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Avascular Necrosis of Hip: Treatment Options

Treatment options for AVN of the hip are typically separated into operative and nonoperative management.

A
Andrew Schleihauf
Sports Medicine Physician · April 19, 2020 · 3 min read

Overview

Treatment options for AVN of the hip are typically separated into operative and nonoperative management. Many factors will affect options for management. There is no definitive or clear pattern on speed of progression, which complicates decision making.

Symptoms

It is important to rule out secondary causes of avascular necrosis of the femoral head (AVNFH) and ask historical questions about chronic steroid use, alcohol use, clotting disorders, sickle cell disease, autoimmune disease, or trauma. Historically, age and staging are the most important factors in regards to definitive treatment options. The goal of all forms of treatment is to maintain the patient’s anatomy as long as possible, delaying the need for arthroplasty in young patients.

Causes and Risk Factors

It is ideal to delay arthroplasty due to the possibility of one or more revision surgeries during their lifetime. Older age, severely collapsed femoral head, and arthritic patients are accepted as candidates for arthroplasty. In general, nonoperative management studies have conflicting results.

Treatment Options

It is important to identify risk factors and treat them accordingly e.g. Anticoagulation if clotting disorder is present, halt alcohol use, etc. Bisphosphonates act to slow bone resorption and treatment with this class has conflicting evidence.

Recovery

One uncontrolled study with 294 patients showed improvement in pain and clinical function when taking alendronate 10 mg daily. The benefit was shown at three years, but not eight years. Another study with 40 patients showed less collapse [7 vs.

When to See a Doctor

If you are experiencing symptoms that may be related to avascular necrosis of hip: treatment options, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.

*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*

Hip
A
Andrew Schleihauf
Sports Medicine Physician
Sports Medicine Review contributor

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