Avascular Necrosis of femoral head
Avascular necrosis is a condition involving disruption of the vascular supply to the subchondral bone of the femoral head, resulting in articular surface collapse with eventual articular degeneration and osteoarthritis.
risk factors
- Chronic steroid use
- Alcoholism
- Smoking
- Hip trauma including femoral neck fracture and hip dislocations
- Prior hip surgery
- Childhood history of Slipped Capital Femoral Epiphysis
- Systemic Lupus Erythematosus
signs and symptoms
- Hip pain (mild at first progressively worse over time)
- Limitation in motion in capsular pattern (IR>flexion>ABd/extention>adduction/ER
- Pain is located in groin/proximal thigh/buttock
- Pain is exacerbated with weight bearing and relieved with rest
- Antalgic gait with (+) Trendelenberg
- Logrolling (passive ER/IR) elicits pain
physical therapy implications
- If this is a chronic condition, education on unloading activities and joint preservation techniques.
- If this an acute condition, then a referral to a physician is warranted.
references:
Kaushik A, Das A, Cui Q. Osteonecrosis of the Femoral Head: An update in year 2012. World Journal of Orthopedics. 2012;3(5):49-57.
Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed: Saunders Elsevier, St. Louis, MO; 2007.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.
Image: http://www.zimmer.co.uk
Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed: Saunders Elsevier, St. Louis, MO; 2007.
Dutton M. Orthopaedic Examination, Evaluation, and Intervention. 2 ed: McGraw-Hill, Medical Publishing Division; 2008.
Image: http://www.zimmer.co.uk