Advanced Hip Arthritis

Pain in the hip joints with progressive limitation of activity is the predominant symptom in a case of advanced Hip arthritis. It may be a result of degenerative changes,/ inflammatory arthritis (RA),/ post-traumatic,/ Post AVN Hip etc.
The picture shows almost complete obliteration of both hip joint spaces (more on the right side).
This patient had a reasonable range of motion in left hip, so we decided to go for conservative management.

The right hip was much worse.
We discussed the options with the patient. The choice of surgery in this case is a Total Hip Replacement (THR). The various bearing options are- Metal on metal/ Ceramic on ceramic/ metal on UHMWPE/ ceramic on UHMWPE.
The choice of bearing depends upon patient factors and age.
Pl read the blog on bearing options regarding further details.

Medical Treatment: Avascular Necrosis (AVN) of Hip

for queries, pl contact

Dr Anurag Awasthi  Orthopaedic Specialist, Sohna Road, Gurgaon 9718112112

AVN Hip is defined as the irreversible changes in the femoral head, as a result of the interuption to the blood supply. It commonly follows fracture of femoral neck/ prolonged steroid intake/ alcoholism/ muco-polysaccharidoses/ sicle cell anemia etc.
The femoral head gradually undergoes changes in the density and architecture, ultimately leading to degenerative arthritis of hip joint.
In late stages, when arthritis has already set in, the only effective treatment is a total joint arthroplasty.
However, in the early pre-collapse stages, there is some role for a group of drugs known as Bisphosphonates.
Alendronate is a commonly used drug of this group. these drugs are available in both tablet and injection form; and dosing schedule varies from once daily to once a year.
Numerous studies have advocated that bisphosphonates, when used in early AVN hip (Ficat & Arlet stage I/II), results in improvement of symptoms and prevents radiological worsening in atleast 60-70 percent of patients. However, this drug needs to be taken for a period of 18-24 months to show appreciable improvement.
The prominent side effect associated with this drug is reflux oesophagitis.

AVN Hip - Symptoms/ Diagnosis/ Tests/ Treatment

for queries, pl contact

Dr Anurag Awasthi  Orthopaedic Specialist, Sohna Road, Gurgaon 9718112112

A 30-35 year young patient enters my clinic with a limping gait. He complains of pain in his Right hip joint especially while attempting to squat or sit cross legged. His wife describes numerous night awakenings due to sudden painful spasms. The pain has been there for almost 6 months now, and is worsening every week.

I asked for an X-ray of both the hip joints.

The X-ray did not reveal anything significant. So, I asked for an MRI of the hip joints.
Now, the sequence of events started. There was evidence of Avascular necrosis of Femur Head in Right hip joint.

Avascular Necrosis of Hip or AVN as often used by Orthopaedic surgeons, describes damage to the Femur head (upper end of thigh bone) which forms an articulation with the Acetabulum (socket).
It produces pain in the Hip joint which gets aggravated with movements and in late stages blocks all movements due to florid arthritis.

Now, the important questions are
A) What do we do now ?
B) What will be the long term fate ?

AVN is presumed to be caused by raised Intra-osseous pressure within the femur head; which eventually causes destruction of bone cells resulting in collapse and later degenerative arthritis.

If presented early, the femoral head may be preserved by use of certain drugs which prevent bone destruction. These drugs have shown good improvement if continued over a period of 2-3 years.

If there are changes in the femoral head, or persistent pain; moderate relief may be obtained by core decompression of the femoral head and neck. This supposedly reduces intra-osseous pressure and preserves femoral head viability. However, there is no warranty against worsening of status.

In late stages, when the arthritis supervenes, the only option left is Total Hip Replacement.
Hip Resurfacing procedures often advocated, may not be viable in most cases because the quality of bone in the femoral neck is often compromised in such patients.