Avascular Necrosis of the Femoral Head

When AVN is caught early there are more treatment options available. As soon as Hubby was diagnosed with AVN he immediately stopped weight bearing by using crutches. This did nothing other than make it easier and less painful to stand that if he were bearing all of his body weight without walking aids. Despite using crutches the pain increased and movement in the joint decreased very quickly. It seemed that within only a few months of being diagnosed his mobility was seriously compromised and he was unable to work.

The first treatment that the Consultant tried was core decompression surgery. The surgeon drilled a hole into each femoral head in order to allow blood flow into the joint and release some pressure. In the left side a trabicular implant was inserted, its purpose to strengthen the joint and also encourage blood flow and cell growth. The hope for this surgery was that the AVN would be slowed, pain decreased and movement increased. Sadly with AVN the only eventual outcome is a total hip replacement, and as AVN strikes the young it is better to stave THR off for as long as possible as new hip joints only last 10-15years and will need to be revised, so the surgeon had to try this first.

Hubby spent six weeks in a wheelchair following this procedure as you are not able to weight bear at all and then gradually got back on his feet with the aid of crutches. Throughout rehabilitation Hubby was having Hydrotherapy which did help to build some strength in his legs; the water supports body weight and allows much more freedom of movement with less pain. It takes around 6 months to show any improvement in pain and mobility following core decompression surgery and so we were waiting quite a long time for it to be declared either a success or failure despite knowing all along that it hadnt worked as there was no improvement.

Six months later X-rays showed the AVN was progressing and that the procedure had not worked. The decision was made to replace both hips, starting with the right side as that was the worse of the two. The first Total Hip Replacement (THR) was a success and pain has been reduced. As the left leg is worsening rehabilitation has been difficult and bar a few sessions in the hydro pool it has not been possible to do any exercises as he cannot weight bear on the left leg in order to move the right new joint. It is also difficult to say how much it still hurts with the new joint as the left leg is still agonising and getting worse and so is a major distraction from the new joint. The difference in pain will only truly be known around six weeks after the second THR when post operative pain has also eased.

The purpose of a total hip replacement is to reduce pain; the doctors do not promise a miracle cure and cannot tell you to what percentage of your normal self you will be after rehab. A lot of patients are able to continue as before, for example Wayne Sleep was dancing again only a few weeks after his THR, but he was not in a disabled state for two years before surgery. I think the overall outcome is influenced by what condition caused the need for a THR in the first instance, what type of replacement was necessary and for how long mobility has been compromised. All we can do is wait and see, my fingers, arms, legs and toes are permanently crossed for a return to a normal life for both of us but mostly for my husband to not be in pain anymore.


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