Osteonecrosis of the Femur – Hip Resurfacing Surgery, Alternatives to Hip Replacement

Osteonecrosis is a condition due to a decreased blood supply to the bone. It mainly affects the upper end of the femur. If left untreated, it progresses to bone collapse and arthritis. The causes are many, such as alcohol abuse, steroid intake, Caisson’s disease, Gaucher’s disease.

The patient may experience sudden pain in the hips that radiates to the knee and can be mistaken for knee pain. Walking is painful. In the first cases, radiographs are negative and magnetic resonance imaging is diagnostic. Treatment in the early stages is controversial and there are no clear guidelines.

Prolonged bed rest and walking with crutches have not been shown to relieve pain or stop disease progression.

Treatment in late cases

Central decompression improves symptoms. It is minimally invasive and does not involve a replacement. If it fails, a replacement is possible at a later date.

Treatment in late cases with advanced destruction

Treatment consists of a total hip replacement if bone destruction is extensive. A partial or total hip resurfacing replacement is performed if the destruction is limited to the superficial cartilage only. Since it occurs in young people, a surface hip replacement is a better option as it preserves bone stock and a total hip replacement can still be performed at a later date. Hip resurfacing is restricted to those cases of osteonecrosis where the amount of destruction is less than 30 percent of the head.

Where it exceeds thirty percent, a new type of hip replacement called proximal hip is available in Chennai.

This Proxima hip is a large diameter uncemented metal-on-metal bearing. It has been done for avascular necrosis and other conditions such as ankylosing spondylitis, post-traumatic arthritis after acetabular fracture.

The vascularized fibular graft is performed with the help of a microvascular surgeon.