becomes constant and severe, and joint mobility decreases.
Motor function is completely reduced, severe pain never stops, the muscles of the buttock and thigh atrophy.

Types and stages of disease development

Doctors distinguish four types of necrosis:

Segmental (observed in 48% of patients with this diagnosis). A small area of necrosis appears as a cone on the upper part of the femoral head.
Complete necrosis (diagnosed in 42% of patients). The entire head is affected.
Peripheral (occurs in 8% of patients). The pathology affects the outer part of the head, located under the articular cartilage.
Central (observed in 2% of cases). A zone of necrosis forms in the center of the head of the femur.

Diagnostic methods

Hardware

Radiography

Computed tomography

Magnetic resonance imaging

Laboratory research

Which doctor should I contact?

Treatment

Medication

Non-steroidal anti-inflammatory drugs. They are prescribed to relax the thigh muscles, restore normal blood circulation and relieve pain. The course of treatment is one ampoule intramuscularly daily for a week. Well-known drugs are Naklofen, Diclofenac, Xefocam, Ibuprofen.
Vasodilators. They eliminate blood stagnation and improve arterial blood flow. The dosage regimen depends on the severity of necrosis of the hip joint, but is at least 8 weeks with repeated courses every six months. Popular vascular agents are “Curantil”, “Trental”, “Dipyridamole”, “Xanthinol nicotinate”.
Regulators of calcium metabolism, preventing excessive loss of calcium. They improve the process of bone restoration and reduce collagen destruction. The drugs are used for at least 8 months continuously or at intervals of several weeks. The best drugs are “Calcium D3 nycomed”, “Xidifon”, “Bonviva”, “Fosamax”, “Vitrum”, “Osteomag”, “Osteogenon”, “Alfacalcidol”.
Chondroprotectors. These are the most effective drugs at stage 3 of necrosis of the hip joint, when the cartilage in the head of the femur begins to peel off and destroy. They help restore cartilage tissue by stimulating ligament regeneration. These drugs must be taken in long courses, at least 6 months, with an interval of six months. The most famous chondroprotectors are “Structum”, “Chondroitin sulfate”, “Chondrolone”.
Muscle relaxants. These drugs can relax muscles, thereby inhibiting the transmission of nerve impulses, improving blood circulation. The course of treatment is 15-20 days, one tablet 2 times daily. The best relaxing drugs are “Mydocalm”, “Sirdalud”.

Surgical methods

tunneling, when additional holes are formed in the bone to reduce pain and intraosseous pressure;
transplantation of a musculoskeletal graft to increase local blood flow and eliminate pain;
intertrochanteric osteotomy to eliminate the worn part of the femoral head and redistribute the load to other areas;
arthrodesis (artificial fusion) to immobilize the joint to eliminate pain;
arthroplasty to increase range of motion, eliminate lameness, and improve blood supply to the hip joint.

Therapeutic gymnastics and massage

Medical centers

Corrective osteotomy of the femur for necrosis of the head of the hip joint		“GrandMed” Moscow, st. Sadovaya, 35
Revision hip replacement (without cost of implants)		“Garant Clinic” Moscow, st. Vavilova, 97
Hip replacement (without consumables and cost of prostheses)		“Central Clinical Hospital of the Customs Service” Moscow, Otkrytoye Shosse, 32
Hip replacement for necrosis of the femoral head (without implant cost)		“Medical Union” St. Petersburg, Grazhdansky Avenue 68 A
A set of procedures for rehabilitation after endoprosthetics		“Pension Baltiysky” St. Petersburg, st. Baltiyskaya, 2/14

Aseptic necrosis of the hip joint can develop for the following reasons:

dislocation or fracture;
frequent minor tissue damage and excessive stress (especially during regular sports activities);
arterial thrombosis;
past inflammatory diseases;
taking certain medications (antibiotics and hormones in large doses and for a long time);
pressure changes (among miners and divers);
alcohol abuse.

In 80% of cases, osteonecrosis is bilateral. In addition to the head of the hip joint, it quite often progresses in the knees, shoulders, elbows and ankles.

Osteonecrosis can appear several months or even years after the injury or pathological conditions that provoked it.

View of the joint at different stages of the disease

The disease process is divided into stages depending on the degree of tissue destruction of the hip or knee joint. Each stage is characterized by the same symptoms, but the intensity of their manifestation is different.

Main symptoms of the disease:

pain;
atrophic changes in the soft tissues of the hip or knee (if the patient has necrosis of the knee joint);
reduction in the range of motion of joints;
transferring the body load to the healthy leg.

At the initial stage, the main symptom of asthenic necrosis is pain, which appears spontaneously. It is concentrated in the hip joint and radiates to the groin, knee joint, lower back and sacrum.

The pain may make it difficult to walk and sit. Gradually they become more intense and prolonged, especially at night.

The ability to move joints does not change. Body weight is distributed evenly across both limbs.

Stage 2 osteonecrosis is characterized by constantly increasing pain, especially after physical activity. The range of motion of the joints decreases slightly.

There is significant death of the thigh muscles (the girth of the affected thigh is smaller than the healthy one). The load of body weight is gradually transferred to the healthy leg.

At stage 3 of the disease, even minimal exertion causes a significant increase in pain. Movement of the joint is limited. The muscles are significantly atrophied. The affected leg may become somewhat shorter.

Stage 4 osteonecrosis is characterized by the appearance of pain, which is the most pronounced. There is a gait disturbance. Muscle atrophy is clearly expressed. The amplitude of movements is zero.

There are several reasons for the development of aseptic necrosis of the head of the hip joint. These are vascular diseases when blood microcirculation changes, which leads to the development of foci of tissue necrosis.

The cause of the disease can also be excessive load on the hip joint. This is due not only to a person’s profession (truck drivers, parquet floor workers, gas welders), but also to excess weight and a shift in the center of gravity when walking.

The reasons for the development of necrosis of the hip joint may be associated with metabolic disorders in the human body or with a genetic predisposition.

But none of the above factors can independently cause this disease; it develops only as a result of a combination of several conditions.

Depending on the severity of damage to the hip joint, the course of the disease has stages, each of which is characterized by the following symptoms:

The main factors that give rise to the development of aseptic necrosis of the head include:

Overloads and minor microtraumas that occur systematically (athletes, hard working people);
Injuries (dislocation of the hip joint, fracture of the femoral neck, etc.);
Alcohol abuse;
The effect of medications (antibiotics, cytostatics, antibiotics and hormonal drugs with long-term use);
Other diseases (ankylosing spondylitis, systemic lupus erythematosus, osteopenia, rheumatoid arthritis, osteoporosis, etc.);
Diseases that are accompanied by endothelial dysfunction (inflammation and colds).
Exposure to pressure changes on the body (for example, miners and divers). May cause air bubbles in the blood, causing blockage of blood vessels.

The hip joint is a complex multi-axial spherical structure that allows for various movements:

flexion and extension;
adduction and abduction;
femoral supination and pronation.

The following factors can provoke a dangerous pathology:

traumatic injury or chronic injury in the pelvic area;
focus of the inflammatory process, infection in the body;
drug intoxication, taking hormonal and antibacterial agents;
alcohol addiction, alcohol poisoning;
vein thrombosis and blood poisoning, sepsis;
excessive physical activity, heavy weight.

Bilateral osteonecrosis is more often diagnosed, which further complicates treatment. This form of pathology is extremely dangerous, because without adequate and timely treatment the patient may be left without legs.

The group at increased risk of developing necrotic lesions of bone and cartilage tissue includes people with congenital anomalies. Diseases suffered in childhood also play a role, because disorders during the period of development make themselves felt already in a fully formed person, when organs should work harmoniously.

Important! The risk group includes people with peculiarities of anatomical structure, when there is a shortening of the limb, and the operation was not performed in a timely manner.

The main reason for the development of this disease is insufficient blood supply to the hip joint. As a rule, this happens due to a defect in the blood vessels, which can be either congenital or acquired. Most often these are the following pathologies:

Narrowed diameter of some or all of the arteries bringing blood to the area.
The absence of some vessels, which makes the blood supply insufficient.
Reduced total volume of the entire vascular basin.

However, the compensatory capabilities of the human body are quite large, and even under these conditions the joint can fully function. But, if unfavorable factors are added, the process of destruction of the femur begins to progress rapidly.

These include:

Frequent or severe injuries to this joint.
Smoking.
Alcohol abuse.
Work in unfavorable conditions (for example, at high atmospheric pressure).

With insufficient blood flow in the joint, ischemia develops, which is further aggravated by impaired venous outflow. Blood pressure inside the head of the femur increases, and the result is its non-inflammatory destruction - aseptic necrosis.

Stages of development of necrosis

STAGES OF DEVELOPMENT OF ASEPTICA NECROSIS OF THE FEMUR

Signs of necrosis of the hip joint

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

Important! The disease manifests itself pronouncedly, since deviation of the function of the joint impairs the movement of the limbs, leading to unbearable pain and accompanying manifestations.

This disease is otherwise called avascular necrosis of the head of the joint, and its clinical manifestations are in many ways similar to the inflammatory process in the organ.

Already at the beginning of the disease, severe pain appears in the hip joint

Symptoms of tissue death:

severe pain during movement, as the disease progresses, this symptom also appears at rest;
it is impossible to stand on one leg on the side of the diseased organ; when walking, the person has a limp;
inability to move your leg to the side while in a sitting position;
active muscle atrophy, decrease in thigh volume on the affected side;
shortening of the limb, which also causes lameness.

All these manifestations are visible already at the beginning of the pathological process. Without therapy, unpleasant consequences of head necrosis appear, the treatment of which cannot be done without surgical intervention.

Important! At each stage of the pathology, the patient notes unbearable pain, which intensifies while walking and after physical activity.

Symptoms and diagnosis

The very first symptom of aseptic necrosis of the head of the hip joint is a feeling of pain with uncertain localization

Usually the pain is mild and manifests itself when walking, but at rest, patients practically do not complain of discomfort. Aseptic necrosis of the head of the hip joint is characterized by periodic pain, either disappearing or reappearing.

Studies have found that most often the pain does not correlate with the hip joint - patients note pain both in the buttocks and lower back, and in the groin area.

Due to such a diffuse nature of the pain, it can be difficult to diagnose the disease. However, most patients note pain radiating to the knee area, which forces them to look for the cause in the knee joint. Doctors usually differentiate the disease from lumbosacral radiculitis and inflammation of the meniscus.

When examining patients, doctors also note such symptoms of the disease as atrophy of the thigh muscles and limited internal rotation, accompanied by pain.

As the disease progresses, abduction of the limb is limited. Apart from subjective sensations, patients have no other symptoms of the disease.

The blood test shows normal numbers, the general condition of the patients remains satisfactory.

To diagnose aseptic necrosis, doctors primarily use the X-ray method, but it is worth noting that this technique has significant errors, because X-ray examination does not allow one to see the disease at its very beginning.

For early diagnosis, you can use computer or magnetic resonance imaging.

Despite the use of such advanced techniques, a significant number of erroneous diagnoses remain in diagnostics, because the symptoms of the pathology can be confused with other diseases.

So, among the possible options are arthrosis of the knee joint, sciatica, radiculitis, and a third of patients cannot be diagnosed at all.

Necrosis, or necrosis, is a complex pathological process that manifests itself in the decomposition of tissue structures due to the influence of various destabilizing factors on them.

If necrosis of the head of the hip joint is not recognized in time, the consequences can be the most unpredictable, including complete cessation of blood supply, leading to death.

Therefore, it is very important to identify pathological symptoms at the initial stage of development. The manifestation of tissue necrosis is accompanied by severe paroxysmal pain in the groin, which limits a person’s ability to move.

The pain is especially acute when transferring body weight to the sore lower limb, which limits a person’s mobility and causes lameness. Treatment of necrosis of the head of the hip joint depends on the stage of the pathological process.

Diagnostics

A complication of the disease led to a femoral neck fracture

The earlier avascular necrosis is detected, the easier it is to treat the disease. X-rays are often prescribed for diagnosis, but in the initial stages, aseptic necrosis of the hip joint is almost impossible to determine using this method.

The damage to the joint on an x-ray will be noticeable only in stages 2 or 3 of the disease. Ultrasound and laboratory tests are also ineffective in diagnosing necrosis.

The disease can be detected at the beginning of its development only with the help of computed tomography and MRI.

Treatment can be traditional and surgical. Aseptic necrosis of the knee and head of the hip joint, identified at the initial stage of development, is amenable to conservative therapy.

The goal of such treatment is to prevent or slow down the development of the disease, relieve or reduce pain, and improve the mobility of the affected joint.

Traditional treatment includes:

taking painkillers, anti-inflammatory drugs (corticosteroids, non-steroidal drugs);
physiotherapeutic procedures (electrophoresis using novocaine, ozokerite, ultrasound methods, the use of diadynamic currents, etc.);
massage that increases the functionality of muscle tissue;
use of orthopedic preventive orthoses.

The main requirement for all treatment methods is that they must be applied before the biomechanical collapse of the head of the hip joint. Evidence of collapse is the crescent moon sign, which can be identified during diagnosis.

MRI of the joint

A magnetic resonance imaging scanner (called an MRI) is used for diagnosis. It can confirm the disease in the early stages, unlike conventional x-rays, which can detect the disease in the middle and late stages of necrosis of the hip joint.

To make an accurate diagnosis of avascular osteonecrosis of the femoral head, X-ray and magnetic resonance imaging methods are used.

The MRI method can be especially useful in the initial stages of the disease, allowing one to detect the smallest necrotic lesions in the head of the femur. On X-ray photographs, necrotic bone changes are clearly visible only at stages 3 and 4.

Obviously, it will be unnecessary to repeat that the earlier the development of hip necrosis is detected, the greater the patient’s chances of saving the joint without resorting to surgery.

In the first degree of necrosis, X-ray scanning, as a rule, does not give a positive result. The head of the femur still retains its original anatomical integrity, the bone segments are not damaged.

Only with a microscopic examination can some changes in the spongy substance and medulla be detected. Already at this stage, one can observe a restriction in movement in a person and the beginning of the process of muscle atrophy.

The second degree, upon microscopic examination, is characterized by the presence of multiple damage to the bone tissue structure and expansion of the articular fissure space. Only magnetic resonance diagnostics can reliably determine the necrotic state in the cartilaginous joint of the femur.

The third degree is the process of sequestration, that is, the rejection of tissue affected by necrosis from its remaining viable areas. The femoral neck is shortened, and the joint space is further increased.

The fourth, reparative degree of aseptic necrosis, involves the restoration of spongy bone substance, however, with X-ray examination, cystic layers are observed.

The fifth degree of deformation of the head is recorded according to the type of deforming state of arthrosis. Bone growths and degenerative manifestations of the secondary cyst can be traced across the entire surface of the head.

The entire pathological process of aseptic tissue necrosis develops very dynamically, so transitions from one stage to another are a conditional division, each of them has its own depth and degree of pathology.

The following measures will help confirm the diagnosis:

standard radiography and magnetic resonance imaging:
cytological examination of pathological material;
general blood and urine analysis.

Visually, the doctor also sees changes: one limb is shorter, the thigh is thinner on the affected side, the person is limping. Complaints of pain and severity of movement are taken into account.

On the left is an x-ray of a healthy hip joint, on the right is one affected by osteonecrosis.

X-ray examination determines four stages of aseptic necrosis of the hip joint:

The first stage is characterized by the appearance of small pockets of osteosclerosis and osteoporosis. Below the subcartilaginous layer of the femoral head, a line of reduced density can be identified. This radiological sign is called the “eggshell sign”. However, neither the contour of the head itself nor the joint space changes.
We can talk about the second stage of the disease when the focus of necrosis is clearly visible on the x-ray. In this case, the joint space widens and the contour of the femoral head is disrupted. A depressed fracture of the superolateral segment of the head will also be observed.
The third stage is more extensive damage to the joint. The focus of necrosis is surrounded by a zone of osteosclerosis and osteolysis. Bone growths – osteophytes – are observed along the edges of the joint. The joint space is usually unevenly narrowed, but sometimes it can be widened.
At the fourth stage, the deformed head of the femur and acetabulum are clearly visible on the x-ray; cyst-like lucencies are identified in them. Osteophytes are extensive and rough. Marked narrowing of the joint space. Also during this period, the transverse ligament of the joint is almost completely calcified.

With clear changes on the radiograph, the diagnosis of avascular necrosis is beyond doubt. But unpleasant symptoms also bother patients in the zero, pre-radiological stage, when the joint looks undamaged on a regular X-ray. In this situation, it is not easy to make a diagnosis.

Pre-radiological stage

If the nature of the pain syndrome and other symptoms lead the doctor to think about aseptic necrosis of the femoral head, this diagnosis must be confirmed. Previously, the following methods were used for this purpose:

Medical thermometry.
Measuring pressure inside the bone.
Intraosseous phlebography with contrast injection.
Radionuclide research.

All these methods are aimed at studying blood microcirculation in the proximal femur.

However, nuclear magnetic resonance tomography is now more popular. This study is highly accurate and informative even in the early stages of the disease.

Treatment

Aseptic necrosis of the hip joint can be cured not only by conservative and surgical methods. Treatment of the disease with folk remedies, which is especially effective at the early stage of the disease, will also come to the aid of patients.

We will offer several recipes that will help restore blood supply to the head of the hip bone.

Pine bud therapy

First aid for the hip joint - an infusion of pine buds. To prepare the product, you need to mix freshly picked pine buds and sugar in a glass container.

The kidneys and sugar are laid out in layers up to about half of the vessel, after which it is covered with a lid and placed in a warm place for seven days.

After syrup is formed in the container, it must be rubbed into the sore joint, and also taken orally - three spoons twice a day for two months.

After a medical examination and diagnosis, the doctor prescribes treatment for necrosis of the femur. The complex of therapeutic measures in the early stages of the disease includes: drug therapy, massage, mud baths in sanatoriums, vitamin therapy, hirudotherapy (treatment with leeches), swimming.

However, conservative methods do not lead to a complete cure of the disease, but only inhibit its development, preserving the function of the joint for many years.

No modern medicine can completely destroy the necrotic process. If it is not possible to slow down the development of the disease, then doctors use surgery.

This is the only radical treatment for necrosis of the femoral head, which can significantly improve the living conditions of a person with this disease.

Surgeries are used at all four stages of the disease.

Medication

The tactics of drug treatment of avascular necrosis of the hip joint depends on the development of symptoms, the age of the patient and the complete picture of the disease after a thorough diagnostic examination. Medicines that doctors prescribe for this disease:

The method of treatment is chosen individually each time, depending on the age, stage of the disease and other physiological characteristics of the patient. Today, on the shelves of pharmacies you cannot find drugs that restore blood circulation. Typically, treatment involves surgery.

Operations to restore blood flow.

Decompression of the femur. One or more channels are drilled through the femoral neck into the head, where blood flow is impaired. Vessels begin to grow inside the canal, which improves blood flow. The second positive effect is a decrease in intraosseous pressure and a decrease in joint pain.
Fibula autograft transplantation. Unlike the first operation, a piece of the fibula on a vascular pedicle is transplanted into the drilled hole. The graft improves blood flow and strengthens the cervix. This is a very complex and rare operation.
Endoprosthetics. Endoprosthetics is the replacement of your natural joint with a mechanical analogue. Single joint replacement is very often used.

Elimination of osteonecrosis and its consequences can be carried out conservatively or surgically, depending on the degree of tissue damage. Drug therapy cannot completely eliminate tissue death, which is why doctors more often resort to surgery.

Important! Long-term progression of the disease with the appearance of unpleasant consequences requires an integrated approach. The patient is prescribed anti-inflammatory, painkillers, antihistamines, hormonal drugs, and antibacterial agents.

A local effect on the pathology is also required, which is why various physiotherapeutic procedures are carried out. These are electrophoresis, traction, physical therapy, massage. All this is necessary in order to improve local blood circulation and increase the mobility of the organ.

Hip replacement

Medicines for osteonecrosis

The following groups of drugs are prescribed:

non-steroidal anti-inflammatory drugs;
strong analgesics;
vasodilator tablets;
sedatives and antidepressants;
medications to stimulate microcirculation;
immunomodulatory and vitamin complexes.

The same medications are also prescribed after surgery to remove a pathological lesion. Therapy with folk remedies can only be carried out under the supervision of a specialist and as an additional way to maintain the condition.

Surgical treatment

The operation is performed when unpleasant consequences occur. Its essence is the complete removal of the necrotic focus and part of the healthy tissue to prevent re-infection. An indication will also be a change in the position of the head of the joint during its deformation in order to increase strength.

Important! A diseased joint will not be able to perform its function until all affected tissue is removed. After the operation, an implant is installed.

Implant for hip joint treatment

Elimination of pain in the hip joint with folk remedies

Before treating pelvic joints with traditional methods, the exact cause of the pathological condition should be established. To do this, you need to see a doctor and undergo a full course of comprehensive diagnostics.

Only after receiving approval from the attending physician can you begin self-medication. The preparation of various ointments, infusions and decoctions is based on herbal preparations, the recipes of which have come to us from our ancestors.

Consequences of aseptic necrosis

The most severe complication will be the transition of necrosis to muscle tissue and the gradual death of the limbs. In this case, it will not be possible to save the leg; it will have to be amputated.

An equally dangerous consequence will be sepsis, blood poisoning, which without timely medical care can lead to death.

Important! Self-medication at home or refusal of surgery for no reason can lead to severe intoxication, when the minutes count and even high-quality doctor’s help cannot save you.

Even in the case of complex treatment, complete recovery of the patient cannot be achieved. As a rule, the long-term consequences of this disease are pain and lameness due to developing coxarthrosis.

Over time, the motor functions of the affected limb are partially or completely lost. This leads the patient to disability.

With surgical treatment, the prognosis is more favorable. The best results today are demonstrated by endoprosthetics, which allows you to replace the affected joint with its synthetic analogue and completely restore the lost functions of the leg.

Prevention and prognosis

Primary prevention is to adhere to a physical activity regimen. Hard work or physical inactivity can be decisive in the onset of the disease. Secondary prevention includes taking anti-inflammatory drugs and immunomodulators to prevent the consequences of osteonecrosis.

Important! The prognosis of the disease is favorable if it is detected in a timely manner and the focus of necrosis is removed.

The disease of the largest joint in the human body is extremely dangerous, and if alarming signs appear, you should urgently consult a doctor for diagnosis and prescribe a therapeutic course.

One of the unpleasant diseases of our time is joint infarction, or aseptic necrosis of the head of the hip joint. Treatment, consequences and symptoms of the disease are most likely to be felt by men today. It is the male part of the population that is approximately 7-8 times more likely than women to be susceptible to destruction of the bone structure in the femoral head.

What happens and what are the symptoms of avascular necrosis?

Several causal factors may influence the occurrence of the disease. First of all, pronounced aseptic necrosis of the head of the femur is a vascular disease that leads to disruption of the blood microcirculation process, and, as a result, is a provoking factor for the formation of dead tissue. The focus of inflammation is formed due to insufficient provision of joint tissues with nutrients, and may also be a consequence of genetic predisposition. Often, aseptic necrosis of the femoral head can be observed in children at a fairly young age. Other reasons leading to aseptic necrosis include:

hip injuries;
excessive loads on the articular parts of the femur;
a consequence of previous diseases of infectious etiology;
chronic diseases, such as pancreatitis;
mechanical unilateral displacement of the 4th lumbar vertebra, resulting in pinching of nerve endings.

However, it is believed that the main causative factor is a stressful situation. Therefore, very often patients from the category of people whose professional activities are associated with a large mental, nervous and/or emotional load turn to specialists for help. It is worth recalling that alcohol, as a remedy against stress, is another provoking factor of the disease.

Aseptic necrosis of the head of the hip joint Aseptic necrosis of the head of the hip joint is a rapidly progressing disease, therefore it is most effective to treat in the initial stages of the disease. The first symptomatic signs of the disease should cause concern and be a reason to contact a specialist. Symptoms of articular infarction are:

pain in the groin with a shooting in the knee part of the lower limb;
lameness when walking;
limitation of mobility.

If any symptom appears, immediate action must be taken. Diagnosis of the disease is determined by magnetic resonance and/or computed tomography.

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

The initial stage of the disease is treated quite simply. Special gymnastic exercises and therapeutic massage can effectively restore blood pumping through the joint. Manual therapy in this case is ineffective. In addition, complex therapy includes a number of pharmacological combinations that ensure restoration of joint functionality:

vasodilators;
anti-inflammatory and non-steroidal groups;
pharmacological painkillers;
vitamin groups.

After taking such therapeutic measures, which are usually well tolerated by patients, restoration of joint functionality occurs within 1-1.5 months. If the causes of articular disease are associated with displacement of the vertebrae, then it is advisable to use chondroprotectors.

Arthrodesis is the artificial fusion of articular elements.

Treatment of necrosis of the head of the hip joint in later stages of the disease requires quite a lot of effort and patience not only from the patient, but also from his environment. Depending on the advanced state of the disease, surgical intervention of varying degrees of complexity is provided. There are several types of surgical correction of the joint:

a musculoskeletal graft is used to ensure sufficient blood flow in the joint;
removal of intra-articular pressure is ensured by tunnelization;
surgical arthroplasty will improve blood circulation in the hip joint and eliminate lameness;
intertrochanteric osteotomy will eliminate wear of the head and redistribute the load mass on the remaining hip areas of the lower limb;
Arthrodesis, the artificial fusion of joint elements, has found widespread use in the treatment of the disease.

If adequate treatment is not carried out, the consequences of necrosis of the head of the hip joint can be very sad, sometimes leading to death.

Diagnosis of the disease is determined by magnetic resonance and/or computed tomography

How to avoid joint infarction?

An effective way to prevent the disease is a person’s resistance to stressful situations. It is necessary to clearly monitor your emotional and mental state. It is not recommended to relieve emotional and psychological stress using methods popular in male circles, specifically alcohol. Sports, walking, water treatments, communication with nature and loved ones are the best ways to recover after a busy day at work.

The human skeleton is made up of bones and joints supplied with blood through arteries and veins. Dysfunction of peripheral blood flow causes necrosis, that is, tissue death, and as a result, the disease leads to serious health problems, including disability. The risk of necrosis is higher in those elements of the skeletal system that are supplied with blood from a single vessel system. For example, the head of the femur of the hip joint, disruption of its blood supply causes avascular necrosis of the hip joint, known as avascular necrosis and requiring treatment as soon as possible.

Description of the pathology

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Necrosis refers to complex degenerative-dystrophic changes, including the death of tissue of the head of the femur in those areas where the greatest load is placed on the hip joint.

It is diagnosed more often in adult men under 45 years of age. The disease progresses rapidly and can lead to disability and disability due to dysfunction of the hip joint. Therefore, it is important to diagnose and treat pathology in the early stages of development.

In childhood, necrosis of the hip joint is called Legg-Calvé-Perthes disease, the etiology is not fully specified.

Anatomical causes

The hip joint is the largest joint in the skeletal system, consisting of the acetabulum of the pelvic bone and the femoral head. The surface of the joint is covered with hyaline cartilage, which provides gliding and shock absorption of the joint parts during movements. The head of the femur has the structure of a closed chamber; three small arteries supply it with blood; collateral blood flow in this area is undeveloped, which leads to ischemia and necrosis of the bone tissue of the joint if for some reason the blood stops flowing. Next, the cartilaginous covering of the articular surfaces is destroyed, and secondary deforming arthrosis occurs.

Why is blood supply disrupted?

The etiology of aseptic necrosis of the femoral head covers several causes:

Vascular:

thrombosis of veins and arteries;
prolonged vasospasm;
stagnation of venous blood;
increased hemocoagulation;
trauma leading to twisting and compression of the supplying artery.

Avascular etiology leads to:

Impaired blood circulation, which causes ischemia and osteonecrosis of the hip joint.
Poor blood circulation, which negatively affects the nutrition of the cartilage, which becomes inelastic and ceases to protect the head of the bone from stress. The consequence is damage to the bone structure and the occurrence of necrosis.

Mechanofunctional:

There is a version that the hip joint “overworks” over time; nerve receptors send impulses about overload to the corresponding areas of the central nervous system. The reverse response leads to vascular spasm, a decrease in the outflow of venous blood, which leads to problems in metabolic processes and breakdown products accumulate in tissues. The structure of the bones changes, loses its physical and chemical characteristics and begins to deteriorate.

According to this theory, people who are engaged in certain professions that involve increased load on the joint, as well as those who have other skeletal pathologies, such as osteochondrosis, hip dysplasia, and others, are prone to the appearance of necrosis of the hip joint. Excess weight is also a risk factor.

Metabolic disorders and chronic conditions:

The following diseases are common causes of necrosis of the femoral head:

alcoholism;
diseases with long-term use of corticosteroids;
osteomyelitis of the hip joint;
bruises, fractures, hip dislocations;
pancreatitis in the chronic stage;
blood diseases;
large doses of radiation;
decompression sickness.

There is evidence that avascular necrosis of the femoral head appears with a genetic predisposition, which determines age, gender factors, metabolic characteristics and influences the occurrence of pathology.

Each cause is not considered as the main one; the occurrence of necrosis is influenced by a combination of causal factors.

Symptoms

Symptoms vary at each stage of the disease.

The initial period is determined by the appearance of sharp and sudden pain, localized in the area of the hip joint, spreading to the groin, knee, lower back and sacrum. The pain prevents the patient from walking or sitting normally for several days. Improvement occurs after some time, but pain persists during physical activity, disappearing at rest. Gradually, the pain becomes more intense and its attacks last longer; it begins to bother you at night. At this time, normal mobility of the joint is still preserved. The patient does not limp, distributes weight equally on his legs, and slight muscle atrophy may appear.
Impression fracture period. Symptoms include persistent, intense pain in the joint, with movement and at rest. Vascular disorders are added. Muscle atrophy makes itself felt: the leg looks thinner, the girth is 3-4 cm less than a healthy leg. The motor activity of the joint is limited, and a limp appears. The clinic develops over the course of six months.

The period of secondary arthrosis. Destruction of bone tissue is observed, followed by deformation of the bone head. Complaints of severe pain combined with significant limitation of movements, sometimes some shortening of the leg is noticeable. There is obvious lameness, the patient has difficulty starting movement, he tries to lean on something when walking.
Severe destruction of the femoral head as a consequence of the lack of therapeutic measures, 8-10 months after the first manifestations of the disease. The pain does not stop, is localized in the hip joint, knee, and radiates to the lower back. Atrophy of the gluteal and thigh muscles is noticeable. The leg shortens, and in severe cases lengthens. There is no movement.

Diagnostic methods

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Pathology is identified based on anamnesis:

Complaints about symptoms.
Medical history.
Chronic diseases.
Occupational hazards.
Physical examination data: examination, palpation, limb flexion, clarification of the abduction angle.
Laboratory and instrumental research data.

X-ray:

In the initial period of the disease it is rarely used due to its low information content. Necrosis on a radiograph looks like local islands of rarefaction or compaction of bone tissue.
The period of an impression fracture is determined on x-ray by the visible deformation of the femoral head. It is flattened or stepwise deformed due to compression and collapse of the islands with necrosis. The widened joint space is also visually determined.

Secondary arthrosis is diagnosed by the uneven contours of the femoral head - it is destroyed and osteophyte growths are visible.
In advanced situations, in addition to the above changes, a modified shape of the socket of the hip joint appears in the pictures.

MRI and CT. They are a priority at the first stage of disease development; pathology is almost always detected.

Radioisotope scanning. Normal bone and bone changed due to necrosis absorb the radioactive drug differently, which allows you to see the affected areas in the image.

Treatment

Treatment for necrosis of the hip joint is selected taking into account the period of development of the disease and the severity of symptoms.

Conservative treatment includes medications, physical therapy, physiotherapeutic procedures, orthopedic regimen, and massage.

Goals of conservative therapy:

Prevent or stop progression.
Relieving pain symptoms.
Maintenance and elimination of hip dysfunctions.

Prescribed drugs:

Nonsteroidal anti-inflammatory drugs: diclofenac, piroxicam, indomethacin and others. Relieve pain, remove muscle spasms, and improve movements. High effectiveness of administration is observed in the first six months of the disease.
Vasodilators: trental, theonicor. Improve blood flow, eliminate congestion and reduce pain symptoms. Prescribed in the initial six months of the disease.

Stimulating regeneration: oxidevit, calcium D3, natecal D. The active ingredients are calcium and vitamin D. They create a calcium depot in the tissue.
Calcitonins: alostin, sibacalcin, myacalcin. They stimulate the formation of new tissue and relieve the symptom of bone pain.
Chondroprotectors: glucosamine, chondroitin sulfate. They regenerate cartilage and work well in advanced cases.

Physical education and massage

An important component of conservative treatment, affecting its effectiveness in stopping the progression of the disease. The patient is prescribed exercises that strengthen the muscular-ligamentous apparatus, without pressure on the femoral head and without active flexion-extension. The set of exercises must be agreed upon with your doctor.

Massage improves muscle blood circulation. It must be done without strong pressure, with a good specialist.

In the treatment of necrosis of the hip joint, it is important to follow an orthopedic regimen; it is not recommended to exclude movement and completely switch to crutches, in order to avoid muscle atrophy, the occurrence of constant pain and loss of movement skills, which can lead to disability.

walk at an average pace, up to 20 minutes, climb stairs;
swim;
exercise on an exercise bike or ride a bicycle;
use a cane when walking at the onset of illness;
reduce excess weight.

Strength loads, heavy lifting, running and jumping are excluded.

Surgical treatment

Surgical treatment is prescribed when there is little effect from conservative therapy. At the onset of the disease, surgery allows you to restore blood circulation in the hip joint and eliminate stagnation. Further surgical manipulations involve changing the position of the femoral head in order to eliminate the load on it, improve blood circulation and reduce intraosseous pressure, as well as increase strength after necrosis.

In advanced situations, the possibility of replacing the destroyed joint with a titanium prosthesis is considered.

Types of surgical treatment:

Decompression method: thin channels are drilled into the head of the femur through its neck, into the area where the blood supply is impaired. New arteries and veins grow in the canals, blood flow improves, intraosseous pressure decreases, and pain decreases.
Transplantation of a section of the fibula, which is transplanted on a vascular pedicle to the area of the femoral head, this provides additional blood supply, strengthens the bone tissue, preventing further deformation.
Hip replacement. This involves replacing the affected joint with an artificial analogue. A titanium or zirconium pin with an artificially made head is fixed in the bone cavity. In parallel, the part where the bed for the head of the joint is placed is operated. The operation restores joint mobility.

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Treatment of pathology in children is based on the same principles as in adult patients.

If aseptic necrosis of the hip joint is treated promptly and competently, in accordance with all indications and recommendations, then the prognosis after treatment is good: the condition either improves or stabilizes without progression.

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