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Medical Forum / Diseases and Disorders / Arthritis / May 2006Avascular necrosis (AVN), osteonecrosis
I was recently diagnosed with AVN and arthritis in both hips. I'm at stage 1. At the time of diagnosis only the left hip was painful, (excruciatingly so). I went through aquatherapy and chiropractic because sciatica and bursitis flared up at the same time and made it more difficult to diagnose. These other problems have been relieved but now the right hip is becoming painful. I'm planning on undergoing core decompression in July with an orthopedist who's won awards and I've been told is the best hip specialist in this region. My experience with him has inspired confidence and trust. I'll ask my questions to him before I have the operation but I'd like to hear from people with a patient's perspective. Have you had surgery done on both hips at once? Did your doctor recommend it or advise against? How long did you use crutches after the operation? Did you have the procedure done on both hips at different times? Besides the advantage of having one good hip during recovery, were there any others? If I can, I'd like to get it over with all at once, endure a little more pain and use crutches for a few more weeks at one time rather than going through the procedure a second time. Thank you in advance for your thoughts. Please mention this post to any person you know who's had this problem and might not know about this forum. I'll report on my experience after the operation. Hello Daveyj. I am also an avn sufferer. AVN left hip. I guess that I have had it for about 3 yrs now and the leg is about 2 inches shorter than the other. We are not so fortunate in the UK as to have reasonable access to orthos who do core decompression. It seems nobody is really interested in curing AVN here, but they will happily do a hip replacement. My rheumatologist missed the AVN, even tho I told him about it when it first occurred and the symptoms were classic. He finally diagnosed it from an x-ray about a year after I first experienced the excruciating symptoms. I have drawn comfort and advice over the years since I have had this condition from the people who frequent this site, but also those on http://health.groups.yahoo.com/group/osteonecrosis/messages . I think those on the osteonecrosis group have a lot of experience and there are articles and recommendations of orthos and procedures. Best wishes Peter > Hello Daveyj. > > I am also an avn sufferer. AVN left hip. I guess that I have had it for > about 3 yrs now and the leg is about 2 inches shorter than the other. That would only happen with complete collapse of the femoral head. Femoral heads aren't all that big! I know, I was handling them in my last anatomy lab. If it's really that far gone, get a hip replacement before it becomes an emergency surgery or before the acetabular area becomes too damaged to install the cup. > We are not so fortunate in the UK as to have reasonable access to > orthos who do core decompression. It seems nobody is really interested [quoted text clipped - 3 lines] > from an x-ray about a year after I first experienced the excruciating > symptoms. Ack, that sucks. By the time it shows up on x-ray, it's probably too late for core decompression anyway. I was lucky and we found it early on an MRI, but I had very few symptoms until my hip virtually shattered. The other hip took a couple more years to do that. > I have drawn comfort and advice over the years since I have had this > condition from the people who frequent this site, but also those on [quoted text clipped - 3 lines] > . I think those on the osteonecrosis group have a lot of experience and > there are articles and recommendations of orthos and procedures. Since I've been using anabolic steroids to keep me from dying from marrow failure, and an oral bisphosphonate drug 'actonel' to stop all the osteoporotic stress fractures, the osteonecrosis in my left wrist has started to recede. I wonder about my knees, but I don't fancy getting an MRI session just to satisfy my curiosity. Regards, Ari  Signaturespammage trappage: remove the underscores to reply I'm going to die rather sooner than I'd like. I tried to protect my neighbours from crime, and became the victim of it. Complications in hospital following this resulted in a serious illness. I now need a bone marrow transplant. Many people around the world are waiting for a marrow transplant, too. Please volunteer to be a marrow donor: http://www.abmdr.org.au/ http://www.marrow.org/ > I was recently diagnosed with AVN and arthritis in both hips. I'm at > stage 1. At the time of diagnosis only the left hip was painful, [quoted text clipped - 4 lines] > > I'm planning on undergoing core decompression Mark my words: when they discover why this works in some people, it isn't going to be anything about 'decompression'! The mechanism will be marrow stem cells regenerating the bone in the dead areas and stimulating revascularisation. I say go for it, but be prepared for hip replacement if it fails. Also, while the bone is regenerating (if it does), be prepared for a lengthy minimal or reduced weight bearing period. When the new bone starts resorbing the dead bone the interface between the two can be much weaker than either they dead or the living bone areas, and this can lead to fractures which can themselves disrupt blood supply to the bone. > in July with an > orthopedist who's won awards and I've been told is the best hip [quoted text clipped - 8 lines] > > Did you have the procedure done on both hips at different times? Yes, bilateral hip replacements done two years apart. > Besides the advantage of having one good hip during recovery, were > there any others? You'll really appreciate that one good hip when trying to get up and down off the raised toilet seat! But for core decompression, it's probably not going to be anywhere near as problematic a surgery as the gigantic 'split you open and hammer a titanium rod down your femur after we bore out your acetabulum' surgery that is hip replacement. > If I can, I'd like to get it over with all at once, endure a little > more pain and use crutches for a few more weeks at one time rather than > going through the procedure a second time. For core decompression, yeah, go for it. It'll prevent you getting cold feet and putting off the second procedure if you find the restrictions too burdensome. I'd probably give the same advice for hip replacement, too: better three months of severe mobility problems than six months of just moderately severe mobility problems. > Thank you in advance for your thoughts. Please mention this post to > any person you know who's had this problem and might not know about > this forum. > > I'll report on my experience after the operation. Please do, and let us know how well it turns out down the road. Regards, Ari Signaturespammage trappage: remove the underscores to reply I'm going to die rather sooner than I'd like. I tried to protect my neighbours from crime, and became the victim of it. Complications in hospital following this resulted in a serious illness. I now need a bone marrow transplant. Many people around the world are waiting for a marrow transplant, too. Please volunteer to be a marrow donor: http://www.abmdr.org.au/ http://www.marrow.org/ > > I was recently diagnosed with AVN and arthritis in both hips. I'm at > > stage 1. At the time of diagnosis only the left hip was painful, [quoted text clipped - 72 lines] > http://www.abmdr.org.au/ > http://www.marrow.org/ > You'll really appreciate that one good hip when trying to get up and > down off the raised toilet seat! I considered this. It's already a miserable situation using the toilet or trying to get dressed in the morning, but now that the right hip is involved, I don't consider it a help because of the pain. > For core decompression, yeah, go for it. It'll prevent you getting cold > feet and putting off the second procedure if you find the restrictions > too burdensome. I'd probably give the same advice for hip replacement, > too: better three months of severe mobility problems than six months of > just moderately severe mobility problems. This was a concern of mine. I know that I am a procrastinator who just doesn't like going to doctors. I believe I would keep putting off the second operation just out of waiting for a better time, time off from work, or just not wanting to go through the whole mess again. I've already used crutches and a cane when the pain was at its worst, so I know what it's like. The doctor and PT informed me of the risks of fracture, dislocation, etc. I'd rather go through a few months on crutches once than 6 weeks each at 2 different times. Thanks for your opinions. They are very encouraging. Keep them coming. Stay tuned. I'll make detailed reports after the procedure(s) then as recovery progresses.
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