Osteonecrosis
Osteonecrosis is a progressive deterioration of the femoral head or any other bone that is not receiving adequate vascular nutrition.
Causes
The exact etiology is not known. The level of unbound maternal cortisol gradually raises towards the end of pregnancy to a level about three times that in normal non-pregnant women. It has been speculated that the rise in unbound cortisol, estrogen and progesterone in late pregnancy, the increased interosseous pressure and a direct injury to the femoral joint by the compression of the growing uterus or during a difficult delivery may all act together to produce insufficiency of blood supply to the femoral head. Most of the cases are idiopathic.
Other causes are:
Signs and Symptoms
PT Implications
MRI should distinguish between osteonecrosis and TPO. Decrease weight bearing, osteotomy, use of a non-vascularised structural graft, electrical stimulation, core decompression and use of a vascularized structural graft.
References
Causes
The exact etiology is not known. The level of unbound maternal cortisol gradually raises towards the end of pregnancy to a level about three times that in normal non-pregnant women. It has been speculated that the rise in unbound cortisol, estrogen and progesterone in late pregnancy, the increased interosseous pressure and a direct injury to the femoral joint by the compression of the growing uterus or during a difficult delivery may all act together to produce insufficiency of blood supply to the femoral head. Most of the cases are idiopathic.
Other causes are:
- Renal transplantation
- Alcoholism
- Autoimmune disorders (systemic lupus erythematosus, rheumatoid arthritis, polyarteritis nodosa)
- Gout
- Cushing’s disease
- Pancreatitis
- Polycythaemia
- Cryoglobulinaemia
- Decompression sickness
- Sickle-cell anaemia
- Liver disease
- Infections
Signs and Symptoms
- During the last trimester or at delivery (in relatively older mothers)
- Higher rate of involvement of the left hip
- Increasing pain of variable severity
- Usually unilateral
- Deep pain in the groin
- Pain radiates to the knee, thigh, or back
- Pain exaggerated by standing and walking
- Painful limitation of AROM or PROM of the hip joint
- Positive Trendelenburg gait on the affected side
PT Implications
MRI should distinguish between osteonecrosis and TPO. Decrease weight bearing, osteotomy, use of a non-vascularised structural graft, electrical stimulation, core decompression and use of a vascularized structural graft.
References
- Goodman, Catherine Cavallaro and Snyder, Teresa E. Kelly. Differential Diagnosis for Physical Therapists: Screening for Referral. 2007 ed. Vol. 4th Edition. St. Louis, Missouri: Saunders Elsevier, 2007. Print.
- Keriakos, R, Bhatta, SR, Morris, F, Mason, S, and Buckley, S. Pelvic Girdle Pain During Pregnancy and Puerperium. J Obstet Gynaecol 31.7 (2011): 572-80. Print.
- Rosenthal, H. E., W. R. Slaunwhite, Jr., and A. A. Sandberg. Transcortin: A Corticosteroid-Binding Protein of Plasma. X. Cortisol and Progesterone Interplay and Unbound Levels of These Steroids in Pregnancy. J Clin Endocrinol Metab 29.3 (1969): 352-67. Print.
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