Massage therapy · Kitchener–WaterlooOsteonecrosis of the Hip

Bone cells need a steady blood supply to stay healthy. Injuries such as hip dislocations and hip fractures can damage the blood vessels that supply the femoral head (American Academy of Orthopaedic Surgeons, n.d.).

The main symptom is pain, usually felt in the groin or, less often, in the buttock. At first it usually hurts when you put weight on the hip, but later the hip may hurt even when you are resting (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.a).

It is not possible to diagnose osteonecrosis of the hip from a hip examination or your medical history alone; imaging is needed. X-rays are usually taken first and help rule out other causes of hip pain, such as a fracture or arthritis. An MRI scan can pick up early changes before they show on an X-ray (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b).

How to Treat Osteonecrosis of the Hip:

Certain types of exercise can help you improve or maintain the range of movement in the joint, and physical therapy can help to reduce stiffness and increase the hip's range of movement (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b). I can choose exercises suited to your hip, teach you how to do them, and use gentle hands-on work to ease stiffness, within your medical team's plan. See the My Approach tab for how I work.

Non-surgical treatments can help to manage the symptoms, but they do not cure the condition, and most people eventually need surgery. Early diagnosis gives treatment a better chance of success (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b).

1. Rest from Painful Activities

Reducing the amount of stress and weight on the affected hip can help to relieve pain, and you might need to limit some of your usual activities (American Academy of Orthopaedic Surgeons, n.d.). Your doctor may recommend crutches or a cane to take weight off the hip when you walk (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b). Talk to your doctor about which exercises are best for you, and whether you should avoid certain activities (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b).

2. Medication

The American Academy of Orthopaedic Surgeons and the National Institute of Arthritis and Musculoskeletal and Skin Diseases say anti-inflammatory medicines may help to relieve the pain and swelling of this condition (American Academy of Orthopaedic Surgeons, n.d.; National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b). (This medicine information comes from the American Academy of Orthopaedic Surgeons and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Options outside my scope

• Steroid injections: a corticosteroid injection may be used to reduce pain and swelling (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b).
• Core decompression: an operation that drills one or more holes into the femoral head to relieve pressure in the bone and help new blood vessels to grow. It works best in the early stages, before the bone collapses, and is often combined with a bone graft (American Academy of Orthopaedic Surgeons, n.d.; National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b).
• Bone graft: healthy bone, taken from your own body or a donor, or a synthetic substitute, is used to help repair the damaged area. In a vascularised bone graft, a piece of bone is moved together with its own blood supply (American Academy of Orthopaedic Surgeons, n.d.; National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b).
• Osteotomy: an operation to reposition the bone so that healthy bone takes more of your weight (National Institute of Arthritis and Musculoskeletal and Skin Diseases, n.d.b).
• Total hip replacement: if the femoral head has already collapsed, the damaged ball and socket are replaced with artificial parts. This relieves pain and restores function in most people (American Academy of Orthopaedic Surgeons, n.d.).
• Treatments still being researched: some medicines (such as those used for osteoporosis, high cholesterol or blood clotting) and bone-stimulation treatments (such as pulsed electromagnetic fields) have been studied, but they are still considered experimental (Mont et al., 2020).

How I can help (see the My Approach tab)

• Exercises to keep your hip moving and the muscles around it strong
• Gentle hands-on work for stiffness and tight, overworked muscles
• Setting up a cane or crutches and pacing your activities
• Support with recovery after surgery, once your surgeon clears you

If pain suddenly worsens or starts in your other hip, tell your doctor.