What sports can be done with femoral head necrosis?
In the case of femoral head necrosis, one should choose sports that are painless and do not put any strain on the affected hip. Ideal sports are swimming and aqua jogging. Nordic walking and cycling are also possible. One should refrain from sports that involve fast starts and stops – such as ball sports.
Diagnosis
Anamnesis (medical history) An anamnesis takes place by means of an inventory within the family, as well as by means of an own anamnesis, in which especially previous hip joint diseases or operations, but also accidents, pain in the area of other joints or metabolic diseases are dealt with.
- Pain: localization of the pain and analysis of its radiance, duration, progression and intensity
- Localization of pain and analysis of its radiance, duration, progression and intensity
- Functional limitations: endurance, limping, mobility, length of pain-free walking distance, possibly necessary walking aids, …
- Endurance, limping, mobility, length of pain-free walking distance, possibly necessary walking aids, …
- Special joint anamnesis: accidents, rheumatic diseases (rheumatism, chronic polyarthritis, psoriatic arthritis, possible hip joint operations, pain in other joints, metabolic diseases, …
- Accidents, rheumatic diseases (rheumatism, chronic polyarthritis, psoriatic arthritis, possible hip joint operations, pain in other joints, metabolic diseases, …
- X-ray of the hip joint in two planes
- CT (computer tomography)
- MRI (magnetic resonance imaging, nuclear spin tomography)
- Localization of pain and analysis of its radiance, duration, progression and intensity
- Endurance, limping, mobility, length of pain-free walking distance, possibly necessary walking aids, …
- Accidents, rheumatic diseases (rheumatism, chronic polyarthritis, psoriatic arthritis, possible hip joint operations, pain in other joints, metabolic diseases, …
The MRI examination is of great importance in the diagnosis of femoral head necrosis, as it can reveal the disease at an early stage. The MRI images show different abnormalities depending on the stage of bone necrosis.
- In the reversible early stage, ARCO 1, the MRI shows a necrosis area in the region of the femoral head, while in the irreversible early stage, ARCO 2, a characteristic “double line sign” is seen. This sign results from the juxtaposition of sclerosed tissue, healthy bone and granulation tissue.
- In the ARCO 3 stage, the transitional stage, fractures are detected by MRI.
- In the late stage, ARCO 4, the MRI shows signs of arthrosis, such as a narrowing of the joint space and changes in the shape of the acetabulum.
The MRI images of the hip show the areas of the necrosis zones marked with the red arrow. The femoral head already appears cystically hollowed out.
This gives the impression of a subchamber. Here there is a risk that the femoral head will collapse. Possible consequences and complications: As with all surgical procedures, complications can occur in femoral head necrosis in the form of hematoma formation, wound healing disorder, wound infection, deep vein thrombosis, embolism, vascular injuries and nerve damage.
General risks generally occur more frequently than specific complications. In particular, leg length differences can occur as a result of joint repositioning. Due to a displacement, the muscles, especially the gluteal muscles, are also stressed differently.
This is called gluteal insufficiency (= weakness of the gluteal muscles with typical waddling gait). The change can result in a widening of the hip silhouette. The osteotomy does not always heal without complications, so that a delay may occur.
So-called pseudarthroses (= formation of false joints), implant failure, loss of correction, persistent pain are also among the special complications. In advanced stages, the destroyed parts of the joint are surgically removed. In advanced stages of hip joint destruction, the destroyed parts of the joint are removed and replaced by artificial ones, which improves the function of the hip joint and relieves pain.
Artificial hip joints are subject to the risk of loosening over time, so that endoprosthetic hip joint replacement should only be considered when the destruction of the hip joint is already more advanced and the patient is suffering from very severe pain. Further, more detailed information can be found under the heading: artificial hip joint After surgical measures have been taken, X-ray checks are necessary, for example, to be able to assess the osteotomy (= repositioning) or to evaluate the installation of the endoprosthetic hip joint replacement. In addition, special positioning and targeted thrombosis prophylaxis are required, which must be taken into consideration for every operation.
In order to strengthen the muscles or – in the case of an osteotomy – to build up specific muscle groups, postoperative physiotherapy can be used as a follow-up treatment for femoral head necrosis. As a rule, early mobilization takes place, whereby the load build-up depends on the individual circumstances. In order to prevent dislocation of the hip joint as far as possible, especially after endoprosthetic surgery, the patient should be informed about the possibility of elevated sitting (= dislocation prophylaxis). In this regard, permitted and unfavorable movements and loads should also be discussed. Postoperative clinical and radiographic checks should be carried out regularly and prophylaxis should be taken to prevent calcification in the muscle area of the hip, e.g. with NSAIDs (= indomethacin) or radiation.
