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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Avascular Necrosis, Femoral Head Deteriorating. Go For Bone Grafting?

My 13 year old son has "extreme" AVN. I am told the femoral head is deteriorating and has "collapsed". In research it has come to my attention that bone grafting may be a better solution than a THR which is scheduled for later this month. Can you provide a specialist available on the west coast (Washington state perhaps)?
Mon, 22 Jul 2013
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Orthopaedic Surgeon, Joint Replacement,  's  Response
Hi, thanks for writing to HCM.

As per your description, I am taking it granted that "extreme" means Stage 4 disease process.

This is just to inform you that the management of AVN depends on the stage of the disease. In your son's case "EXTREME" AVN means stage 4, in which case Bone grafting is not going to work. Because during bone grafting procedure only the femoral head is addressed but not the acetabulum (as acetabulum is also damaged in stage 4 disease), so bone grafting will fail inevitably.

MRI scan of the hip joint will provide the exact extent of damage inside the joint. IF THERE IS NO INVOLVEMENT OF THE ACETABULUM IN MRI SCAN, then THR is not indicated.

Total hip replacement is meant only for stage 4 cases .

I suggest you to consult an arthroplasty surgeon and follow his advice accordingly.

Hope this information is helpful.
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Avascular Necrosis, Femoral Head Deteriorating. Go For Bone Grafting?

Hi, thanks for writing to HCM. As per your description, I am taking it granted that extreme means Stage 4 disease process. This is just to inform you that the management of AVN depends on the stage of the disease. In your son s case EXTREME AVN means stage 4, in which case Bone grafting is not going to work. Because during bone grafting procedure only the femoral head is addressed but not the acetabulum (as acetabulum is also damaged in stage 4 disease), so bone grafting will fail inevitably. MRI scan of the hip joint will provide the exact extent of damage inside the joint. IF THERE IS NO INVOLVEMENT OF THE ACETABULUM IN MRI SCAN, then THR is not indicated. Total hip replacement is meant only for stage 4 cases . I suggest you to consult an arthroplasty surgeon and follow his advice accordingly. Hope this information is helpful.