With the development of the economy and society, nowadays, society, such as friends gathering, business negotiation, workplace social occasions, can not help but drink to cheer or socialize. When it comes to the drawbacks of drinking, people’s first reaction is often drunk driving, or even alcohol poisoning after drinking too much. But there is one complication of drinking that is often overlooked by the general public. That is femoral head necrosis caused by drinking. Usually, moderate alcohol consumption can improve blood circulation and relieve mental tension. However, if long-term, heavy alcohol consumption may lead to femoral head necrosis. At present, long-term heavy drinking in China is one of the three major causes of femoral head necrosis in young adults; while in western developed countries, drinking alcohol is one of the most important causes of femoral head necrosis.
I. Alcohol causes femoral head necrosis
Some people may ask why drinking alcohol will cause femoral head necrosis? This is to first introduce what kind of structure the femoral head is. It is in the linkage between our trunk and lower limbs, and is a hub. The blood supply to the femoral head is inherently insufficient (Figure 1), and the increase in fat cells and volume in the femoral head caused by long-term heavy drinking increases the pressure in the small space of the femoral head and reduces the blood supply, which, together with the blood stagnation caused by drinking, further reduces the blood supply to the femoral head. Other causes of femoral head necrosis due to alcohol include, 1. Alcohol can affect bone metabolism, inhibit the activity and proliferation of osteoblasts, and at the same time accelerate bone resorption and bone loss, with the end result of osteoporosis; 2. Drinking leads to insufficient nutritional intake, which indirectly leads to bone loss; 3. Drinking can affect bone metabolism by affecting the secretion of gonadal and parathyroid hormones.
Figure 1: Blood supply to the femoral head
Second, the relationship between the type and amount of alcohol consumption and femoral head necrosis
A small amount of red wine has the effect of softening blood vessels, while relieving the body of fatigue, while a small amount of alcohol consumption can inhibit the function of the central nervous system, thus improving the symptoms of somatic pain. A common example is that patients with osteoarthrosis can experience a reduction in symptoms after drinking wine, so red wine can be consumed in small amounts for femoral head necrosis. However, it should be noted that drinking white wine and beer, especially long-term drinking, or even alcoholism, is harmful to the body.
The performance of alcoholic femoral head necrosis
According to the statistics of orthopedic department of Peking Union Medical College Hospital, the femoral head necrosis caused by drinking during the last 20 years accounts for 15.4% of all femoral head necrosis in our hospital. Alcoholic osteonecrosis of the femoral head has a bilateral onset and is common in young and middle-aged men between the ages of 30 and 50 who have the habit of drinking large amounts of liquor for a long time.
Patients with early stage femoral head necrosis may experience pain at the root of the thigh or have difficulty crossing their legs, and the pain may radiate to the inner thigh and knee joint, which is sometimes easily misdiagnosed as lumbar disc herniation or knee joint disease. At the same time, the lower limbs of the femoral head necrosis side have cold symptoms, weakness, soreness and fatigue when moving around. It is especially important to remind you that because the nerves innervating the hip joint are partly divided into the knee joint, some patients with femoral head necrosis do not complain of hip pain, but feel pain in the knee joint, which is called “involvement pain” in medical science. In outpatient clinics, we have encountered patients from overseas who have repeatedly moved around due to knee pain, but no abnormality was found in the examination of the knee joint until they finally developed long and short legs, and only then did they consider the problem of the hip joint.
With the progression of femoral head necrosis, subchondral osteonecrosis of the femoral head gradually appears, and the necrosis site is often located in the weight-bearing area, and the specimen in surgery shows subchondral osteonecrosis, defect and sclerosis of the femoral head (Figure 2). At this point, painful symptoms worsen. With further progression, femoral head collapse occurs and the femoral head loses its smooth structure; in simple terms, this is when bone rubs against bone (Figures 3 and 4). In addition to significant pain, the patient gradually develops symptoms such as difficulty squatting, difficulty putting on socks, and limping due to restricted joint movement.
Figure 2: Intraoperative specimen image of femoral head necrosis, subchondral bone necrosis, defect
Figure 3: Femoral head necrosis with advanced femoral head collapse
Figure 4: X-ray image of advanced femoral head necrosis showing collapse of the femoral head and loss of joint space
Those who have the habit of drinking a lot of alcohol for a long time should go to a regular hospital in time once the above situation occurs. MRI can detect the lesion at an early stage and thus help to determine whether there is osteonecrosis.
Fourth, treatment
When necrosis occurs, the progress of femoral head necrosis should be slowed down by timely quitting alcohol, supporting double crutches, and taking relevant drugs orally. Here, it is necessary to focus on the fact that because smoking can lead to lipid metabolism, which may affect the blood supply to the femoral head, patients suffering from femoral head necrosis should quit smoking, in addition to quitting alcohol.
If the head of the femur is intact on X-ray, but the pain is worse, and there is cystic degeneration, partial sclerosis, or the characteristic “half-moon sign” in the femoral head, the best treatment is a combination of medullary decompression and bone grafting to reduce the pressure in the femoral head (Figure 5), remove the necrotic bone (Figure 6), and slow down the progression of The further development of femoral head necrosis, about 70% – 80% of patients can obtain satisfactory results and preserve the femoral head.
Figure 5: Intraoperative picture of medullary core decompression
Figure 6: Necrotic bone removed from the femoral head during decompression surgery
If the head of the femur is found to be poorly shaped and collapsed on X-ray, the lesion is already at the end stage of the disease, and any attempt to preserve the head of the femur is not satisfactory at this time. Many patients have gone through multiple attempts to “save the head”, spending money and suffering, but in the end, they cannot escape joint replacement.
Other treatments, such as interventional therapy and Chinese herbal medicine, may be effective, but there is a lack of evidence-based medical evidence to date.
Above we explain the knowledge of femoral head necrosis. If you can recognize this knowledge early, you can avoid the occurrence of osteonecrosis of the femoral head. If you find any of the above types of osteonecrosis of the femoral head at home, please go to the hospital in time to avoid missing the best treatment period.