Inadequate blood supply to the femoral scales can lead to excessive necrosis of the hip. Predicting this appearance is almost impossible because the pathology can contribute to an active and mobile lifestyle. There are also people at risk who are under pressure from working conditions (divers, miners). This disease cannot be completely protected, but by managing a healthy lifestyle you can prevent the development of necrosis of the hip joint.

What happens to the necrosis of the hip during bone?

Avascular necrosis (also known as aseptic occurrence, heart attack) is the hip death of various parts of the bone tissue at the upper end of the femur due to disturbances in the area of ​​supply of oxygen and nutrients. This results in a decrease in vital function and subsequent death of living cells and the formation of necrotic foci.

In the affected hip joint, the mechanical properties of all tissues as well as the motor functions are reduced. The patient has severe visual pain, which is exacerbated by palpitations and increased exercise. Circulatory disorders cause bone cells to die because the blood vessels in the head are clogged. As a result, the supply of oxygen, minerals and nutrients to the hip bone is severely limited. The main function of bone cells is to maintain a balance between bone shrinkage and growth in the process of adapting to the changing load.

Hip bone death can no longer support this natural process.  As a result, the bones on the bones no longer regenerate, which is associated with the stability and shape of the femoral head. Bones damaged by necrosis are broken due to insufficient strength. A hole forms under the cartilage bone. The cartilage on top can be severely damaged and there is osteoarthritis of the hip joint. 

Hip Necrosis - Symptoms

• Back and side pain that is given to the knee. Pain occurs when legs are formed while walking or ascended from an armchair or sofa;
• Constantly observed sore knee. After exercise, the pains begin to place in the concave or lumbar region;
• The man begins to walk;
• A few days after the onset of the disease, the patient's leg becomes immobile;
• After 14 days, the femoral muscles begin to atrophy. For this reason, the muscles shrink and the leg becomes healthy;
• The diseased leg is shortened or lengthened.

When the patient is lying down, the shortening to the leg is clearly visible. Such a defect is also seen by placing the patient on the abdomen and joining his heels.

When researching, it is important that the person is in the corridor. A half-foot difference of one centimeter or one centimeter is normal "physiological".

To compensate for this defect, place a very special insole in the shoes of the short foot.

One of the earliest symptoms of the disease is the restriction of the rotational movement of the hip, especially the internal rotation (80-85% of cases), which is accompanied by pain syndrome.

Then there is limited lead, and above all - a decrease in mobility at the sagittal level.

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How can avascular necrosis of the hip be diagnosed?

The main type of radiation diagnostics is X-rays, which proved to be a universal examination method.

However, it must be acknowledged that the radiological diagnosis is delayed compared to the planned clinical one. Identifying the primary signs of pathological changes in the hip joints is a very difficult diagnostic task.

Radionuclide methods are given the importance of early detection of bone damage. Scang graphics are widely used to diagnose ONHA.

In scintigrams, the avascular site of the proximal femoral epiphysis of the ONGBK (so-called ischemic zone) indicates a decrease in the accumulation of radiopharmaceuticals in the necrosis zone during the first weeks of the disease.

With the introduction of combined tomography into clinical practice, it became possible to assess the ratio of hip bone formation at a new higher level in order to qualitatively assess femoral head bone density.

In the earlier stages, it is difficult to diagnose the clinic and ONBK, and diagnostic errors are often noticeable.

In most cases, patients are treated for "lumbar osteochondrosis", "radiculitis" or "systemic", "osteoarthritis" of the knee. One in three patients is not diagnosed at all.

The study criteria are as follows:

1. Hip mobility
2. Feelings of hip joint movement
3. Thigh pain areas
4. Positions where pain can be triggered
5. Tibial muscle mass and strength
6. Gait 

Laboratory studies in patients show that these patients have capillary blood flow, increased intraocular pressure, hypercoagulable syndrome, impaired vegetatrophic regulation.

ONBKK diagnostics consists of two stages:

• In the first stage, if there are complaints of pain in the hip joint, thigh and even the knee joint, an X-ray examination of both hip joints should be performed.

In the later stages of aseptic necrosis, this study is sufficient. The area of ​​necrosis, its shape and size are clearly visible on X-rays.

How to treat avascular necrosis  hip necrosis 

In order to make a decision on treatment, classification in the ARCO is mandatory. The patient's age, degree of necrosis and location are very important.

Unlike adults diagnosed with femoral necrosis (M. Perthes), recovery is not impossible.

The treatment decision process also takes into account the condition of the hip joint, the general condition of the patient, additional diseases and life expectancy.

If necrosis is detected in the early stages, our doctors recommend conservative treatment, which includes:

1. Symptomatic treatment (painkillers);
2. Physiotherapy;
3. Physiotherapy;
4. Orthopedic treatment, etc.

However, conservative treatment provides temporary relief and only slows down the process of destroying articular cartilage. The earlier the stage of femoral necrosis is present, the greater the chance of relief of symptoms and even complete recovery. Reduction of hip load with the help of physiotherapy, disregard for sports abstinence, immobilization of the hip joint (for example, orthopedic prosthesis).

Therapeutic gymnastics and massage

By improving the blood supply, back massage and femoral massage continue to bring real benefits with aseptic necrosis - provided the massage is performed correctly, gently without gross effects.

It is important to know: after an incorrect effect, it may be an improvement, but the patient's condition may worsen. Pain and spasm in diseased muscles may increase. In addition, blood pressure may increase, nervousness and nervous system relaxation may occur. This usually happens when the massage is too active, vigorous, especially when manipulating the masseur himself is harsh and painful.

The usual massage should be performed smoothly and gently, without sudden movements. This should give the patient a pleasant feeling of warmth and comfort and should in no case cause pain and bruising.

Massage is contraindicated in:

• all conditions involving fever
• inflammatory diseases of the joints in the active phase of the condition (until stable normalization of blood parameters)
• bleeding and slope to them
• in case of blood diseases
• thrombosis, thrombophlebitis, inflammation of the lymph nodes
• the presence of benign or malignant tumors
• vaskulaarne aneurüsm
• significant heart failure
• severe skin damage to the massage area
• Massage is contraindicated for women on critical days.

Home therapy for avascular necrosis of the hip 

1. Slowly raise the right leg, straightened at the knee, to about 15 floors and hold it for 30-40 seconds. Then lower your leg slowly and relax completely. After a short break, repeat the exercise with the other leg. In this static version, each leg is performed only once.
2. Slowly turn your knees on your right leg to about 10 floors and hold it for about 30-40 seconds. Then slowly lower your leg to the starting position and relax completely. After a short rest, repeat the exercise with the left leg. In this static version, each leg is performed only once.
3. Slowly raise both legs (straight) to a height of about 15 floors. Holding your feet by weight, pave them from each other. Then slowly move your legs together. Make 8-10 such slow foot dilutions.
4. Raise your left leg and hold it at about a 45 ° angle for about 30 seconds. Then slowly put your foot down and relax completely. Then turn over to the other side and repeat the exercise with your right leg.
5. Turn forward and try not to bend your legs or toes with the palms of your hands without bending your knees. Then pull your body forward with your hands as far as possible and allow this position to fully relax for 2-3 minutes. Do this exercise only once a day.
6. Slowly push the right knee and lift it straight as far as it will go. Hold your foot in this position for 30-60 seconds.
7. Put your palms firmly on your thigh just above the knee and begin to rub vigorously on the foot, gradually moving up through the thighs, from knee to groin. Rub the thigh for about 3 minutes until you feel a constant heat, but no burning sensation or pain.

Contraindications for therapeutic exercise:

• women on critical days;
• significantly elevated arterial and intracranial pressure;
• at higher body temperatures (above 37.5 ºC);
• in the first month after operations on the abdominal organs and chest;
• abdominal cavity and abdominal cavity;
• in the case of acute internal diseases;
• severe heart disease and blood disorders.

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