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    Osteonecrosis Caput Femur

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    drhendyjunior
    Osteonecrosis, also known as avascular necrosis, is a disease caused by interruption of blood supply to bone, leading to bone cell death. It commonly affects the femoral head. Early stages may be asymptomatic, but can progress to joint damage requiring surgery. Risk factors include steroid use, alcoholism, smoking, and hip trauma or surgery. Diagnosis involves history, examination, and imaging like x-rays and MRI. Treatment depends on stage, ranging from conservative measures to core decompression, osteotomy, or arthroplasty. The goal is to relieve pain and delay or prevent joint collapse.

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    Osteonecrosis Caput Femur

    Uploaded by

    drhendyjunior
    102 views23 pages
    Osteonecrosis, also known as avascular necrosis, is a disease caused by interruption of blood supply to bone, leading to bone cell death. It commonly affects the femoral head. Early stages may be asymptomatic, but can progress to joint damage requiring surgery. Risk factors include steroid use, alcoholism, smoking, and hip trauma or surgery. Diagnosis involves history, examination, and imaging like x-rays and MRI. Treatment depends on stage, ranging from conservative measures to core decompression, osteotomy, or arthroplasty. The goal is to relieve pain and delay or prevent joint collapse.

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    osteonekrosis

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    Osteonecrosis, also known as avascular necrosis, is a disease caused by interruption of blood supply to bone, leading to bone cell death. It commonly affects the femoral head. Early stages may be asymptomatic, but can progress to joint damage requiring surgery. Risk factors include steroid use, alcoholism, smoking, and hip trauma or surgery. Diagnosis involves history, examination, and imaging like x-rays and MRI. Treatment depends on stage, ranging from conservative measures to core decompression, osteotomy, or arthroplasty. The goal is to relieve pain and delay or prevent joint collapse.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    102 views23 pages

    Osteonecrosis Caput Femur

    Uploaded by

    drhendyjunior
    Osteonecrosis, also known as avascular necrosis, is a disease caused by interruption of blood supply to bone, leading to bone cell death. It commonly affects the femoral head. Early stages may be asymptomatic, but can progress to joint damage requiring surgery. Risk factors include steroid use, alcoholism, smoking, and hip trauma or surgery. Diagnosis involves history, examination, and imaging like x-rays and MRI. Treatment depends on stage, ranging from conservative measures to core decompression, osteotomy, or arthroplasty. The goal is to relieve pain and delay or prevent joint collapse.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23

    Osteonecrosis caput femur

    Supervisor :
    dr. Essy Dwi Damayanthi Sp.OT

    Hendy Buana Vijaya


    Pendahuluan
    • Osteonecrosis yang juga dikenal sebagai avascular necrosis (AVN),
    aseptik nekrosis atau nekrosis tulang iskemik
    • penyakit yang dapat mempengaruhi beberapa tulang sebagai akibat
    dari terputusnya/hilangnya suplai darah ke suatu bagian tulang,
    sehingga menyebabkan kematian pada tulang tersebut.
    • Pada stadium awal pasien tidak menunjukkan gejala, tetapi dengan
    berjalannya waktu, osteonecrosis menyebabkan kerusakan pada
    sendi, sehingga memerlukan pembedahan, dan pada tahap akhir
    penyakit ini memerlukan penggantian panggul total (THR)
    Anatomi
    Definisi
    • Osteonecrosis of the femoral head, also referred to as
    avascular necrosis, is a pathological state with multiple
    possible etiologies that causes decreased vascular supply
    to the subchondral bone of the femoral head, resulting
    in osteocyte death and collapse of the articular surface

    Kaushik A, Das A, Cui Q. Osteonecrosis of femoral head : an update in year 2012. World Journal
    Orthopedic. 2012 3(5) : 49-57
    Epidemiologi
    • In US there are approximately 10.000-20.000 case per years have
    been report.
    • Incidency of ON of femoral head ratio about male : female depending
    patient comorbidity.
    • Patients are generally younger adults age 35 years to 45 years and risk
    factors for 75%-90% of cases include chronic steroid use, alcoholism,
    smoking, hip trauma including femoral neck fractures and hip
    dislocations, and prior hip surgery.
    Etiologi dan faktor resiko

    Zibis A. H, Fyllos A. H, Karantanas A. H, Arvanitis D. L, Dailiana D. H, et al. Osteonecrosis of the


    femoral heal – diagnosis and management. Precis Med. 2015 ; 2 : 1-8
    Patogenesis

    Seamon J, Keller T, Saleh J, Cui Q. The


    pathogenetic of nontraumatic
    osteonecrosis. Review article. 2012 :
    1-11
    Patogenesis
    Modified Ficat – Arlet classification
    University of Pennsylvania classification of
    osteonecrosis
    ARCO classification
    Diagnosis
    Presentation-History
    • Trauma
    • Corticosteroid use
    • Alcohol intake
    • Medical conditions – malignancy, thrombophilia, SLE
    • Pain – progressive, severity correlates with size of infarct
    • Deformity and stiffness – later stages
    Presentation - examination
     Limp

     Antalgic gait

     Restricted ROM

     Tenderness around bone

     Joint deformity
    X ray examination of the hip joint

    Flattening Cresent sign


    MRI examination of the hip joint
    Management - conservative
    • Offloading affected joints with use of crutches
    • Immobilisation
    • Analgesia
    • Bisphosphonates to delay femoral head collapse
    • Statins in patients on high dose corticosteroids – reduced lipid
    deposition
    Core decompression
     Indicated in ARCO I and II

     8 – 10 mm anterolateral core of bone

     Filled with bone graft (vascularised/non vascularised)

     Decompresses medullary cavity, reduces pain

     Vascularised graft may reverse necrosis


    Realignment osteotomy

     Indicated in ARCO III & IV

     Used to relocate necrotic area from weight bearing portion of femoral head

     Angular osteotomies more common

     Multiple techniques for holding the fixation

     Sugano intertrochanteric rotational osteotomy technically demanding but higher


    success rate
    Arthroplasty

     Indicated in ARCO IV onwards

     Main aim is pain reduction

     Young patients will need revision

     Higher failure rates than in OA

     Hemi arthroplasty an option


    Terima Kasih

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