Hip Pain, is a common phenomenon among patients. Often the patient was an avid athlete in their youth , doing long marathons and triathlons, when he suddenly develops a nagging source of pain within the hip. This normally presents over years and is very subtle at first. It may be a general stiffness in the hip and subsequently progressing to pain with a reduced ability to do regular exercises. Sometimes, the pain may even disturb sleep at night.
In all cases of Hip pains, a basic pelvic x-ray is required as well as a lateral x-ray view of the affected Hip. Ideally, MRI scans of the hip should be performed. These will provide much detail in to the pathology afflicting the painful hip.
Very often, we see signs of osteoarthritis in the hip joint, with reduction in cartilage thickness or even full thickness cartilage loss with bone spurs and cyst formations in the femoral head. However, these represent only the pathology of Hip Osteoarthritis. In severely painful cases of hip pain, one has to move on from the diagnosis of hip arthritis, to investigate if a condition called Avascular necrosis, is setting into the bone of the hip joint.
Avascular necrosis (AVN) is the death of bone tissue due to a loss of blood supply. You might also hear it called osteonecrosis, aseptic necrosis, or ischaemic bone necrosis.
If it isn’t treated, AVN can cause the bone to collapse. AVN most often affects your hip. Other common sites are the shoulder, knees, and ankles.
In its early stages, AVN usually doesn’t have symptoms. As the disease gets worse, it becomes painful. At first, it might only hurt when you put pressure on the affected bone. Then, pain may become constant. If the bone and surrounding joint collapse, you may have severe pain that makes you unable to use your joint. The time between the first symptoms and bone collapse can range from several months to more than a year.
Treatment options:
Treatment options can be difficult in cases of AVN on the background of Hip arthritis.
Often , Core decompression, doesn't serve much use as the risk vs benefit ratio are not good. Pain relief in such circumstances is poor.
Surgical replacement of the hip may be an option in cases of severe hip arthritis. However, patients may not be open to the idea of a full hip replacement surgery.
So no what?
Conservative management options must focus on the bone structure that is at risk.
AVN results from bone pressure and subsequent bone death resulting in a form of matrix structure that is bereft of living bone cells. Over time, if the structure of this matrix can be preserved and pressure on the hip can be relieved, new bone cells do migrate into the area and regenerate new bone.
Therefore, conservative management of such hip avn diseases can start by 1. offloading the hip 2. maintaining muscular strength and flexibility of the hip joint.
3. Medications to strengthen the bone matrix to prevent collapse and to reduce bone oedema can be used as well.
Do you have a nagging hip pain?
If you do, call us and find out where or what is going on with that hip of yours !
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