Osteonecrosis Of The Hip Stages & Treatment - Everything You Need To Know - Dr. Nabil

Dr. Ebraheim’s educational animated video describes osteonecrosis of the femoral head - Hip.
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Osteonecrosis of the Hip
Osteonecrosis or avascular necrosis of the hip means death of a segment of the bone in the femoral head due to interruption of the blood supply. The etiology of this condition is not fully understood. There are several risk factors associated with osteonecrosis of the hip. Direct risk factors for osteonecrosis include trauma, radiation, and hematologic disorders such as lymphoma, leukemia, cytotoxins, Gaucher disease, Caisson disease, and Sickle Cell disease. Indirect risk factors for osteonecrosis include steroid use, alcohol abuse, renal failure, organ transplant, systemic lupus erythematosus (SLE), idiopathic osteonecrosis, hemophilia, and thrombophilia. Osteonecrosis may be bilateral in about 80% of the patients. Check the other hip even if it is asymptomatic. Early diagnosis and treatment may improve the chances for success of a head preserving surgical procedure, such as core decompression or bone grafting. In late stages of osteonecrosis, the femoral head collapses and cannot be saved. For the patient to have a good outcome, the femoral head will need to be replaced at this late stage. Obtain AP and frog leg lateral views of the hip. The frog leg lateral view will show the crescent sign. MRI is the study of choice, especially when the patient has persistent hip pain and the radiographs are negative and the diagnosis of osteonecrosis of the femoral head is suspected, especially if the patient has risk factors. On the T1 MRI, there is a well-defined band of low signal intensity usually within the superior anterior portion of the femoral head. Decreased signal from the ischemic marrow and there is a single band-like area of low signal intensity (crescent sign). The crescent sign represents the reactive interface between the necrotic and reparative zone. The single line density demarcates the normal from the ischemic bone. Double Line Sign is seen in T2 images. The subchondral lesion on T2 shows two lines the low signal intensity line and the high signal intensity line. The lesion will show a high signal intensity inner border with a low signal intensity peripheral rim (double line). The high signal intensity represents hyper vascular granulation tissue. The size of the lesion is the most important factor in determining the development of symptoms and the progression of the disease. The best prognosis occurs in a small lesion with sclerotic margins. The presence of bone marrow edema on the MRI is predictive of worsening of the pain and future progression of the disease. Multifocal osteonecrosis, which is disease involving three or more sites such as the hip, the knee, the shoulder, and the ankle, occurs in about 3% of patients. A patient that presents with osteonecrosis at a site other than the hip should undergo MRI of the hip to rule out the asymptomatic lesion in the femoral head. Transient osteoporosis of the femoral head is not osteonecrosis of the femoral head. In transient osteoporosis, the symptoms are usually more than the x-ray findings. Transient osteoporosis affects pregnant women, and it affects men during the 5th decade of life. On x-ray, you probably will not find much (may find osteopenia). The MRI is probably characteristic (you will find bony edema and increased signal intensity in T2 MRI). The signal changes will involve the femoral head and extend into the neck, and may be even the intertrochanteric area. With transient osteoporosis, there is no double density which is on MRI with osteonecrosis. Transient osteoporosis is not a tumor, it is not osteonecrosis and it does not need surgery. The Ficat classification is a commonly used system to stage osteonecrosis of the hip. Stage I has a normal x-ray; MRI has abnormal signal (changes in the marrow), and the bone scan will show increased uptake. In Stage II, the x-rays will show mixed osteopenia and/or sclerosis. There might be subchondral cysts and lucencies. There is no crescent sign, no subchondral fracture, and no collapse. The MRI and bone scan will be abnormal. In Stage III, the x-ray will show the crescent sign, which is a subchondral fracture line and may be associated with collapse of the femoral head. MRI will show the changes that are seen in the x-rays. In Stage IV, the x-ray will show collapse of the subchondral bone and severe deformity of the head with secondary degenerative changes affecting both sides of the joint.

[casch]

Un grand merci pour toutes vos vidéos accompagnées d'explications claires.

Votre connaissance des problèmes osseux et nerveux est remarquable.

Merci encore car la compréhension de la douleur et de ses origines encourage le patient à être acteur de sa guérison.

[robertjackson]

I was just diagnosed with osteonecrosis and this is my first real information ive received so far

[renatepalm]

That was the best AVN report any one can ask for. Big thank you to Dr. E

[conniemiles]

I just found out that this is what is causing my pain, and should be getting a Total Hip replacement soon, I'm trying to be positive. I'm grateful for what information there is available. These videos and explanations help me cope.

[laithhasm]

الله يجزك خير وكتب أجرك بالعلم النافع
⛤⛤

[leafrazer]

Excellent video! I wish you were my doctor.

[DeKarle]

Best knowledge available on Youtube about AVN. Have you experienced how predictable the results for core decompression in Stage I in younger patients are? Can't find anything on this.

[dryacoobomarcarrim]

This is by far the most helpful AVN review.
And
Excellent radiology review.

Amazing

[yallampallilakshmikanthara]

Good massage we will very helpful massage

[trappistd]

Deceptive thumbnail - after my accessing this video, the figure on this video is running and I accessed this video for its title, but because it appeared like the "science" of avascular necrosis pain was being discussed on this video, but that wasn't the case.
Either way if folks out there assumed that this video was my declaration of my having no more pain, well that wasn't the case. And if folks think this situation means that I was "explaining how my hip pain is gone and my pain while walking has improved, " well thats not the case at all, not even close- but I wish that were the case.

But it's not. I'm doomed to have excruciating hip pain for life it seems.

With that "Crime Victim's Compensation" that was mentioned a number of times on YouTube some weeks ago, some figures were suggested and seemed as if Compensation is going to me after all of this, well I guess I'd like to consider getting the major surgery on my hip done if that is obtainable. I've had only one companion through all of this - and that is God and physical pain - and the pain gets quite excruciating most times.
The pain hurts, it's embarrassing and it's dehumanizing.


I've needed that surgery for 23+ years.
Someday I hope to get that surgery and live one full day without limping as well as going without hip pain. I can't even remember living like a human being because if I had my way, that surgery would happen.

Who knows what fate has in store.
Daniel

[scowlfarm]

I'm scheduled for a fifth hip surgery in July. I had my first one when I was 21.

[bradnewman]

Does cutting back on drinking beer slow the progression of ANV? My hip has been hurting for 3 months now and i was diagnosed with this last week. I usually drink 4-5 beers a night. I didnt think that was too much but it may have been what let to me developing this disease.

[KcRadhakrishnan-qd]

Recent radio diagonal film is directed me to be done like thought, G i, like mention on tibial limb is it ok if i stay in away from surgery

[TransformerEngineer]

Im suffering from avn. How to cure without surgery. Please explain. Im 38 yrs. It is came after COVID treatment.

[nadaahmed]

What about ostonecrosis due to loose bodies intra articular at medial femoral condyle.?

[BattleCatEmma]

Is it safe to use Serrapeptase enzymes with avascular necrosis

[sherifelsawy]

Dear sir thanks for your educative beniftial vedios .
May I ask about treatment option for young patient has AVN stage one or two with history of renalbtransplantation ?
Do we go for direct THR or we may try head perserving procedure

[babykp]

I can't believe because l studied born fill all damage repair themself

[ManikantSharma]

Hi, can Anyone help me..
My father has hip joint injury pelvic has been crack.. i can show x-ray.. if someone wants to help me..

[mamtamaurya]

मुझे इंग्लिश नहीं आती हैं लेकीन मेरे यहीं दिक्कत है क्या मैं ठीक हों सकता हूं