Avascular necrosis of the femoral capital epiphysis

Avascular necrosis of the femoral capital epiphysis is a common type of osteochondral avascular necrosis disease. The causes of the disease are quite diverse. Patients often show symptoms such as weakness and limping when walking, mild flexion or deformity of the lower limbs, and atrophy of the rectus femoris. So, if this disease is not treated in time, will it leave serious sequelae? Let us take a look at it together through the article below.

1. Concept

Avascular necrosis of the femoral capital epiphysis, also known as Legg-Cave-Perthes disease, osteochondritis of the femoral capital and flat hip, is a common type of avascular necrosis of osteochondral cartilage.

2. Causes

1. The cause of the disease is mostly related to trauma. Most scholars believe that intraosseous venous drainage obstruction and increased intraosseous pressure are the main factors causing this disease.

2. It is also related to race and family genetics.

3. It is generally believed that the blood supply to the femoral head is poor between the ages of 4 and 8, and it is only supplied by the lateral epiphyseal artery. Trauma and synovitis can easily cause blockage of this artery, leading to ischemic necrosis of the femoral head.

2. Symptoms

The initial symptoms are swelling of the hip synovium, congestion, joint effusion and increased intra-articular pressure. It is manifested as congestion of bone tissue, hyperplasia of granulation tissue, and the appearance of cystic or irregular low-density translucent areas in the femoral head epiphysis. At the same time, due to the effect of gravity, compression fractures occur in the center of the epiphyseal bone, the trabeculae are interlocked, and the epiphysis is flat. This disease is common in boys aged 3-12 years old, especially in those aged 5-9 years old. It is usually unilateral, but can also affect both sides successively or simultaneously. The main symptoms are hip pain, fatigue and limp, which may be relieved intermittently. The affected lower limb is slightly shorter, with mild flexion or adduction deformity, and the range of motion of the hip joint is limited. Especially in internal rotation and abduction, there is mild rectus femoris atrophy. Pain in the inner thigh, groin area, and inner knee.

3. Hazards

When "critical symptoms" appear on X-ray films, active treatment should be given, otherwise the prognosis is often poor.

5. Diagnosis

Plain X-ray is the main method for detecting infiltration of this disease, but it cannot show early lesions. CT examination can show early repair changes of necrosis that are suspicious or difficult to show on plain films. MRI is a relatively sensitive and specific method for diagnosing early necrosis of this disease and can make a timely diagnosis for those with negative plain film and CT results.

6. Treatment

Avascular necrosis of the capital femoral epiphysis is a self-limiting disease that completes its course in 4 to 36 months. Therefore, the purpose of treatment is to prevent deformity or dislocation of the femoral head during its self-healing process. The femoral head, which is well accommodated in the acetabulum, can achieve this goal through self-reshaping. Therefore, no matter what treatment method is used, the purpose is to achieve good accommodation of the femoral head by the acetabulum.