Necrosis of the femoral head in children

Necrosis of the femoral head can also occur in childhood. In contrast to the adult variant, the disease known as Perthes disease has the major difference that the process of destruction of the hip joint in children is reversible, as reversible. The disease progresses in children in 4 stages: The therapy of Perthes disease in children depends on the stage of the disease and the general state of health.

If there is no joint malposition or destruction, treatment is initially conservative. Relief of the affected leg is unavoidable. This means that means must be resorted to means such as walking aids (for short distances) and a wheelchair (for longer distances). The affected joint should still be moved further, so regular physiotherapy and additional measures such as swimming or cycling, which is particularly easy on the joints, are very important for the course of therapy. and Perthes disease – exercises

The initial stage, where oedema forms in the hip bone, which then leads to inflammation of the joint capsule.
The stage of condensation in which the bone mass becomes dense.
The fragmentation stage, in which a complete or partial disintegration of the hip joint occurs.
The repair stage, in which the femoral head heals in a deformed position or the hip bone is rebuilt.

Operation

The surgical procedure chosen for femoral head necrosis depends on how advanced the disease is. There are basically different treatment approaches for surgery. Drilling: As described below, drilling is an operation that is intended to lead to the formation of new blood vessels and thus to halt the degradation process.

It can be used in the first and second stage of the disease. Reverse Plastic Surgery: Reverse plastic surgery involves using a hollow reamer to remove a bone cylinder from the affected area and reinsert it in the reverse direction, so that intact bone tissue can reach the center of the problem. The transplantation of healthy bone tissue from the iliac crest is also a possible surgical approach to stem the progressive destruction process.

This is necessary if the hip joint is already destroyed or severely deformed by the disease. With a hip joint prosthesis, those affected then have the prospect of a relatively normal life again after the operation following rehabilitation. Regardless of which operation is used for femoral head necrosis, the subsequent rehabilitation measures are just as important for the success of the therapy as the actual operation itself.

For the patient this means a lot of patience and stamina.

Tapping: As described below, tapping is an operation that is intended to lead to the formation of new blood vessels and thus to halt the degradation process. It can be used in the first and second stage of the disease.
Reverse plastic surgery: Reverse plastic surgery involves using a hollow reamer to remove a bone cylinder from the affected area and reinsert it in the reverse direction, so that intact bone tissue is at the center of the problem.
The transplantation of healthy bone tissue from the iliac crest is also a possible surgical approach to stem the progressive destruction process
As a last resort, the artificial replacement of the hip joint can be considered.
This is necessary if the hip joint is already destroyed or severely deformed by the disease. With a hip joint prosthesis, those affected then have the prospect of a relatively normal life again after the operation following rehabilitation.

>The so-called cannulation is a small surgical procedure in which the diseased femoral head is drilled with the help of a surgical drill.Through the small canal thus created in the femoral head, it is hoped that the resulting bleeding will promote the formation of new blood vessels in the course of the healing process, thus stopping the tissue from dying. Drilling can only be considered as a therapeutic option in the first or second stage of femoral head necrosis, as the blood vessels must still be intact and the bone remodeling should not have taken place yet. Following the operation, the patient must then relieve the hip joint for about 6 weeks, at which time it should also be clear whether the operation was successful or whether other therapeutic procedures need to be applied.