Aseptic hip necrosis

Aseptična nekroza glave femura definirana je kao smrt kosti, osteocita i drugih sastojaka koštane srži, zbog poremećaja vaskularizacije kosti, što dovodi do urušavanja i destrukcije koštane strukture glave femura, a klinički se očituje kao bol i gubitak funkcije zahvaćenog zgloba. ANGF, poznata i pod imenom avaskularna tj. ishemijska nekroza glave femura ili osteonekroza glave femura važan je zdravstveni problem. Pravodobno postavljanje točne dijagnoze nužan je preduvjet za rani i ispravan početak liječenja budući da neliječena ANGF dovodi do teške sekundarne artroze zgloba kuka i teške invalidnosti. Bez obzira na danas dostupne vrlo dobre slikovne metode prikaza ANGF, čak i u ranim stadijima bolesti, i bez obzira na dobro definirane postupke u liječenju takvih bolesnika, medicinski ishodi često nisu zadovoljavajući. Liječenje bolesnika s ANGF ovisi primarno o etiologiji bolesti kao i o stupnju bolesti. U ranijim stadijima bolesti konzervativno liječenje može dovesti do usporavanja procesa nekroze, ali ipak u više od 50% bolesnika je indicirano ortopedsko kirurško liječenje u vremenu od 3 godine od postavljanja dijagnoze. U SAD-u liječenje ANGF-a ugradnjom totalne endoproteze kuka čini godišnji trošak većim od milijardu dolara. Etiologija početka razvoja ANGF vezana je najčešće za traumu, toksički učinak alkohola, zloporabu alkohola, kao i uzimanje kortikosteroida. Oko 25% slučajeva javlja se u osoba bez faktora rizika i smatra se idiopatskom. ANFG može imati veliki raspon kliničkih slika te klinički i laboratorijski testovi najčešće nisu specifični. Konačna dijagnoza ANGF postavlja se isključivo radiološkom obradom: RTG obradom, CT, scinitigrafijom i magnetskom rezonancijom. MRI je najosjetljivija dijagnostička metoda te predstavlja metodu izbora u neinvazivnoj obradi takvih bolesnika.Aseptic necrosis of the femoral head is defined as death of bone, osteocytes and other bone marrow components, that results from interruption of blood supply to the bone, leading to collapse and destruction of the femoral head bone structure and clinically it presents with pain and loss of function of the affected joint. Aseptic necrosis of the femoral head, also known as avascular, ischemic necrosis of the femoral head or osteonecrosis of the femoral head is an important health problem. Furthermore, there is a huge importance of accurate and early diagnosis and prompt treatmeant because if untreated, aseptic hip necrosis leads to severe secondary arthrosis of the hip joint and disability. Regardless of modern imaging techniques that exist today in showing aseptic necrosis of the femoral head, even in the early stages of the disease, and dispite of well-defined protocols for treatment of those patients, medical outcomes are often not satisfactory. Treatment of patients with primary aseptic necrosis of the femoral head depends on the etiology and stage of the disease. In earlier stages of the disease, conservative treatment can lead to slowing down the progression of necrosis, but still, in more than 50% of patients orthopedic surgical treatment is indicated within three years from diagnosis. In the USA, treatment of aseptic necrosis of the femoral head by implanting total hip endoprosthesis makes annual expenses higher than one billion dollars. The etiology of development of aseptic necrosis of the femoral head is usually related to trauma, toxic effects of alcohol, alcohol abuse, as well as taking corticosteroids. About 25% of cases occur in people with no risk factors and is considered to be idiopathic. Aseptic necrosis of the femoral head can have a wide range of clinical presentations while both, clinical and laboratory tests are usually unspecific. Therefore, final diagnosis of aseptic hip necrosis is exclusevely established by performing radiology tests: X-ray processing, CT, scintigraphy and magnetic resonance imaging. Moreover, MRI is the most sensitive diagnostic method and is a method of non-invasive imaging workup of those patients