Is Your Hip Pain The Sign of a Rare Condition?

Your hips are largest and most powerful of muscle groups—the glutes, quads, and hamstrings—all connect at the hips, and they allow you to walk, run, climb. The hip joint is crucial to all movement, in sports and day-to-day life, which is why persistent hip pain can be such a pain in the ass literally and often debilitating.

hip

 

Wear and tear on your hip joint can worsen with age. According to the Centers for Disease Control and Prevention, 7 percent of adults in the U.S. suffer from hip pain, the third most common joint pain behind shoulder pain, at 9 percent, and knee pain, at 18 percent. There’s also a growing prevalence of young athletes with hip injuries, especially young women, due to repetitive overuse and acute trauma.

Trauma can sometimes lead to osteonecrosis  in any joint but we are focusing on the hip , and some of the medications given to help inflammation and strengthen bones can also be a cause of osteonecrosis aka avascular necrosis.

Your Hip Pain May be the Sign of a Rare Condition

If you have hip pain don’t always brush it off as arthritis, if it persists, get it checked out to be safe

Persistent or worsening hip pain warrants a visit to your health care provider and possibly a sports medicine specialist or ortho. Some problems, particularly hip stress fractures, are commonly misdiagnosed due to the confusing presentation of symptoms.

 

A thorough evaluation is necessary and often includes X-rays and other studies, such as an MRI or bone scan. As with all injuries, the absence of pain does not mean that all is well. Strength and flexibility deficits must be addressed to allow a healthy return to helping your quality of life.

 

 

Although a person may not initially experience symptoms, hip pain is usually the first indicator. The earlier the diagnosis is achieved, the better the patient’s potential outcome. AVN has four stages that can progress over a period of several months to more than a year. In Stage I, the hip is healthy; in Stage II, the patient experiences mild to moderate pain in direct proportion to the deterioration of the head of the femur (or ball of the hip joint). By Stage III, usually the patient will find it difficult to stand and bear weight on the hip, and joint movement will be painful. During this stage, the ball of the hip has deteriorated to what is called a subchondral fracture and early collapse. Stage IV is a full collapse of the femoral head and degenerative joint disease (DJD).

 

Treatment for AVN is recommended based on the stage of the disease coupled with the age of the patient. In Stage I, medication and crutches may be prescribed to provide relief and enable the bone to heal on its own. This treatment may require the patient to be non-weight-bearing for up to six months. It also has a failure rate greater than 80-percent.

On the horizon treatments are stem cell.

 

Surgical treatment is recommended with a Stage II diagnosis, or very early in a Stage III diagnosis. A procedure, known as a core decompression, typically involves drilling one large hole in the core of the effected bone, with or without a bone graft, to reduced pressure and improve blood circulation in the hip. Another surgical option is the vascularized fibular graft, which takes a healthy piece of bone from the fibula, along with the artery or vein, and transplants and reattaches it into the hip, to help healthy bone grow. Recovery can take several months.

 

Because most patients are diagnosed in late Stage III or IV of the disease, when the bone quality of the femoral head is poor (subchondral fracture) or has collapsed, total hip replacement is the most successful treatment for AVN. This procedure replaces the damaged bone with artificial parts. Recovery takes about eight to twelve weeks. If left untreated, AVN progresses and results in pain and severe debilitating osteoarthritis.

Treatment decisions for AVN are ultimately up to the patient and are based on his or her lifestyle and goals. If you are suffering with hip pain, talk with your primary care doctor about a referral to an orthopedic surgeon

You won’t keep me down

Osteonecrosis can be painful you never know when the pain will come or go.

But I do know it’s already taken my job away from me.

I love the optical field. But the pain was too intense.

Well I’m back in school learning something new.

#YourNeverToOldToLearn

Avascular Necrosis-Osteonecrosis

The real term is Osteonecrosis

Synonyms of Osteonecrosis

  • aseptic necrosis
  • avascular necrosis of bone
  • ischemic necrosis of bone

What is avascular necrosis-osteonecrosis ?

AVN-ON is a disease that results from the temporary or permanent loss of blood supply to the bone.

When blood supply is cut off, the bone tissue dies and the bone collapses. If it happens near a joint, the joint surface may collapse.

This condition may happen in any bone. It most commonly happens in the ends of a long bone. It may affect one bone, several bones at one time, or different bones at different times.

What causes avascular necrosis?

Avascular necrosis – Osteonecrosis may be the result of the following:

• Injury

• Fracture

• Damage to blood vessels

• Long-term use of medicines, such as corticosteroids

•To many steroid injections

• Excessive, long-term use of alcohol

• Specific chronic medical conditions

What are the risk factors for avascular necrosis-osteonecrosis?

Risk factors include:

• Injury

• Steroid use

• Gaucher disease

• Caisson disease

• Alcohol use

• Blood disorders, such as sickle cell anemia, factor V, eNOS, mthfr, factor viii

• Radiation treatments

• Chemotherapy

• Pancreatitis

• Decompression disease

• Hypercoagulable state

• Hyperlipidemia

• Autoimmune disease

• HIV

• Vasculitis

• Bone Marrow Edema

• Legg Calves Perthes is avn in childhood

What are the symptoms of avascular necrosis?

The following are the most common symptoms of avascular necrosis. However, each person may experience symptoms differently. Symptoms may include:

• Minimal early joint pain

• Increased joint pain as bone and joint begin to collapse

• Limited range of motion due to pain

The symptoms of avascular necrosis may look like other medical conditions or bone problems. Always talk with your healthcare provider for a diagnosis.

How is avascular necrosis treated?

Specific treatment for avascular necrosis will be determined by your healthcare provider based on:

• Your age, overall health, and medical history

• Extent of the disease

• Location and amount of bone affected

• Underlying cause of the disease

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the disease

Key points about avascular necrosis

• Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. It happens most commonly in the ends of a long bone.

• Avascular necrosis may be the result of injury, use of specific medicines, or alcohol.

• Symptoms may include mild to severe joint pain and limited range of motion.

• Medications,assistive devices, new experimental treatments like Prp and stem cell injections have show great promise but usually not covered by insurance or you may need to have surgery to improve functionality or to stop further damage to the affected bone or joint.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions. You’re physician should always take a few minutes to talk to you and discuss concerns, treatments all treatments not just the ones they do.

If you don’t get good communication you may want to get another opinion and consider changing providers.

Learn to be your own advocate

Your worth it.

Osteonecrosis has many different causes. Loss of blood supply to the bone may lead to bone cell death and can be caused by an injury (bone fracture or joint dislocation; called traumatic osteonecrosis). At times, there may be no history of injury (non-traumatic osteonecrosis); however, other risk factors are associated with the disease such as some medications (steroids, also known as corticosteroids), alcohol usage or blood coagulation disorders. Increased pressure within the bone also is associated with osteonecrosis. One theory is that the pressure within the bone causes the blood vessels to narrow, making it difficult for blood to circulate through the bone. Osteonecrosis can also be associated with other disorders.

The exact reason osteonecrosis develops is not fully understood for some risk factors. Sometimes, osteonecrosis occurs in people with no risk factors (idiopathic).

Some people have multiple risk factors. Osteonecrosis most likely develops because of the combination of factors, possibly including genetic, metabolic, self-imposed (alcohol, smoking), and other diseases that you may have and their treatment. 

Injury:
When a joint is injured, as in a meniscus tear, fracture or dislocation, the blood vessels may be damaged. This can interfere with the blood circulation to the bone and lead to trauma-related osteonecrosis. Studies suggest that this type of osteonecrosis may develop in more than 20% of people who dislocate their hip joint. And 15 % of people who have trauma to knee.

Corticosteroid Medications:
Corticosteroids, such as prednisone, are commonly used to treat diseases in which there is inflammation, such as systemic lupus erythematosus, copd, rheumatoid arthritis, inflammatory bowel disease, and vasculitis.

Studies suggest that long-term, high dose systemic (oral or intravenous) corticosteroid use is a major risk factor for non-traumatic osteonecrosis with reports of up to 35 percent of all people with non-traumatic osteonecrosis.

However, there is still some risk of osteonecrosis associated with the infrequent use of corticosteroids, inhaled corticosteroids, or most steroid injections into joints.

Patients should discuss concerns about corticosteroid use with their doctor.

Doctors aren’t sure exactly why the use of corticosteroids sometimes is associated with osteonecrosis. They may have negative effects on different organs and tissues within the body. For example, they may interfere with the body’s ability to build new bones and to break down fatty substances.

These substances would then build up in and clog the blood vessels, causing them to narrow. This then would reduce the ability of blood to flow inside a bone.

Alcohol Use:
Excessive alcohol use is another major risk factor for non-traumatic osteonecrosis. Studies have reported that alcohol accounts for about 30% of all people with non-traumatic osteonecrosis. While alcohol can slow down bone remodeling (the balance between forming new bone and removing bone), it is not known why or how alcohol can trigger osteonecrosis.

Other Risk Factors:
Other risk factors or conditions associated with non-traumatic osteonecrosis include Gaucher disease, pancreatitis, autoimmune disease, cancer, HIV infection, decompression disease (Caisson disease), and blood disorders such as sickle cell disease, factor v, mthfr, and more so always ask your doctor to check you for a clot disorder.

Certain medical treatments including radiation treatments and chemotherapy can cause osteonecrosis. People who have received a kidney or other organ transplant may also have an increased risk.

Affected Populations

Osteonecrosis usually affects people between 20 and 50 years of age; about 10,000 to 20,000 people develop osteonecrosis each year in the United States alone.

Osteonecrosis affects both men and women and affects people of all ages. It is most common among people in their thirties and forties. Depending on a person’s risk factors and whether the underlying cause is trauma, it also can affect younger or older people.

Diagnosis

After performing a complete physical examination and asking about the patient’s medical history (for example, what health problems the patient has had and for how long), the doctor may use one or more imaging techniques to diagnose osteonecrosis. As with many other diseases, early diagnosis increases the chances of treatment success.

It is likely that the doctor first will recommend an x-ray. X-rays can help identify many causes of joint pain, such as a fracture or arthritis. If the x-ray is normal, the patient may need to have more tests.

Research studies have shown that magnetic resonance imaging (MRI) is currently the most sensitive method for diagnosing osteonecrosis in the early stages. The tests described below may be used to determine the amount of bone affected and how far the disease has progressed.

X-Ray
An x-ray is a common tool that the doctor may use to help diagnose the cause of joint pain. It is a simple way to produce pictures of bones. The x-ray of a person with early osteonecrosis is likely to be normal because x-rays are not sensitive enough to detect the bone changes in the early stages of the disease. X-rays can show bone damage in the later stages, and once the diagnosis is made, they are often used to monitor the course of the condition.

Magnetic Resonance Imaging (MRI)
MRI is a common method for diagnosing osteonecrosis. Unlike x-rays, bone scans, and CT (computed/computerized tomography) scans, MRI detects chemical changes in the bone marrow and can show osteonecrosis in its earliest stages before it is seen on an x-ray. MRI provides the doctor with a picture of the area affected and the bone rebuilding process. In addition, MRI may show diseased areas that are not yet causing any symptoms. An MRI uses a magnetic field and radio waves to produce cross-sectional images of organs and bodily tissues.

Bone Scan
Also known as bone scintigraphy, bone scans should not be used for the diagnosis of osteonecrosis because they may miss 20 to 40% of the bone locations affected.

Computed/Computerized Tomography (CT)
A CT scan is an imaging technique that provides the doctor with a three-dimensional picture of the bone. It also shows “slices” of the bone, making the picture much clearer than x-rays and bone scans. CT scans usually do not detect early osteonecrosis as early as MRI scans but are the best way to show a crack in the bone. Occasionally it may be useful in determining the extent of bone or joint surface collapse.

Biopsy
A biopsy is a surgical procedure in which tissue from the affected bone is removed and studied. It is rarely used for diagnosis, as the other imaging studies are usually sufficiently distinct to make the diagnosis with a high level of confidence.

Standard Therapies

Treatment
Appropriate treatment for osteonecrosis is necessary to keep joints from collapsing. If untreated, most patients will experience severe pain and limitation in movement within two years. There is no agreed upon optimal treatment for individuals with osteonecrosis.

Early intervention is essential to preserve the joints, but most people are diagnosed late in the disease process. 

Several treatments are available that can help prevent further bone and joint damage and reduce pain. To determine the most appropriate treatment, the doctor considers the following aspects of a patient’s disease: the age of the patient; the stage of the disease–early or late; the location and amount of bone affected–a small or large area. The underlying cause has not been shown to influence outcomes of treatment.

The goal in treating osteonecrosis is to improve the patient’s use of the affected joint, stop further damage to the bone, and ensure bone and joint survival. If osteonecrosis is diagnosed early enough, collapse and joint replacement can be prevented. To reach these goals, the doctor may use one or more of the following treatments.

Non-operative Treatment

There is no known pharmaceutical cure for osteonecrosis. Several non-operative treatments have been studied including hyperbaric oxygen therapy, shock wave therapy, electrical stimulation, pharmaceuticals (anticoagulants, bisphosphonates, vasodilators, lipid lowering agents), physiotherapy and muscle strengthening exercises, and combinations thereof. There are conflicting results for some of these treatments, therefore, rigorous, randomized controlled trials with large numbers of patients are still needed to determine the effectiveness of these treatments. Non-operative treatment may be part of a wait-and-see approach based on the size of the area of dead bone. Non-operative treatments cannot be labeled as conservative, since many of them do not slow the progression of the disease or lead to avoidance of a total hip arthroplasty. Most are simply pain-relieving at best.

Reduced weight bearing does not alter the course of the disease and is not a treatment. It may be used to simply permit the patient to better cope with pain until appropriate treatment is instituted. 

Surgical Treatment

Core decompression – This surgical procedure removes or drills a tunnel into the area of the affected bone, which reduces pressure within the bone. Core decompression works best in people who are in the earliest stages of osteonecrosis, before the collapse of the dead bone. This procedure sometimes can reduce pain and slow the progression of bone and joint destruction in these patients.

Osteotomy – This surgical procedure reshapes the bone to reduce stress on the affected area. There is a lengthy recovery period, and the patient’s activities are very limited for 3 to 12 months after an osteotomy. This procedure is most effective for patients with advanced osteonecrosis and those with a small area of affected bone.

Bone graft – Bone grafts can be used as part of the surgical treatment for osteonecrosis. Bone grafts can use bone from the same patient or donor bone. Bone graft or synthetic bone graft can be inserted into the hole created by the core decompression procedure. A specialized procedure, called vascularized bone grafting, involves moving a piece of bone from another site (often the fibula, one of the bones of the calf, or the iliac crest, a portion of the pelvic bone) with a vascular attachment. This allows for support of the diseased area as well as a new source of blood supply. This is a complex procedure and is performed by surgeons that are specially trained. Another type of bone grafting, involves scraping out all of the dead bone and replacing it with healthier bone graft, often from other portions of the patient’s skeleton. 

A unique type of bone graft involves the use of a patient’s own cells that are capable of making new bone. Often these cells are a type of stem cell from the bone marrow or other bodily tissues. There has been increasing interest in the potential of stem cell therapy. This is also being studied for the treatment of osteonecrosis. Mesenchymal stem cells, which are a type of ‘adult’ stem cell, can grow and develop into many different cell types in the body. Physicians take the patient’s own mesenchymal stem cells (autologous transplant) and place them into the affected bone to stimulate bone repair and regeneration.

Arthroplasty/total joint replacement – Total joint replacement is the treatment of choice in late-stage osteonecrosis when the joint is destroyed. In this surgery, the diseased joint is replaced with artificial parts. It may be recommended for people who are not good candidates for other treatments, such as patients who do not do well with repeated attempts to preserve the joint. Various types of replacements are available, and people should discuss specific needs with their doctor.

For most people with osteonecrosis, treatment is an ongoing process. Doctors may first recommend the least complex and invasive procedure, such as protecting the joint by limiting high impact activities, and watch the effect on the patient’s condition.

Other treatments then may be used to prevent further bone destruction and reduce pain such as core decompression with bone graft/stem cell therapy,Prp injections, A2m injection. But some of these new treatments may not be covered by your insurance.

Eventually patients may need joint replacement if the disease has progressed to collapse of the bone. It is important that patients carefully follow instructions about activity limitations and work closely with their doctor to ensure that appropriate treatments are used.

Investigational Therapies

Scientists, researchers, and physicians continue to pursue a better understanding of how this disease occurs as well as compare the effectiveness of current and newly developed therapies. Often, this requires a clinical trial to answer questions and gain additional knowledge.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

Information

Stem Cell

Alcohol and Osteonecrosis

Osteonecrosis Knee

Various Links Osteonecrosis

Material Used In Hip Replacements

The Many Different Materials Used in Hip Replacement Devices.

If you need a hip replacement it’s best to educate yourself .

Hip replacement devices break into a few big categories:

Metal on Metal (MOM) – These are what they sound like. Both the socket and the ball are made of stainless steel, titanium, chromium, cobalt or some combination of these. One sub-type of a MOM hip is a minimally invasive model which usually is smaller in size, so it can be installed with a smaller incision.

Polyethylene and Metal on Polyethylene (MOP) – Polyethylene is basically plastic, so these hips usually have metal structural pieces and a plastic liner where the ball and socket meet. They can also have a metal ball meeting a plastic socket liner. A sub-type of a polyethylene hip is made with a newer plastic called cross linked polyethylene, which is more durable.

Ceramic on Metal (COM), Ceramic on Ceramic (COC), Ceramic on Polyethylene (COP) – Ceramic hips are made of specialized and more durable versions of the same type of material that plates and bowls are made from. There are ceramic on metal, ceramic on ceramic, and ceramic on polyethylene versions. While these are durable, they can be vulnerable to fracture and breaking under big stresses.

Wear Particles

If for some reason I would need a hip replacement, my single biggest concern would be wear particles. This phenomenon first came to light about 5 – 7 years ago when surgeons began to replace the first worn out or failed metal on metal (MOM) hips. What they found in some patients was scary. Basically, the entire area directly around the hip replacement device had turned into a mass of black goo.

Then studies were published showing that those microscopic metal shavings were leaching into the blood stream and causing elevated metal ion levels. Additional studies began to point out that some people’s tissue was so sensitive to this junk that they formed pseudotumors, which are basically big solid masses of irritated tissues, some of which could press on important nerves. Finally, genetic studies showed that not only was this tissue visibly unhappy, the cells were getting damaged at a genetic level from the wear particles.

When all of this first came to light, it looked like only MOM hips were involved. However, as the research below shows, the issue of wear particles extends to every type of hip made.

ARMD – Adverse Reactions to Metal Debris

Before we begin, it’s worth noting that there is now a name for pissed off tissue caused by wear particles. In a 90s movie, a nuclear war head falls into the wrong hands and the main character is informed that this is called a “Broken Arrow”. He responds to the effect of, “I’m not sure what’s more disturbing, the fact that we just lost a nuclear warhead or that you actually have a name for this”. I feel the same about the fact that the orthopedic joint replacement community now has a name for wear particles that cause problems in patients.

In addition to highlighting research on wear particles, I’ll also look at the durability of each type. So let’s take a look at how to navigate this minefield.

The Research on the Various Types of Hip Replacement Materials – Focused on Wear Particles and Device Failure

MOM or “Metal on Metal”

The “bad boy” of hip replacement types is clearly MOM hips. The funniest thing is that despite all of the absolutely horrific things published about these devices, you can still find Internet ads for many surgeons who will be happy to implant them. They do this by claiming that these are “minimally invasive” hips. While there’s a tiny kernel of truth in that hogwash (the incisions needed to implant them are smaller), there is nothing minimally invasive about amputating a joint and inserting a prosthesis, no matter how you skin that cat. In addition, the smaller the device, the bigger the wear particle issue.

MOM hips produce metal wear particles locally that are then taken up in the bloodstream. In general, smaller MOM hip devices (usually those used for small framed women) have a higher likelihood of producing metal wear particles. This study showed more metal ions in the blood with MOM devices compared to conventional hip replacement prostheses. This randomized trial again demonstrated more metal ions in the blood of women with MOM hips when compared to conventional hip replacement, but also noted that pseudotumors occurred both around these MOM devices and the more conventional MOP devices as well. This recent study showed that metal debris was present in both large and small MOM hip replacement devices.

Photo from Breaking Muscle It’s all in the hips

The latest 2015 consensus guidelines are now not to perform a MOM hip replacement in small women or anybody with a known metal allergy. The latest study on MOM hips and pseudotumors concludes, “Adverse reactions to metal debris in MOM hips may not be as benign as previous reports have suggested.” Not good.

Polyethylene and Metal on Polyethylene (MOP)

When I initially began this literature search, I thought that MOP hips may be better in the wear particle department. After all, you don’t have metal rubbing on metal, but usually metal on plastic. However, I was wrong.

To see how bad things can get with MOP wear particles, I didn’t have to look far. This recent study from 2014 showed an awful side effect of both polyethylene and metal wear particles, a pseudotumor that invaded a woman’s vaginal tissues. This 2015 study was very concerning in that it compared MOP hips to MOM hips with regard to metal levels and chromosome damage in cells. It couldn’t conclude that one was better than the other. Based on this 2014 study, MOP hips wear less, but their wear particles produce slightly more tissue reaction than MOM hips. This is all consistent with a recent study I blogged on, showing that conventional polyethylene wear particles reduced stem cell activity in bone marrow and muscle.

If there is one bright spot in this category, it’s likely the newer highly cross linked polyethylene (HCLP). Based on this recent study, HCLP hips produced fewer wear particles than regular polyethylene. In another study of shoulder replacement devices, the lower debris for these devices was confirmed. In addition, based on this 2014 study HCLP devices seem to withstand unexpected wear and part failure better.

Ceramic on Metal (COM), Ceramic on Ceramic (COC), Ceramic on Polyethylene (COP)

Maybe ceramic is the way to go? After all, what could go wrong with installing a hip replacement device made of the same substance as dinner plates?

This 2015 randomized trial showed that COM hips still regrettably produced metal wear particles that ended up in the blood stream. Some good news for COM hips could be found in this 2015 study. It concluded that while there was swelling around these devices, when compared to minimally invasive MOM hips, there were no pseudotumors seen in COM hips. However, based on this analysis of many studies, there doesn’t seem to be any advantage of COC compared to COP. How does COM and COC compare? Ceramic on metal doesn’t seem to have the same durability as ceramic on ceramic based on this study.

Is Your Surgeon Being Paid to Promote a Certain Type of Hip?

One of the real challenges in navigating this landscape is that regrettably, joint replacement devices have been one of the worst areas of payola in medicine. As reimbursements have declined for the surgical procedures of installing and replacing devices, many surgeons have figured out that they can keep their cash flow stable by taking money from the device manufacturers. This has been the subject of many Department of Justice lawsuits through the years.

The big issue for patients is how to know if their surgeon is recommending a hip device because they really feel that it’s the best, or because they’re getting paid by the company making the device. This Propublica web-site will allow you to research your surgeon’s payment history.

Correct Sizing is Key!

It’s very clear from reviewing the medical research on this topic that a poorly sized hip device is a huge problem for many reasons. First, it will reduce the longevity of the device. Perhaps more importantly, it virtually guarantees more harmful wear particles. And since we’re talking about replacing your hip, a good fit is common sense.

Given the modular nature of these hip devices and the wide array of options, a poor fit should never happen. However, in my experience, hardware fitting issues usually happen when the operating room and/or hospital don’t have the correct size in stock on the day of the surgery. So agree before hand on the size of the components and make sure the staff has double-checked to make sure the hospital has that size in stock.

The upshot? All hip replacement devices produce wear particles. But which is best? It’s clear that when metal on metal implants go bad, things can go very bad with a local tissue reaction that can cause pseudotumors and high metal ions levels in the blood. If I had to get my hip replaced, I would cross this type of implant off my list. Ceramics still produce wear particles and have the added problem of fracturing in an active individual. Polyethylene wear particles in a MOP hip can be just as bad as those from a MOM hip. Given that highly cross linked polythylene has the least wear particles, this is likely the winner. However, realize that not as much is known about tissue reaction to cross linked polyethylene, so that recommendation may change with time. In addition, there are newer types of ceramics that once mated with HCLP could produce less debris.

More information Hip Replacement Material- Regenexx

Hip Replacement

FDA on Hip Replacement Parts

Tired of Doctors? I am also.

If you are like me,your sick of seeing doctors , some see so many my heart breaks for them, pcp, orthos, hematologist, cardiologists, pain management, endocrinologist dentists, optometrist whatever it just gets tiring. then you might get so nervous at your appointment you forget to ask specific questions.

Or maybe your anxiety has gotten you to a place where your heart is beating out of your chest, and your voice quivers or you just become blank.

Either way, having a list of things you mean to ask will help not only you but your doctor be able to better communicate.

So here we go:

1. What is the exact name of whatever is wrong with me? 1a if Osteonecrosis what stage is it? 1-2-3-4-5-5a-6

2. Is this something that is treatable and may possibly go away, or heal on its own or is this something that is chronic?

3. What are the short-term and long-term prognoses?

4. What are the short-term and long-term goals with treatment?

Example : Prp injections- physical therapy- hyperbaric oxygen-water therapy- stem cell treatments- joint replacement .

5. Is this something that genetically I can pass down to my child(ren)?

5a. Will you check me for underlying clot issue like Factor V Leiden-MTHFR-eNOS

6. What do you recommend as far as treatment?

7. What are the medications you recommend? I heard and read statins like Zocor and Lipitor can help lower lipids (fat) in the blood which can help blood flow better. I personally took simvastatin for 6 m and it helped me. I also during that time changed how I ate to consume less fatty meat cheeses etc

To lower my cholesterol on my own and I must say I am grateful I tried this.

Not only do I love eating REAL food but my blood work shows fantastic results and my pain is less.

So it’s good to talk to your doctor about this stuff also. Of course your doctor is not a specialist in nutrition which is kinda sad , you’d think they would teach that in medical school. But a good plant based diet was a great change for me.

 

8. How will this condition and/or medications affect my life?

9. Is there a specialist I can see? So I may try to avoid a joint replacement?

10. Will this condition or medications affect my ability to exercise? Walk-Bike- Swim.

Will this be temporary?

11. Is there a special diet that might ease symptoms or improve this condition?

For me personally it is plant based. I will eat meat (beef) rarely . Chicken or fish 1x a week but I am all about plant based.

My pain is lessened by over 60percent. I still have pain I’m not cured but I’m not in constant misery anymore. I rarely take a pain pill.

Never start or stop anything without talking to your doctor.

As always, if you have any concerns about your health, it’s always best to consult your primary care physician.

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Specific Questions To Ask Your Otho

What stage is osteonecrosis?
Will I be checked to make sure it also is not affecting other joints since I have pain in other bones/joints?
What is your treatment plan for Osteonecrosis ?
Why is this procedure being recommended? Are there alternatives?
What are the benefits of this procedure in terms of pain relief, functioning/mobility? How long will the benefit last?
What are the risks involved?
What is the success rate for this procedure?
What is the procedure called? How is it done?
How many patients with osteonecrosis do you see a year?
If Surgery Will this surgery solve the problem? Will any more surgery be required in the future?
How many of these procedures are annually performed at this hospital?
How many patients with osteonecrosis do you see a year?
What percentage of patients improve following the procedure?
What will happen if I don’t have the surgery now?
If I want a second opinion, whom can I consult?
Will I need any tests or medical evaluations prior to the surgery?
What kind of anesthesia will be used?
Are there possible after effects or risks?
Will I meet with the anesthesiologist in advance? Will her or she know my needs/allergies?
What kind of implant or prosthesis will be used? What are the outcomes using this device?
How long will it last?
Will I have pain following the procedure? What pain relief or pain control measures will I be given?
How long will the recovery take? What are my limitations during recovery?
Will I need assistance at home afterwards? For how long?
What will discharge instructions be?
Will I have any disability following surgery? Will I need physical therapy?
When can I return to work? When can I drive my car? When can I have sexual activity?
Are there any materials about this surgery that I can review?
What will I have for pain management?
Are their any patients I can ask about their experience?

 

Here is some info you may be interested in.

Clinical Trials

Atorvastatin to Prevent Avascular Necrosis of Bone in Steroid Treated Exacerbated Systemic Lupus Erythematosus

https://clinicaltrials.gov/ct2/show/NCT00412841

Statin therapy decreases the risk of osteonecrosis in patients receiving steroids.

https://www.ncbi.nlm.nih.gov/m/pubmed/11347831/

Aseptic osteonecrosis of the hip in the adult: current evidence on conservative treatment

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832407/

How Our Joints Work and Move

How Our Joints Work

Joints are the place where two or more bones meet. All of your bones, except for one (the hyoid bone in your neck), form a joint with another bone. Joints hold your bones together and allow your rigid skeleton to move.

Fixed joints
Some of your joints, like those in you skull, are fixed and don’t allow any movement. The bones in your skull are held together with fibrous connective tissue.

Slightly movable joints
Other joints such as those between you vertebrae in your spine, which are connected to each other by pads of cartilage, can only move a small amount.

Synovial movable joints
Most of your joints are “synovial joints”. They are moveable joints containing a lubricating liquid called synovial fluid. Synovial joints are predominant in your limbs where mobility is important. Ligaments help provide their stability and muscles contract to produced the desired movement. The most common synovial joints are listed here:

Ball and socket joints, like your hip and shoulder joints, are the most mobile of joints in the human body. They allow you to swing your arms and legs in many different directions.
Hinge joints like in your knee and elbow , enable movement similar to opening and closing a hinged door.
The pivot joints in your neck allow you to turn you head from side to side.
Ellipsoidal joints such as the joint at the base of your index finger, allow bending and extending, rocking from side to side, but rotation is limited.
Gliding joints occur between the surfaces of two flat bones that are held together by ligaments. Some of the bones in your wrists and ankles work by gliding against each other.

Conyloid joints. These joints are similar to ball-and-socket joints, just without the socket (the “ball” simply rests against another bone end).
Saddle joints are found in your thumbs, the bones in a saddle joint can rock back and forth and from side to side, but they have limited rotation.

 

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Avascular Necrosis – Osteonecrosis eBooklet

 

Click link below

 

AVN Awareness Booklet    

To access link on cell press on above link and you will be re-directed to Booklet.

If on computer just click above link.

🌻 Hi, I’m Deborah Andio

I wrote this booklet in 2016  to help patients like myself and their families understand avascular necrosis- osteonecrosis  and give helpful ideas to patients and help our doctors understand the pain we often feel.

My goal is throughout this booklet is to first let you know you are not alone .

Those who also have been diagnosed with avn know exactly how your feeling,scared, afraid, searching for knowledge and resources and coming up with very little.

That’s why I started a support group and wrote this booklet.

Disclaimer

  • This booklet is not intended as a substitute for the medical advice of physicians. The reader should regularly consult a physician in matters relating to his/her health and particularly with respect to any symptoms that may require diagnosis or medical attention.
  • No part of this eBook may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the author.
  • The information provided within this eBook is for general informational purposes only.
  • Copyright © protected
  • While I try to keep the information up-to-date and correct, there are no representations or warranties, express or implied, about the completeness, accuracy, reliability, suitability or availability with respect to the information, products, services, or related graphics contained in this eBook for any purpose. Any use of this information is at your own risk.

I give an actual copy to members of my support group. But many felt the information was so helpful, I wanted to share it with everyone.

I have recently completed a better spell check and next print will have all errors corrected.

No-one can use any contents of this booket words or graphics

 

Supprt Group Link  Avascular Necrosis/ Osteonecrosis Support Int’l

Wishing you all a pain free and relaxing day

God Bless

Debbie

 

ChronicallyGratefulDebla2018© ™️

Debla©2014-2019 ™️

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