Explanation of Diagnosis

Avascular necrosis (AVN) of the hip occurs when blood flow to the femoral head (top of the thigh bone) is reduced or blocked, leading to bone death and joint damage. It can be caused by trauma, long-term corticosteroid use, excessive alcohol consumption, or certain medical conditions (e.g., sickle cell disease, lupus). Symptoms include hip pain, stiffness, reduced range of motion, and difficulty walking. If untreated, AVN can lead to hip arthritis and collapse of the femoral head, requiring hip replacement surgery.

Specific Work Modifications

• Avoid prolonged standing, walking, or weight-bearing activities.
• Use a cane or crutches to reduce stress on the hip.
• Modify tasks to allow seated work when possible.
• If standing is required, take frequent breaks and shift weight between legs.
• Use an ergonomic chair with lumbar support to minimize hip strain.

Specific Activity Modifications

• Avoid high-impact activities such as running, jumping, or heavy lifting.
• Modify workouts by switching to low-impact exercises such as swimming, stationary cycling, or water aerobics.
• Use proper warm-ups and stretching before any activity.
• Gradually return to activity under medical guidance.

Recommended Supplements

• Vitamin D3 (1000-2000 IU daily) – Supports bone health and calcium absorption.
• Calcium (1000-1200 mg daily) – Helps maintain bone density.
• Magnesium (300-400 mg daily) – Supports muscle relaxation and bone strength.
• Collagen peptides (10 g daily) – Aids in joint and bone repair.
• Omega-3 fatty acids (1000 mg daily) – Reduces joint inflammation.

Recommended Nutrition and Hydration

Diet Recommendations:

• Bone-supporting foods: Dairy products, leafy greens, almonds, salmon, and fortified cereals.
• Anti-inflammatory foods: Fatty fish (salmon, sardines), turmeric, berries, walnuts, and olive oil.
• Protein-rich foods: Chicken, eggs, lentils, and dairy to support bone and muscle function.
• Limit processed foods, sugar, and alcohol, which can weaken bones and increase inflammation.

Hydration Tips:

• Drink at least 2–3 liters of water daily to support joint and bone health.
• Limit caffeine and alcohol, which can interfere with calcium absorption.

Home Exercise Prescription

No high-impact exercises. Focus on non-weight-bearing exercises to maintain hip mobility and strength.

Phase 1: Pain Management & Mobility (Weeks 1-4)

1. Seated Hip Flexor Stretch

1. • Sit in a chair, bring one knee toward your chest, and hold.
   • Hold for 20-30 seconds, repeat 3 times per side.

2. Pelvic Tilts

1. • Lie on your back with knees bent, tighten your core, and flatten your lower back.
   • Hold for 5 seconds, repeat 10 reps.

3. Ankle Pumps (Maintain Circulation)

1. • Move your foot up and down like pressing a gas pedal.
   • 10 reps, 2-3 times daily.

Phase 2: Strength & Stability (Weeks 4+, If Pain Improves)

4. Bridges

1. • Lie on your back, bend knees, and lift hips without arching your back.
   • 10 reps, 2 times daily.

5. Clamshells (Hip Strengthening)

1. • Lie on your side with knees bent, open knees like a clamshell.
   • 10 reps per side, 2 times daily.

6. Water-Based Therapy (Pool Exercises)

1. • Walk or do gentle leg lifts in a pool to reduce joint impact.
   • 10-15 minutes, 2-3 times weekly.

Avoid running, jumping, or prolonged weight-bearing activities until cleared by a doctor.

Helpful Books

1. "Saving My Hip: A Personal Guide to Avascular Necrosis" – Ann Kearns
2. "The Hip Handbook: A Guide to Preventing and Treating Hip Pain" – Nicolas Piuzzi, MD

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.