Avascular Necrosis
Avascular necrosis, most commonly seen the femoral head, results when the vascular supply of the bone is interrupted leading to bone death. Many times, the necrosis is idiopathic, asymptomatic, and the cause of it is still not clearly understood by the medical community. However, early detection is important in order to reduce the collapse of the articular surface which leads to degeneration of the hip. In very severe cases, a joint replacement may need to be done in order to repair the dead area. This condition is serious and should be referred out to a physician.
Signs & Symptoms
- May be asymptomatic at first
- Hip pain (becomes progressively worse over time)
- Groin or anteromedial thigh pain
- Pain worse with weight bearing
- Antalgic gait with a gluteus minimus limp
- Limited hip range of motion (internal rotation, flexion, abduction)
- Tenderness to palpation over the hip joint
- Hip joint stiffness
- Hip dislocation
- May have click in the hip when standing up from sitting
Risk Factors
- Chronic use and abuse of alcohol
- Systemic lupus erythematosus
- Panceratitis
- Kidney disease
- Blood disorders (i.e. sickle cell, coagulogathies, diabetes mellitus, Cushing’s disease, and gout)
- Long term use of corticosterioids or immunosuppressants (i.e. organ transplant recipients, patients with cancer, patients with rheumatoid arthritis (RA), or those with a cronic autoimmune disease)
Questions to ask
- When did the pain start?
- Do you remember how you hurt it?
- Do you drink alcohol? If yes how many a week/month?
- What medications are you currently taking?
- Past Surgeries (i.e. organ transplants, cancer biopsies, etc.)
- Aggravating/Easing factors
Special tests
- AROM
- PROM
- Log-rolling test
- Gait observation
- FABERs (video)