Perils of that peg: Too much alcohol can lead to a broken hip

What if we told you that drinking excessive drinking could necessitate a hip replacement ? Don't believe us? Read on to find why we say so.

By: Aishwarya Iyer | | Updated: July 24, 2018 7:17 pm

People tend to consume more alcohol in cold climate. ©Shutterstock

Alcoholism among the youth is a rising problem. It is fairly simple to understand that excessive and regular drinking of alcohol can lead to many health problems. However, something that is not spoken about is how alcoholism could lead you to avascular necrosis.

What is avascular necrosis or AVN?

“Avascular Necrosis, AVN or Osteonecrosis of the femoral head is a pathological process that results from interruption of blood supply to the bone which leads to the death of marrow and osteocytes resulting in a collapse of the necrotic segment of the femoral head. In the early stages of the disease there is severe pain from the dying bone,” said Dr Sanjay Agarwala, Head – Orthopedics and Traumatology, Director-Professional Services, P.D. Hinduja Hospital and Medical Research Centre.

Simply put, AVN is the death of a bone tissue caused due to the disruption of blood supply. Commonly known as osteonecrosis, it can cause breakage of bones. This breakage can eventually lead to bone collapse. Last year, a lot of cities in the country experienced young men coming for hip replacement surgery- caused only due to drinking.
AVN leads to frank arthritis of the hip, causing stiffness, limitation of movement and adds to the disability of the patient in a day to day routine life.

“This is the most common cause of total hip replacement in young patients in India. In India, as there is no statistical data available, extrapolating for a population of over a billion people probably 70 to 90,000 new patients get affected with AVN. The disease occurrence is more in men than in women,” observed Dr Agarwala.

What are its causes?

AVN is often seen in association with a number of different conditions. Some of them are as follows:
• Trauma with the fracture of the femoral neck. “The risk has been reported to be as high as 10-43% after a displaced femoral neck fracture,” he added.
• Excess alcohol consumption.
• Sickle cell disease
• Caisson’s disease
• Gaucher’s disease
• Systemic Lupus Erythematosus
• Rheumatoid arthritis
• Immuno-deficiency syndrome

What are its symptoms?

In early stages, patients experience pain the groin, buttock, thigh pain or knee region. In later stages, patients start limping or limit their hip, joint movements due to pain.

Alcoholism and AVN: What’s the connection?

“AVN of bone is a painful, progressively disabling disorder. The hip is the most common site. Untreated, it progresses to frank hip arthritis needing surgical intervention (Total hip replacement),” said Dr Agarwala.
Simply explained, AVN is an allergic manifestation to the steroids, 25 per cent of which could be due to alcohol.

Drinking alcohol is known to cause AVN through as yet unknown biochemical/ allergic/immune response. The terminal blood vessels of the head of the hip get blocked. This causes a sequence of necrosis (death) of the hip bone leading to excruciating pain and destruction of the hip.

Methods of treatment:

• Surgical management
There are various surgical procedures which have been described such as core decompression, vascular fibular bone grafting, osteotomies around the femoral head and vascular pedicle graft, with varied success rate.
“All these surgical procedures help in early stages of AVN with poor success and add morbidity to the patient. The only consistent good results are seen in total joint replacements. Directly implanted stem cells are the latest in this long road to salvation and are showing promise in controlled trials,” explained Dr Agarwala.

• Medical Management involves:
o Aspirin has a role with very poor results.
o Vaso-active drugs may play a role in early AVN but never proven.
o Chinese herbal products
o Pulse Electromagnetic therapy with no proven results.
o Bisphosphonate therapy, the only currently available peer-reviewed and consistently proven in world literature. This is pioneered by Dr Agarwala.

Image source: Shutterstock

Published : July 24, 2018 5:28 pm | Updated:July 24, 2018 7:17 pm

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