Hip Replacement and Femoral Head Necrosis

Q:  I have necrosis of both femoral heads with the right side causing minor to significant pain, depending on the day. Would I normally be in pain at some level most of the time? When does a person know it's time for hip replacement?

A:  Pain from necrosis can be variable, depending on the degree of damage to your hip joint. It could be months or years before the pain becomes constant and intolerable. The decision for hip replacement is based solely on how much pain you're experiencing, not on what the x-rays look like. Dr. James Nimomiya, Assistant Professor of Orthopaedic Surgery at the Medical College of Wisconsin and Director of Adult Reconstruction, will proceed with joint replacement if the patient experiences significant pain when climbing stairs, putting on clothes and shoes, getting up from the chair, or sleeping at night. When the pain is interfering with your life, it's time to get a hip prosthesis, which will usually last for 10-15 years.

For very early stage femoral head necrosis, an experimental surgical procedure is available to delay progression of disease. A "vascularized fibular graft" involves taking a piece of bone from your lower leg and grafting it into your hip and may provide pain relief as well as put off hip replacement for many years.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.