Tom Smith Arthritis

Definition

• Tom Smith's arthritis is a form of avascular necrosis of the femoral head.

Pathology

• It is due to aseptic necrosis of the femoral head secondary to interruption of blood supply.
• The condition is also known as idiopathic avascular necrosis of the femoral head.

Causes

• Trauma
• Avascular necrosis
• Steroid use
• Hyperlipidemia
• Sickle cell disease
• Diabetes mellitus
• Alcoholic liver disease
• Radiation therapy

Clinical Features

• Pain in the groin and thigh
• Pain on weight-bearing movements
• Limited mobility of the hip joint
• Decreased range of motion
• Abnormal gait

Investigations

• Radiographs: show a crescent sign or a "ghost" appearance of the femoral head
• CT or MRI scans: confirm the diagnosis and show the extent of the necrosis

Complications

• Osteoarthritis
• Non-union of fractures
• Malunion of fractures
• Shortening of the limb

Management

• Conservative treatment: rest, non-weight-bearing, and pain management
• Surgical treatment: 1 → Core decompression 2 → Bone grafting 3 → Osteotomy 4 → Hip replacement

Blood Supply

• The blood supply to the femoral head is from the medial and lateral circumflex arteries
• The blood supply is disrupted in Tom Smith's arthritis

Nerve Supply

• The femoral nerve supplies the muscles of the thigh and hip joint
• The sciatic nerve supplies the muscles of the lower leg

Clinical Anatomy

• The femoral head is a spheroid structure covered by cartilage
• The hip joint is a ball-and-socket joint

Homoeopathic Therapeutic Medicines

• Arnica: for pain and inflammation
• Rhus toxicodendron: for stiffness and limited mobility
• Calcarea carbonica: for avascular necrosis
• Silica: for bone health and strength