DEAR DR. DONOHUE: I started to have a pretty bad ache in my left hip. I wondered if it was arthritis, but I thought I was too young for that — I’m 34. My doctor had me get an X-ray, and it turns out I have osteonecrosis of that hip. I’m on crutches now, and there’s talk of a hip replacement. Aren’t I too young for that? — R.E.

ANSWER: You’re not too young for hip replacement if you need it done. You might not. A famous ballplayer had osteonecrosis and a hip replacement and continued his baseball career after his surgery.

Osteonecrosis — bone death — occurs when the blood supply to bone suddenly shuts off. The part of the bone deprived of blood dies. It can happen to any bone, but it often happens to the hip bone and joint.

This condition also goes by the name avascular necrosis.

Causes are many. Trauma can bring it on. Lupus and sickle cell anemia patients are often victims of it. Alcoholics get it. When cortisone drugs are used in high doses for a long time, they can promote osteonecrosis. For many, and you might be one of them, a cause can’t be discovered. The process just happens out of the blue.

Treatment depends on the extent of involvement and the stage at which the process is discovered. There are four stages. Stage I is minimal involvement and stage IV represents collapse of the bone and joint. Resting the bone is treatment for stage I, and that’s what you’re doing with crutches. You might see a complete regrowth of bone at this stage if all goes well. For more advanced stages, a number of treatments are acceptable. Bone decompression is one. Small plugs of bone are removed to reduce bone pressure and encourage the growth of new blood vessels. In another procedure, dead bone is removed and good bone is repositioned to bear the brunt of body weight. And finally, there is always the option of replacing the collapsed bone with an artificial hip. You are young, and you might need a second operation later in life if hip replacement is necessary. We’re crossing bridges, however, well before we need to. Let’s see what time does for your joint.

DEAR DR. DONOHUE: I have a very good friend who is two months pregnant and she still smokes marijuana daily. It’s not my place to say anything to her, but I wonder what effect this has on her baby. — D.K.

ANSWER: The effects of marijuana on the maturing fetus aren’t known with certainty. Heavy use might be associated with lower birth weight.

I can’t believe that marijuana does anything beneficial for the infant, and I suspect it might be harmful, but I don’t have the facts to back that up. Cigarette smoking is detrimental to the fetus and, by analogy, I would reason that marijuana must also be.

DEAR DR. DONOHUE: My brother has had diabetes for 20 years. Now he has something called Charcot joint. I don’t know for sure what this is, but I take it that it is related to diabetes. Is it? I have diabetes too, and wonder how common it is and what can be done to prevent it. — L.T.

ANSWER: When people sit or stand for any length of time, they unconsciously move their joints from time to time. Keeping a joint in one position damages it. A small number of diabetics lose the sensation of discomfort that arises when a joint is kept completely immobile for too long. As a result, that joint suffers. That’s a Charcot (SHAR-coe) joint. The damage to the joint can be severe and deforming, and can make the joint functionless. Usually, it’s the ankle joint or one of the foot joints that is the target.

Diabetes is not the only illness that leads to such joint destruction.

Strict blood sugar control, as it is in prevention of other diabetes complications, is the only preventive measure to take. That’s not exactly a fair statement. It makes it appear that every diabetic with a Charcot joint has been negligent in watching his or her diabetes. Some diabetics, even with the best of control, come down with this complication.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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