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What is Avascular Necrosis of the Femoral Head?

H. Colledge
H. Colledge

The femoral head is the ball-shaped top of the thigh bone, or femur. It fits inside a socket-shaped hollow in the hip bone, known as the acetabulum, and the two parts make up the hip joint. Avascular necrosis of the femoral head is a condition in which the blood supply to the femoral head is lost, resulting in osteonecrosis, or death of bone cells. Causes of the condition can include steroids and other drugs, alcoholism and accidental injury. While medication and a combination of rest and stretching exercises can help with symptoms, surgical treatment is usually required to treat the condition effectively.

Blood is supplied to the femoral head through arteries which travel along the femoral neck, a narrow section of bone connecting the femoral head to the shaft of the femur. As this is the only blood supply, if the flow is disrupted, the bone of the femoral head dies and its rounded structure may collapse and flatten. Once the hip joint no longer fits together smoothly, the joint surfaces can become worn and joint deterioration may set in.

Avascular necrosis of the femoral head may require a hip replacement, if the joint has deteriorated.
Avascular necrosis of the femoral head may require a hip replacement, if the joint has deteriorated.

Avascular necrosis of the femoral head typically leads to pain, which is experienced when weight is placed on the hip. Most often, the pain is felt in the groin, but it can also be felt in the buttock or thigh. If femoral head necrosis progresses, hip pain may occur even when the person is resting, and it may become difficult to walk, with stiffness and a limp developing in time. Fractures of the femoral neck can cause avascular necrosis, as can hip dislocation. Conditions such as alcoholism and diabetes may damage the blood supply to the femoral head, as may taking steroids at high doses or for a long time.

Advanced cases of avascular necrosis of the femoral head and deteriorate the hip and cause arthritis.
Advanced cases of avascular necrosis of the femoral head and deteriorate the hip and cause arthritis.

If avascular necrosis of the femoral head has not progressed too far, and the head of the femur has not collapsed, the most common treatment is a surgical procedure called core decompression. During the core decompression operation, the surgeon drills through the femoral neck, creating channels through which new blood vessels can grow and form a blood supply for the head. The procedure can be carried out using minimally invasive techniques, often known as keyhole surgery, and does not require a stay in the hospital.

In some instances, alcoholism is the cause of avascular necrosis.
In some instances, alcoholism is the cause of avascular necrosis.

Core decompression usually prevents progression and relieves any pain due to avascular necrosis of the femoral head. In cases where the condition has advanced and the hip joint has deteriorated, arthritis usually develops. Then, the recommended treatment is to remove the femoral head and neck, together with the acetabulum, and insert artificial hip parts instead. This operation is known as a total hip replacement.

Discussion Comments

CarolD

I have avascular necrosis in both my hips. I have had the core depression done on my right hip, which still hurts just as bad as before the surgery in June, 2013. The left hip is bothering me now. I have been on a walker since March 2013. I had to have cancer surgery in April and had to wait to have the first surgery in June.

It is now the end of September and I am still having pain in both hips. The core depression has not led to the desired effect. I almost wish they would do hip replacements rather than have me live on hydrocodone, muscle relaxants and anti-inflammatories, most of which I am allergic to (Mobic, Relafan, Neurontin). I can't sleep well at night due to trying to get in a good position, have to have the walker at all times, and ride the electric buggies in stores, if they are charged. I hate living like this.

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    • Avascular necrosis of the femoral head may require a hip replacement, if the joint has deteriorated.
      By: NICOLAS LARENTO
      Avascular necrosis of the femoral head may require a hip replacement, if the joint has deteriorated.
    • Advanced cases of avascular necrosis of the femoral head and deteriorate the hip and cause arthritis.
      By: bilderzwerg
      Advanced cases of avascular necrosis of the femoral head and deteriorate the hip and cause arthritis.
    • In some instances, alcoholism is the cause of avascular necrosis.
      By: yellowj
      In some instances, alcoholism is the cause of avascular necrosis.
    • A surgeon may perform a core decompression on a patient if avascular necrosis of the femoral head has not progressed.
      By: Monkey Business
      A surgeon may perform a core decompression on a patient if avascular necrosis of the femoral head has not progressed.
    • Alcoholism can damage the blood supply to the femoral head.
      By: KoMa
      Alcoholism can damage the blood supply to the femoral head.
    • The femoral head fits inside a socket-shaped hollow in the hip bone.
      By: videodoctor
      The femoral head fits inside a socket-shaped hollow in the hip bone.
    • Avascular necrosis of the femoral head may cause buttock pain.
      By: igor
      Avascular necrosis of the femoral head may cause buttock pain.