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Orthopaedic Clinic

Avascular necrosis of femoral head 3
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No single method or surgery has shown to be universally effective in  prevention of progression of the disease.During early stages , procedures are directed at preventing further progresion of disease and during later stages salvage or reconstructive procedures are the treatment choice.
Early stages:
Conservative mangement in form of non weight bearing or ambulating with crutches have been shown to be largely ineffective and are reserved for people with medical contraindication for surgery or those with limited life expectancy.
Pharmacologic Treatment have a debatable value. various agent that are currently used include:
  • Anti hypertensives like ACE Inhibitors.
  • Lipid lowering drugs.
  • Fibrinolytics.
  • Vasoactive agents.
Core Decompression:
First described by Ficat and Arlet in 1964.
8-10mm of core of head was removed that reduces the elevated interosseous pressure and stimulates the repair by promoting vascular ingrowth.
The effectiveness remain controversial but the patients who underwent core decompression benifited from pain relief. The femoral head preservation and delay in arthroplasty was statistically significant in early stage of disease when compared to the conservative management.
 Rotational or angular types have been described.
Aimed at shifting the affected area of the femoral head away from the weight bearing regions of the joint.
Technically complicated procedures and benifits have been consistently been shown by selected centers.
It complicates future reconstructive surgeries.
Later Stages:
Once femoral head is collapsed reconstructive procedures like total hip arthroplasties are the treatment of choice. Uncemented arthroplasties have shown to perform equally well in younger patients.
THR Technique.
Surface arthroplasty is another option which has gained popularity in recent years. It has shown to preserve the bone stock for  afuture total hip revisions.
Surface arthroplasty technique.
Minimally Invasive Total hip arthroplasty technique.
Computer navigated surgeries.

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