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Disease Process
ANV is caused by an impaired blood supply to the bone. In the case of the hip, blood flow is decreased to the head of the femur. This decrease in blood supply causes a decrease in the oxygen and nutrition reaching the joint. The bone eventually dies which causes weakness and susceptibility to collapse.
Causes
The actual cause of avascular necrosis is unknown. Most cases seem to be associated with alcoholism or steroid use. Other risk factors include sickle cell disease, trauma to the hip (dislocation or fracture), lupus and some genetic disorders.
Symptoms
- Aching pain in the groin.
- Pain with movement of the hip.
- Difficulty walking on the hip.
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Diagnosis
- Medical History
- Physical Examination
- X-Rays (will show bone damage only in the later stages)
- Further Imaging:MRI, CT, Bone Scan
- Bone Biopsy (a procedure in which tissue from the affected bone is removed and studied. This test is rarely used because it requires surgery.)
- Functional Evaluation of Bone (a test used to measure the pressure inside a bone. This test is highly sensitive for the diagnosis of AVN, but like the bone biopsy is rarely used because it requires surgery).
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Current Treatment
- Crutches or a walker to decrease weigh-bearing on the affected hip.
- Medication such as NSAIDS to decrease pain and inflammation.
- Exercise to help strengthen the muscles around the hip.
- Surgery:
How Can Physical Therapy Help
While physical therapy cannot cure avascular necrosis, in some cases it can help slow the progression of the disease and decrease the associated pain. A physical therapist can teach the correct way to use the appropriate assistive device (such as a cane or walker) to decrease weight bearing on the joint . They can provide proper exercises to help increase the strength of the muscles around the affect area (which will also decrease the weight on the joint). They may also use modalities such as electrical stimulation, ultrasound, joint mobilization, and heat to attempt to increase bloody supply to the area and help decrease pain.
Patient Resources
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Johns Hopkins Hospital
e.Medicine
Arthritis Foundation
American Academy of Orthopedic Surgeons
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