Avascular Necrosis: Two Words I Really Did NOT Want to Hear at the Doctor's Office

Well, the dreaded day has finally arrived. I was just diagnosed with a case of avascular necrosis of the left femur. While I knew this was a possibility, I was hopeful that I would be able to hide among the 70% of hip fracture patients that do not wind up in this category.

Avascular necrosis is a fancy way of saying bone death due to blood loss. In my case, the condition is the result of a femoral neck fracture I sustained when hit from behind by a car on a 1000K brevet in Eastern Pennsylvania in 2010. The femoral neck is the narrow section of bone that connects the "ball" of the femur with the rest of the leg bone and when mine was shattered the surgeon immediately put it back together with the addition of several pins and screws. [See lovely illustration below]. I've not regained the full range of motion I once had in my left hip, but pain has not really been a factor . . . until recently. Over the past year, I've noticed a subtle weakening of and soreness in my left hip that's particularly evident when I get up from sitting in a soft chair or the driver's seat of my car after a long drive. I haven't yet developed a pronounced limp, but increasingly it takes me a few steps to sort things out.

In cases of avascular necrosis, the bone slowly dies as the result of inadequate blood circulation. There's nothing to be done to slow, stop or reverse the process and eventually, the joint will simply collapse into more of a "block and socket" than a "ball and socket." The great news here is that my cycling is not dramatically affected and does not contribute to making the condition any worse. The bad news is that it's only a matter of time before I will need a total hip replacement. So what's next? Well, my orthopedist suggests that I continue to live my life and enjoy my time on the bike with the addition of some strengthening and stretching exercises to keep things strong and limber. I'll be heading back for a follow-up visit in a year unless I notice any dramatic changes and it may be 3-5 years (or longer!) before I need a new hip.

My goal this year is to continue to strengthen my overall performance on the bike. I hope to build greater endurance, speed and climbing fitness with the overall goal of strength and comfort rather than a podium finish. Floyd Landis may have been able to win the Tour de France on a broken hip, but I'm shooting for something a bit less dramatic (and less drug-fueled). While I was hoping that 50 was going to be the new 30, at least it looks like won't be the new 70.