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Is hip joint replacement the only solution for avascular necrosis?

Q: I am a patient of avascular necrosis of left hip joint, caused by long use of steroids (taken for skin allergies). I am 44 years old, and my general health condition is OK with no diabetes, BP or any other major ailment. AVN of left hip was detected about 2 years back when I started getting pain in the left leg after any long walk. I was asked to stop oral steroids then and I'm presently on intermittent use of low-powered topical ointments for any skin lesion. Skin condition is under control. Now I am able to walk normally, with little pain. Doctors are saying that joint replacement is the only alternative, but to be considered only after reaching the age 55 years. Does it mean that I have to bear the pain and it may even increase after a few years? Presently I am restricting on my movements, and not walking for a lot of time. Can I continue like this, till I become 55? Three MRIs taken have shown neither improvement nor deterioration.

A:You write your diagnosis as steroid induced AVN. However, you do not mention whether the changes present only on MRI or if they are seen on X-rays also. The implications are different. If the X-rays are normal and the changes are only on MRI then you could be considered for what is known as core decompression. Though this is also empirical and supposedly gives relief only in some patients particularly those with rest pain, this is an option that can be considered to buy time. Several other procedures are described including muscle pedicle graft but core decompression is one surgery that does not affect future THRs. Whether or not an intervention is done now, the decision to operate for THR will depend on your symptoms and not merely on MRI or X-ray findings. Therefore, there is no way of predicting accurately how long you will be able to manage. Some patients carry on for long without significant disability. However, some deteriorate rapidly. If you can carry on with some pain killers or life style modification, it is worth while delaying a total hip replacement to as long as possible.

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