Causes of femoral head necrosis

introduction

The femoral head necrosis (also aseptic femoral head necrosis) is a bone disease in which bone tissue dies due to insufficient blood supply to the femoral head. This results in osteoarthritis and deformities, which lead to pain and restricted mobility.

The femoral head is the upper end of the thigh bone, which is part of the hip joint next to the acetabulum, which is formed by the hip bone. The necrosis is mainly felt through load-related pain in the grointhat can also radiate into the knees. In addition, there is often one Rotation restriction in the hip joint in front. Femoral head necrosis can occur in adults and children. The form that occurs in adolescence is also called Perthes disease designated. Femoral head necrosis can be due to a specific cause such as Femoral neck fracture but can also occur without a known cause (idiopathic hip arthrosis).

causes

The causes of femoral head necrosis are diverse and often still unexplained. The idiopathic femoral head necrosis may be due to certain risk factors like alcoholism or Metabolic disorders be favored. A femoral head necrosis of traumatic origin (Femoral neck fracture) is usually caused by injuries to the surrounding vessels.

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Femoral head necrosis due to trauma

The reason for femoral head necrosis can, for example, be lateral or central Femoral neck fracture be. This is a fracture of the neck of the thigh bone near the joint (Femur). These are mostly elderly people and patients with osteoporosis affected.

The Femoral neck fracture can through Fall on the upper outside of the thighbone or Stumble arise with forced external rotation. Also one chronic overload of the thigh bone can lead to a femoral neck fracture. The femoral head necrosis is a complication of the injury, since it damages the vessels running along the femoral neck (especially the A. circumflexa femoris medialis) can come. The result is an insufficient supply of the femoral head, which results in the destruction of the bone on the femoral head. Also one direct femoral head fracture can be the cause of femoral head necrosis, in which vessels can also be injured, resulting in an insufficient supply of the femoral head.

Idiopathic femoral head necrosis

This form of femoral head necrosis is not caused by an accident (trauma). Idiopathic means that the cause is unknown. However, risk factors are known that favor idiopathic femoral head necrosis. However, the exact relationship between the risk factors and femoral head necrosis is not always clear. Metabolic disorders are sometimes a risk factor for developing femoral head necrosis. These include, for example, diabetes mellitus, hyperuricemia (too high uric acid levels in the blood) or hyperlipoproteinemia (too high fat levels in the blood), which can lead to disease of the vessels and thus to an undersupply in the area of ​​the femoral head. Long-term treatment with glucocorticoids such as cortisone can also cause femoral head necrosis. Furthermore, alcoholism, smoking and obesity are possible risk factors. Necrosis of the femoral head is also favored by sickle cell anemia, lupus erythematosus and Gaucher's disease (lipid storage disease). Radiation and chemotherapy (especially in the case of lymphoma and leukemia) can also promote necrosis of the femoral head.

Perthes disease

Perthes disease describes a idiopathic, aseptic femoral head necrosisthat at Children especially between the 4 to 8 years of age occurs. Various causes are discussed here. One is the Clasp or the Adhesion of vessels on the causes of a juvenile (occurring in adolescence) femoral head necrosis, which leads to an undersupply and thus to the breakdown of the bone. The other will be repetitive microtraumascaused by increased stress on the hip when running and jumping are among the possible causes. Also can Blood clotting disorders cause a closure of vessels and thus an undersupply of the femoral head.

Hip dysplasia

In the Hip dysplasia is it a inherited diseaseat which it too Malfunction of the acetabulum already in the uterus (Womb) is coming. This has the consequence that the femoral head is not sufficiently secured in the socket and thus the risk for Dislocations (Dislocations) of the hip joint is increased. Since a dislocation can often occur without treatment, the hip joint has to be adjusted again and again. Here, too, the femoral head necrosis is a complication and is favored by frequent repositioning of the hip joint, as this is easy Vesselsthat supply the femoral head can be damaged.