Avascular necrosis of the hip

[kmo]

A dive buddy of mine has been diagnosed with avascular necrosis in his hip and will need hip replacement therapy. He has tried to get a second opinion, but three doctors now say the same thing. The thing is, he isn't that deep a diver (most diving between 10 and 20m), and he isn't even 40 years old!

He had a nasty fall at work 9 months ago where he twisted his hip almost to dislocating and he believes that was the cause, but without the doctors' approval he can't get the hip replacement under insurance.

I know at least one other deeperblue member has experience in this, but that was an older, deeper diver. Can anyone shed some light on whether this is caused by freediving or point us in the direction of research that can?

 

[kmo]

Sorry, just reread that post. I forget to mention that the doctors are saying that the necrosis has been caused by freediving.

 

[trux]

Interesting. I'd like to know on what studies they base their claim. I searched through the 700 scientific documents about freediving physiology in APNEA.cz database, and did not find necrosis mentioned anywhere.

On the other hand it is true that prolonged pressure expossure and nitrogen saturation may result in necrosis, but that's usually the case at quite high doses and regular exposure - more usual at very deep scuba and tech divers, and at pro divers. So if he freedives very frequently and in serious depths, it could be perhaps a contributing factor. However, there are plenty of other factors that can contribute to avascular necrosis, so I recommend searching through the available literature, and finding out if some of those other factors may apply in his case too. This, for example, comes from WikiPedia:

Causes
There are many theories about what causes avascular necrosis. Proposed risk factors include alcoholism,[2] excessive steroid use,[3] post trauma,[4][5] caisson disease (decompression sickness),[6][7] vascular compression,[8] hypertension, vasculitis, thrombosis, damage from radiation, bisphosphonates (particularly the mandible),[9] sickle cell anaemia,[10] and Gaucher's Disease.[11] In some cases it is idiopathic (no cause is found).[12] Rheumatoid arthritis and lupus are also common causes of AVN. Prolonged, repeated exposure to high pressures (as experienced by commercial and military divers) has been linked to AVN, though the relationship is not well-understood.

 

[kmo]

Thanks Trux. I had a look on your database last night too.

It makes you wonder how 2 specialists can both arrive at the conclusion that his recreational freediving to shallow depths has caused AVN?

 

[kmo]

Trux, another diving information database for you to mine:
Rubicon Research Repository: Search Results

 

[trux]

Great! Thank you! I'll add what is not included yet.

 

[Jon]

I've know divers who have had it happen to them, but they were all deep (scuba) divers who regularly dove to 200'+ on air or trimix. One guy had to have his shoulder replaced on his 30th birthday. He never was (knowingly) bent, but the doctors figured he must have had a sub-clinical hit that festered over time and eventually killed off all the blood vessels in the area.

I've never heard of a case from strictly freediving before, but anything is possible.

Jon

 

[Rik Rosken]

Well, as previous posters wrote, avascular necrosis of the hip is known to occur in deep technical divers and commercial divers. This is associated with long dives, especially those who would affect the "slow tissues" in the tissue dive models.

It can't remember an article on avascular necrosis being associated with breath-hold diving. And I would be intrested in the medical explanation of the consulted doctors and would look forward for reading their medical case report.