AVASCULAR NECROSIS OF FEMORAL HEAD

# Understanding Avascular Necrosis of the Femoral Head: 

Insights from Dr. A. Mohan Krishna, Senior Consultant Orthopedic Surgeon at Apollo Hospitals

Hello, I’m Dr. A. Mohan Krishna, and as a senior consultant orthopedic surgeon at Apollo Hospitals, I often encounter patients struggling with various musculoskeletal conditions. One condition that is particularly concerning yet often misunderstood is Avascular Necrosis (AVN) of the femoral head. Today, I’d like to shed some light on this condition, its causes, symptoms, diagnosis, and treatment options, as well as offer guidance for those affected.

## What is Avascular Necrosis?

Avascular necrosis, also known as osteonecrosis, is a condition where the blood supply to a bone is disrupted, leading to the death of bone cells. When this occurs in the femoral head—the ball portion of the hip joint—it can result in severe pain, limited mobility, and potentially significant joint damage if not addressed in a timely manner.

## Causes of Avascular Necrosis

AVN can arise from a variety of causes, including:

1. **Trauma:** A fracture or dislocation can damage blood vessels supplying the femoral head, leading to ischemia (lack of blood flow).

2. **Long-Term Steroid Use:** Prolonged use of corticosteroids, commonly prescribed for inflammatory conditions, is a significant risk factor.

3. **Medical Conditions:** Diseases such as sickle cell disease, lupus, and Gaucher's disease can impair blood flow to bones.

4. **Alcohol Use:** Excessive consumption can lead to fat deposits in blood vessels, further restricting blood flow.

5. **Other Factors:** Certain medications, radiation therapy, and medical conditions affecting circulation can also increase the risk.

## Symptoms to Watch For

The symptoms of AVN can develop gradually and may include:

- **Hip Pain:** Often the first sign, this pain may begin as a minor discomfort and gradually intensify. It can be felt in the groin, thigh, or buttocks.

- **Limited Range of Motion:** Patients may experience difficulty moving the hip joint, especially during activities like walking or climbing stairs.

- **Pain During Weight Bearing:** Increased pain when standing or walking is common and can significantly impact daily activities.

## Diagnosis: How We Identify AVN

A thorough evaluation is crucial for diagnosing AVN. The diagnostic process typically includes:

1. **Medical History and Physical Examination:** We’ll discuss your symptoms and any relevant risk factors.

2. **Imaging Tests:**

   - **X-Rays:** While these may not show early signs, they can help identify later changes in the joint.

   - **MRI:** This is often the most effective method for early diagnosis, as it can detect changes in the bone before structural damage occurs.

   - **CT Scan:** Provides detailed images of the bone and joint, especially in complex cases.

## Treatment Options: A Path to Recovery

Treatment for AVN varies based on the stage of the disease and the severity of symptoms. Options include:

1. **Non-Surgical Treatments:**

   - **Medications:** Over-the-counter pain relievers, such as NSAIDs, can help manage pain.

   - **Activity Modification:** Limiting weight-bearing activities can protect the hip joint.

   - **Physical Therapy:** Therapeutic exercises can enhance strength and mobility.

2. **Surgical Treatments:**

   - **Core Decompression:** This procedure involves removing a portion of the inner bone to reduce pressure and improve blood flow.

   - **Bone Grafting:** Healthy bone tissue can be transplanted to the affected area to promote healing.

   - **Total Hip Replacement:** In advanced cases where the femoral head is severely damaged, a total hip replacement may be necessary to restore function and relieve pain.

## Living with Avascular Necrosis

If you or a loved one is living with AVN, here are some strategies to help manage the condition:

- **Lifestyle Changes:** Maintaining a healthy weight, avoiding alcohol, and managing underlying health conditions can help slow the progression of AVN.

- **Regular Follow-ups:** Continuous monitoring with your healthcare provider is vital to manage symptoms and adjust treatment as necessary.

- **Support Systems:** Engaging in physical therapy or joining support groups can provide the necessary tools to manage daily activities and maintain quality of life.

## Conclusion

Avascular necrosis of the femoral head is a serious condition that requires attention and care. If you experience hip pain or have risk factors for AVN, I encourage you to consult your healthcare provider for a thorough evaluation. Early diagnosis and treatment can make a significant difference in your quality of life.

At Apollo Hospitals, we are committed to providing comprehensive orthopedic care tailored to each patient’s needs. If you have any questions or concerns about AVN or other orthopedic conditions, please don’t hesitate to reach out.

Stay healthy and take care!

**Dr. A. Mohan Krishna**  

Senior Consultant Orthopedic Surgeon  

Apollo Hospitals

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This blog aims to educate patients about AVN and encourage proactive healthcare management. Always consult with a healthcare professional for personalized advice and treatment options.

How to Identify Health Issues of Vitamin D Deficiencies ?

 Vitamin D is essential for strong bones. It helps the body absorb calcium from the food that we eat. Lack of vitamin D can lead to bone diseases such as rickets and osteoporosis. But did you know that deficiency of vitamin D can also affect your overall health and well-being?

Dr. A. Mohan Krishna, an orthopedic surgeon at Apollo Hospitals, suggests that being aware of the following symptoms can help identify vitamin D deficiencies:

1. Muscle Weakness: Vitamin D is necessary for the proper functioning of muscles. Deficiency of vitamin D can lead to muscle weakness and aches in various parts of the body.

2. Chronic Pain: Muscle and joint pain, particularly in the lower back and knees, can be a sign of vitamin D deficiency.

3. Mood Swings: Vitamin D plays a crucial role in the production of serotonin, a hormone responsible for regulating mood. Low levels of vitamin D can lead to mood swings and depression.

4. Frequent Infections: Vitamin D is vital for a strong immune system. A deficiency can make you susceptible to infections like cold and flu.

If you experience any of the above symptoms, it's essential to get tested for vitamin D deficiency. This can be done through a simple blood test. If diagnosed with a deficiency, your doctor may recommend taking supplements or increasing sun exposure.

Don't ignore the signs of vitamin D deficiency. Take care of your bones and overall heal

Frozen Shoulder: Expert Treatment Recommendations by Dr. A. Mohan Krishna, Consultant Orthopedic Surgeon at Apollo Hospital

 

Introduction

Are you experiencing stiffness and pain in your shoulder that's making it difficult to perform day-to-day activities? Welcome to the club of frozen shoulder sufferers. Frozen shoulder, also known as adhesive capsulitis, is a condition that affects the shoulder joint. It occurs when the tissues in your shoulder joint become thicker and tighter, which eventually makes it difficult to move your shoulder. The causes of frozen shoulder aren't always clear, but it usually affects people who've had an injury, surgery, or conditions that limit shoulder movement. Initially, you may only feel a dull ache in your shoulder before it progresses to severe pain. As the condition worsens, night pain and stiffness, combined with limited movement, make it outright unbearable. Frozen shoulder can last for several years before it completely heals. In the next sections, we'll discuss how to diagnose and treat frozen shoulder, including the different surgical procedures available.

Diagnosis of Frozen Shoulder

Frozen shoulder can be diagnosed through physical examination and imaging tests. During a physical examination, the doctor will assess the mobility of your shoulder, look for any visible deformities, and apply pressure to determine the level of pain. Imaging tests such as X-rays, Ultrasound, and MRI scans may be conducted to rule out other possible conditions. The doctor may also ask about your medical history to determine any underlying medical conditions that may be causing the frozen shoulder. The diagnostic process helps the doctor ascertain the severity and stage of the condition and develop a personalized treatment plan that is best suited for your individual needs. Remember, the earlier the diagnosis, the better the chances of effective treatment.

Treatment Options for Frozen Shoulder

Frozen Shoulder: Expert Treatment Recommendations by Dr. A. Mohan Krishna, Consultant Orthopedic Surgeon at Apollo Hospital. Treatment Options for Frozen Shoulder So you’ve been diagnosed with a frozen shoulder? That’s tough luck, but the good news is that there are several treatment options that can help you recover much faster than you thought. Let’s take a look at the various ways you can get your frozen shoulder treated. Medications There are several pain relief medications that your doctor may prescribe to you. These include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to help reduce inflammation in the shoulder joint. Additionally, your doctor may also prescribe stronger medications if necessary. Physical therapy Physical therapy can help you regain mobility and restore function in your shoulder joint. Your therapist will work with you to design a treatment plan that involves gentle exercises to help stretch and strengthen the joint. Regular physical therapy sessions can go a long way in reducing the pain and stiffness associated with frozen shoulder. Minimally invasive procedures If physical therapy and medications don’t work, you may want to consider minimally invasive procedures such as arthroscopy, where a small camera is inserted into the joint and used to guide the surgeon while removing scar tissues and adhesions. Other minimally invasive procedures include hydrodilatation which involves the injection of a sterile fluid into the joint capsule to help stretch it. Surgical Procedures When all else fails, surgery may be the only option left. Your doctor may recommend surgery if you do not experience any relief from non-invasive treatments or the mobility of your shoulder is severely limited. Surgical procedures for frozen shoulder may include manipulation under anesthesia, where the surgeon moves the shoulder joint in different directions while the patient is under anesthesia. Other procedures include shoulder arthroscopy and shoulder replacement surgery. In a nutshell, there are many treatment options available to you if you are suffering from frozen shoulder. Medications can help with pain relief, physical therapy can help restore mobility, and minimally invasive procedures and surgery can help in severe cases. The key is to work closely with your doctor and therapist to find the best treatment plan that works for you.

Surgery for Frozen Shoulder

Having exhausted all non-surgical approaches to treat frozen shoulder, surgery remains the only viable alternative. Surgery for frozen shoulder is typically a last resort option in the event all other interventions fail. There are two different surgeries that may be performed to address frozen shoulder, namely manipulation under anesthesia and arthroscopic capsular release. Manipulation under anesthesia involves you being put under anesthesia while your doctor forcibly manipulates your arm to remove the adhesions causing the frozen shoulder. On the other hand, arthroscopic capsular release entails your doctor making small incisions in your shoulder and inserting a camera and tools to detach the adhesions, allowing for improved movement. Following surgery, you may have to wear a sling for a while as you convalesce. You may also need to undergo physical therapy as part of your rehabilitation process, which may last between six weeks and six months.

Rehabilitation and Prevention

The road to recovery from frozen shoulder doesn't end after treatments or procedures. Post-treatment rehabilitation is fundamental in restoring your shoulder's mobility and functionality. As you may have noticed, frozen shoulder can restrict you from your daily activities and generally impact your quality of life. But don't worry, it's not the end of the world. Physical therapy is crucial in post-treatment rehabilitation. It gradually progresses by reducing pain and stiffness, restoring function, and improving strength and range of motion. It may include exercises such as stretching, low-impact aerobic conditioning, and weight-bearing exercises. The exercises help you reach behind your back, up above your head, and across your body. Sounds easy, right? Well, it's not a walk in the park because some exercises can be painful, but, hey, you got this! Prevention is always better than cure, and in the case of frozen shoulder, the saying stands. It would be best if you made some lifestyle adjustments. Specifically, everyone should have periodic check-ins with their doctors. Secondly, stretching exercises can be beneficial to prevent frozen shoulder. Still, ensure you don't force your shoulder too much during the exercises as this may lead to injury. Lastly, try not to have sedentary days but remain active with activities such as swimming, cycling, and walking. Overall, post-treatment rehabilitation and prevention of frozen shoulder are crucial components for maintaining your shoulder's functionality and mobility after treatment. Don't be afraid to take it slow and steady, and remember to make those lifestyle adjustments to avoid future episodes of a frozen shoulder.

Conclusion

Frozen shoulder is a common problem that affects a significant number of people. Fortunately, with the right treatment and management, you can alleviate symptoms, restore function and reduce pain. Treatment options for the frozen shoulder include medications, physical therapy, minimally invasive procedures, and surgical procedures if required. If conservative treatments don't work, surgery may be necessary. Following surgery, careful rehabilitation is necessary to restore full m

PLANTAR FASCIITIS

 PLANTAR FASCIITIS

Plantar Fasciitis:  It is the most common condition that causes heel pain. Plantar fasciitis is due to irritation and inflammation of the tight tissue that forms the arch of the foot. The most common symptom is pain under the heel after a period of rest, i.e. severe pain and inability to walk in the morning after getting up from sleep. The same might happen after sitting for a long time and then trying to walk. Interestingly the pain gets better after a few steps though it may not go away completely.  Again, the pain may get worse with prolonged walking and standing. X ray may show a bony spur which may develop in long standing cases of heel pain due to plantar fasciitis, but it may not cause the symptoms.

Treatment Options:

Not all of these treatments are appropriate for every condition, but they may be helpful in your situation.

1.Rest - Avoiding the precipitating activity; for example, take a few day off jogging or prolonged standing/walking.  Rest can reduce the severity of pain and will allow the inflammation to begin to cool down.

2.Ice Packs - Icing will help to diminish some of the symptoms and control the heel pain. Icing is especially helpful after an acute exacerbation of symptoms.

3.Exercises and Stretches - Are designed to relax the tissues that surround the heel bone. Some simple exercises performed in the morning and evening, often help patients feel better quickly.

4.Anti-Inflammatory Medications - Help to both control heel pain and decrease inflammation.

5.Shoe Inserts - Are often the key to successful treatment of heel pain. The shoe inserts often permit patients to continue their routine activities without heel pain.

6.Injection therapy - In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.

7.Removable walking cast - May be used to keep your foot immobile for a few weeks to allow it to rest and heal and is used only for severe cases.

8.Night splint - Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.

9.Weight reduction – It helps to reduce stress on foot and heel and thus help to reduce the severity of pain.