Essay On Osteonecrosis

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Osteonecrosis has become a subject of interest amongst orthopaedic surgeons predominantly during the last four to five decades.

There are several etiological factors of osteonecrosis of femoral head. They may be traumatic (after femoral neck fractures or dislocations of hip joint), idiopathic, corticosteroid induced, alcohol abuse, following infection, haemoglobinopathy, post¬irradiation, Caisson's disease, Gaucher's disease and associated with gout. Commonly, the patients belong to third to fifth decades of life. Since the etiopathogenesis is different, the pathomechanics vary from case to case. Though the ultimate fate of the necrotic femoral head is the same, the results of treatment may vary with the etiology.

Diagnosis of osteonecrosis of femoral head is done clinically by pain around the hip, gradual limitation of motions, radiographic criteria and staging of Ficat and Arlet. Radionuclide Scintigraphy (99 mTc Di-phosphonate ) can be done especially for diagnosis in the early stages of osteonecrosis, CT to detect the early details of bone changes, MRI to record very early marrow necrosis not detectable by CT and tests for haemodynamic functions (intramedullary pressure measurements and venography) for vascular stasis.

Patients may present with pain in hip which is due to subarticular increased intravenous pressure in early stages of osteonecrosis marrow oedema, necrosis and also due to increased intracystic pressure associated with degenerative changes of hip in advanced stages of necrosis. In advanced stages, there may be collapse of femoral head, cheilus formation with adhesions around the periphery of femoral head and associated contracture of articular capsule which causes pain due to its stretching effect over t...

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...ure of choice based on surgeon's expertise.

A femoral head preserving operation having satisfactory results in long term follow up should be the treatment of choice in younger individuals and THR in elderly where femoral head is badly damaged and in younger patients with multisystem diseases and poor general health. Considering the life style of people of our country who needs squatting habit, decompression of femoral head and TFL muscle pedicle bone grafting is a good option both in early and even in advanced stages of the disease unless the femoral head is badly deformed or collapsed more than 5mm. Considering its technical simplicity compared to the use of other vascularised bone grafts like vascularised fibular or vascular pedicle iliac crest graft, the above method can be recommended in patients of developing countries like ours where osteonecrosis is common.

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