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    Suggest treatment for avascular necrosis in right hip

Posted on Fri, 26 Dec 2014 in Bones, Muscles and Joints
Question: I was diagnosed with AVN (Stage II) in my right hip. Please find attached the MRI report herewith. I went through Core Decompression Surgery a month ago. I have been advised to be on complete rest and walk with the help of a walker for a period of 6 weeks.

Even after a month after the surgery, I am feeling pain in the same movements as I used to feel before the surgery. Kindly let me know the tips/precautions/diet for the speedy recovery.

My question to you are as follows:
1) Do I need to go for physiotherapy - if yes, when should I start and how many sessions should I take?
2) Can I get my whole body massaged except the right leg? Will this be helpful to my body?
3) What all movements I should be avoiding?
4) What all precautions I will have to take once I on my feets and for how long?
5) What all excercises can I do at home?
6) I am a married, can I do sex/make love?
7) Any good tips to be patient to pass this crucial/boring period of life constructively/positively.

Answered by Dr. Praveen Tayal 26 minutes later
Brief Answer:
Details below.

Detailed Answer:
Thanks for posting your query.
1. Physiotherapy may be needed after 4-6 weeks to regain the complete range of movement. It should be started gradually and the increase in exercise is done in a graded manner to avoid any damage to the hip joint.
2. YEs. Whole body massage will be helpful. You can get the right leg also massaged to keep the blood circulation in the leg intact. Avoid any extreme or painful movements of the affected leg.
3. Avoid all the painful movements. Do not try to bear extra weight on the leg.
4. Try to begin your daily routine gradually. Do not put too much stress too early. Once you attain the full range of motion painlessly then you can feel normal.
5. Right now you can start with passive leg exercises. You can take the help of a trained physiotherapist for proper guidance.
6. You can indulge in sex without putting a stress on the leg till it is fully healed.
7. You can join online health forums to increase your knowledge. Try creative activities like indoor games. Do have a healthy nutritious diet rich in calcium and vitamin D3 for early healing. Avoid alcohol and smoking.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Praveen Tayal 19 minutes later
Thank you Doctor for the prompt, crystal and clear advise. I forgot to mention the below in my earlier questions:-

I am diagnosed with abnormally high RA Factor - value 173 as on 2nd Nov'14. Earlier in the month of July'14 the value was 229. I believe you must have gone through my current prescription slip and noticed that, I am taking Tab Saaz (500 mg) 2 times a day - Kindly share your opinion on the same.

Answered by Dr. Praveen Tayal 48 minutes later
Brief Answer:
Continue taking saaz.

Detailed Answer:
Thanks for writing again.
The raised RA factor will not affect the healing process. Continue taking SAAZ as has been advised by your orthopedician. Doing a hot fomentation at the hip joint will also cause vasodilataion and increase the blood supply to the area thus decreasing the pain and increasing the rate of healing.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Praveen Tayal 2 hours later
Hello Doctor,

Because of the higher RA factors I do have pains in joint (Shoulders, wrists and sometimes in knees as well). Most of the times in Wrist movements. Should I be avoiding some specific eatables in my normal diet etc. and how long I should continue taking SAAZ? On what frequency I should get the RA Factor checked? Normally in my age what is the average time duration it takes to get back in normal range? How would I come to know that it is normal now? I am really worried about any future consequences of Rhemutade Arthrities, being highly / abnormally RA positive.

It has already been 4 weeks, since I don't have any major pains and any problems in sitting, by when I should get back to driving seat of my car.

I would expect and appreciate a detailed/elaborated response.
Regards, XXXXXXX

Answered by Dr. Praveen Tayal 1 hour later
Brief Answer:
Details below.

Detailed Answer:
Yes. Raised RA factor can cause multiple joint pains. You need to avoid taking alcohol and non vegetarian food. You need to continue taking SAAZ as long as the symptoms are progressive in nature. Once the symptoms start decreasing, the dose of Saaz can be decreased. You can check the progress by evaluating RA factor every 6 weeks. The response to medicine varies from person to person. There is no set tome frame in which we can assure a complete cure. Your pain and swelling of the joints will decrease as the RA factor is controlled.
You can try gaultheria oil or oil of winter green,so many patients of mine are telling they are relieved of pain with that.
You have to apply the oil on the area that has pain.

Increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation .
Take vegetables and fruits that are rich in Vitamin C, Vitamin D, Calcium, Omega-3 Fatty acid, Zinc, Magensium and many more.
You can drive again once the hip joint regains the complete range of movement and the muscles regain the lost strength. Do not try to do too much too soon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Praveen Tayal

Orthopaedic Surgeon

Practicing since :1994

Answered : 12074 Questions


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