Q: I am a patient of avascular necrosis of the femoral head (bi-lateral) for the last four years. At present I am working as a computer operator in Saudi Arabia. Before six months I did an MRI of both my hips and was then told of this disease. My MRI report says the disease is in stage IV. At present I am unable to walk, so please suggest an appropriate treatment?

A:Avascular necrosis of the femoral head (AVN) is an increasingly common cause of musculoskeletal disability. Although initially patients are asymptomatic, AVN usually progresses to joint destruction, requiring total hip replacement (THR) in individuals, usually before the fifth decade. No universally satisfactory therapy has been developed, even for early disease. Since joint preservation measures have a much better prognosis when the diagnosis of AVN is made early in the course of the disease and since the results of joint replacement therapy are poorer in younger age groups, diagnosing AVN as early as possible is critical to prevent or delay progression of the disease. The disease may be due to factors affecting the blood supply or the bone. A large number of diseases are associated with it – Trauma, alcoholism, steroid use, pancreatic disease, hematologic diseases (hemoglobinopathies, thalassaemia, haemophilia, thrombotic disorders), dialysis etc. The option for you is total hip replacement and this facility is available at most major hospitals in metros.