Integrating manual therapy into conservative management of a patient with bilateral femoral head avascular necrosis: A case report with a 2-year follow up

Background

Femoral head avascular necrosis (AVN) can contribute to substantial functional limitation. Although surgical intervention for advanced staged AVN can be useful, non-surgical interventions to improve functional independence of patients with hip AVN are not well described.

Objective

The purpose of this case report is to describe the physical therapy intervention provided to a patient with bilateral hip AVN.

Methods

The patient was a 56-year-old male presenting to physical therapy with bilateral femoral head AVN. Impairment-based manual therapy, therapeutic exercise, and education were provided to promote decreased pain and improved self-reported function.

Results

The patient completed eight visits over the course of 10 weeks. Clinically significant improvements were noted in pain ratings and functional level as measured by the Lower Extremity Functional Scale and Harris Hip Score. Improvements were maintained at a two-year follow up period.

Conclusion

Early identification and physical therapy intervention can contribute to promoting functional independence for patients with bilateral hip AVN. Early intervention could potentially reduce the need for surgical intervention. Further research is necessary to describe with detail the optimal methods to accomplish these goals.