Stephen J. Schueler, M.D.

Overview Incidence Symptoms Evaluation Treatment questions for doctor specialist Home Care pain in adults pain in children taking control using a cane using a walker using crutches warning signs Underlying Cause Anatomy

Avascular Necrosis of the Hip Home Care

Home care for avascular necrosis of the hip includes:

Avascular Necrosis of the Hip Pain in Adults

Medications commonly used to control pain and inflammation in adults with avascular necrosis of the hip include:


Acetaminophen
  • Acetaminophen decreases fever and pain, but does not help inflammation.
  • Adult dosing is 2 regular strength (325 mg) every 4 hours or 2 extra-strength (500 mg) every 6 hours.
  • Maximum dose is 4,000 mg per day.
  • Avoid this drug if you have alcoholism, liver disease or an allergy to the drug. See the package instructions.
  • Common brand names include Tylenol, Panadol, and many others.

Aspirin

Ibuprofen

Naproxen

Ketoprofen

NSAID Precautions

Avascular Necrosis of the Hip Pain in Children

Common medications used at home for pain in children with avascular necrosis of the hip include:


Aspirin and most of the other nonsteroidal anti-inflammatory drugs (NSAIDS) are not used in children except under a doctor's care.

Acetaminophen
  • Acetaminophen decreases fever and pain, but does not help inflammation.
  • Dosing is 10-15 mg per kilogram (5-7 mg per pound) of body weight every 4-6 hours, up to the adult dose.
  • Do not exceed the maximum daily dose.
  • Acetaminophen products come in various strengths. Always follow the package instructions.
  • Avoid this drug in children with liver disease or an allergy to acetaminophen.
  • Common acetaminophen products include Tylenol, Panadol and many others.

Ibuprofen
Always follow the package instructions.

Naproxen

Avascular Necrosis of the Hip Taking Control

The successful treatment of avascular necrosis of the hip requires your participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Avascular Necrosis of the Hip Using a Cane

Some patients with avascular necrosis of the hip may benefit from the use of a cane if you have difficulty walking due to hip pain. If you are elderly, a cane might allow you to perform normal activities without assistance.

Proper Cane Length
The handle of your cane should reach to the crease in your wrist when you stand upright and the end of the cane is resting on the floor.

Using a Cane
Hold the cane in the hand on the opposite side of the leg that needs support. With the cane, you can support some of your weight with your opposite arm. For example, if your left leg needs support, you should use the cane with your right arm. When you step with your left leg, the cane and your left leg should be on the ground at the same time, and you should support some of your weight with the right arm.

Follow these steps:

  • Position your cane one small stride ahead and step forward onto the bad leg. Place weight on your bad leg and the arm that is supported by the cane. Your elbow should be slightly bent as you support your weight.
  • Step forward with the good leg.

Climbing Stairs with a Cane
Climb one stair at a time and rest on one step before moving to the next step.

Follow these steps:
  • Grasp the handrail with the hand that is on the same side as the bad leg.
  • Place your weight on the bad leg and on the arm that is supported by the cane.
  • Step up to the next step with your good leg.
  • Transfer your weight to the good leg.
  • Move the cane and the bad leg to the step where you placed the good leg.
  • Support and stabilize yourself with your legs, the cane, and the handrail before moving to the next step.

Going down Stairs with a Cane
Go down one stair at a time and rest on one step before moving to the next step.

Follow these steps:
  • Grasp the handrail with the hand that is on the same side as the bad leg.
  • Place your weight on the good leg.
  • Place your bad leg and the cane on the step below.
  • Transfer your weight to the bad leg and the arm supported by the cane.
  • Move the stable leg to the step where you placed the cane and the bad leg.
  • Support and stabilize yourself with your legs, the cane, and the handrail before moving to the next step.

Avascular Necrosis of the Hip Using a Walker

Some people with avascular necrosis of the hip may require more support than a cane or crutches can offer. Walkers with four solid feet on the bottom give you the most stability. A walker is much more stable than crutches or a cane. A walker allows you to keep weight off one leg while you walk. It is also lends support if both of your legs are unstable or painful.

The handles of your walker should reach the crease in your wrist when you stand upright and the walker is placed on the floor. Moving slowly is important when you use a walker.

Using a Walker

  • Place your walker one stride ahead of you. Make sure that all 4 legs of your walker are on the ground.
  • Grasp the handles on the walker with both hands. Lean forward and support your weight on your arms.
  • Step forward with your good leg. Place your foot in the center of the square that is made by the walker feet.
  • Step forward with the other leg.

Walker Rules
  • Take small steps when you turn.
  • In order to sit in a chair, back up until your legs touch the chair. Reach behind you in order to feel the seat and then sit down.
  • In order to get up from a chair, push yourself up with your arms and then grasp the handles on the walker.
  • Make sure that the rubber tips on the legs of the walker are tightly fastened. Replace the rubber tips if they become worn.
  • Do not use your walker to climb stairs.
  • Do not use your walker on an escalator.

General Safety Tips
  • Remove small area rugs, electrical cords, spilled liquids or other items that may cause you to slip.
  • In the bathroom, install non-slip bath mats, toilet grab bars, a raised toilet seat, shower grab bars, and a shower tub seat.
  • Keep needed household items in close reach. Store less used items out of the way.
  • Use a backpack, fanny pack, apron or briefcase in order to carry items.

Avascular Necrosis of the Hip Using Crutches

Some patients with avascular necrosis of the hip will require crutches. You must be able to support your entire weight on one leg in order to use crutches. Crutches allow you to walk without placing any weight on an injured or painful leg.

Proper Adjustment for Crutches

  • The top of your crutch should be 1-1.5 inches below your armpit as you stand upright and the crutch rests on the floor.
  • The hand grips should be even with your hip joint.
  • Your elbows should bend as you use the hand grips.

Non Weight Bearing Technique
  • Stand on the good leg while using the crutches for balance.
  • Hold the bad leg off the floor.
  • Begin your step as if you are going to step on the bad leg, but do not place any weight on this leg. Instead, place both crutches in front of you and place your weight on your arms.
  • Your arms are supported by the crutches as you grip the crutch handles.
  • The crutches should be placed on the floor at an angle away from the side of your body, in a shape like the upright arms of the capital letter, "A."
  • Your elbows should bend as you support your weight.
  • Gently push off with your good leg after the crutches are firmly planted on the floor. Swing your body forward between the crutches.
  • Rest the top of the crutches tightly against each side of your chest and continue to support your weight with your arms.
  • Do not rest your armpits on the tops of the crutches. This can cause nerve damage.
  • Place your good leg on the floor and allow it to completely support your weight. Swing your crutches slightly away from your body and forward. Place the crutches on the floor to prepare for the next step.
  • Focus on where you are walking -- do not look at your feet.

Partial Weight Bearing Technique
  • Stand on the good leg while using the crutches for balance.
  • Begin to step on the bad leg, but do not place your entire weight on this leg. Instead, place most of your weight on your arms.
  • Your arms are supported by the crutches as you grip the crutch handles.
  • The crutches should be placed on the floor at an angle away from the side of your body, in a shape like the upright arms of the capital letter, "A."
  • Your elbows should bend as you support your weight.
  • Gently push off with your good leg after the crutches are firmly planted on the floor. Swing your bad leg forward between the crutches.
  • Rest the top of the crutches tightly against each side of your chest. Continue to support your weight with your arms and the bad leg.
  • Do not rest your armpits on the tops of the crutches.
  • Place your good leg on the floor and allow it to completely support your weight. Swing your crutches slightly away from your body and forward. Place the crutches on the floor to prepare for the next step.
  • Focus on where you are walking -- do not look at your feet.

Climbing Stairs with Crutches
When climbing stairs, you should climb one stair at a time, completely resting for a moment on one step before moving to the next step.

Follow these steps:
  • Start by supporting your weight with your good leg and both crutches.
  • Place your weight on both of the crutches and move your good leg up to the next step.
  • Transfer your weight to the good leg.
  • Lift the bad leg and the crutches onto the same step where you placed the good leg.
  • Support and stabilize yourself with both crutches and the good leg before moving to the next step.

Going down Stairs on Crutches
When going down stairs, you should go down one stair at a time. Stop and rest for a moment on one step before moving to the next step.

Follow these steps:
  • Start by supporting your weight with your good leg and both crutches.
  • Place your weight on the good leg and place both of the crutches onto the next lower step.
  • Transfer your weight to both crutches.
  • Place the good leg onto the same step where you placed the crutches.
  • Support and stabilize yourself with both crutches and the good leg before moving to the next step.

Avascular Necrosis of the Hip Warning Signs

Notify your doctor if you have avascular necrosis of the hip and any of the following:

Continue to Avascular Necrosis of the Hip Underlying Cause

Last Updated: Dec 1, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Avascular Necrosis of the Hip References
  1. Balakrishnan A, Schemitsch EH, Pearce D, McKee MD. Distinguishing transient osteoporosis of the hip from avascular necrosis. Can J Surg. 2003 Jun;46(3):187-92. [12812240]
  2. Desai MM, Sonone S, Bhasme V. Efficacy of alendronate in the treatment of avascular necrosis of the hip. Rheumatology (Oxford). 2005 Jun 21. [15972347]
  3. Watson RM, Roach NA, Dalinka MK. Avascular necrosis and bone marrow edema syndrome. Radiol Clin North Am. 2004 Jan;42(1):207-19. [15049532]
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