1.How to prevent the occurrence of femoral head necrosis?
(1) Change the habit of drinking alcohol in large doses continuously for a long time.
(2) Avoid applying excessive doses or long-term improper use of hormone drugs. If you have to use them, you should supplement the intake of vitamins and limit excessive intake of lipids, and you can give a high-protein diet or apply traditional Chinese medicine to regulate the level of lipid metabolism.
(3) Avoid strenuous overload sports to minimize the chance of hip joint injury.
(4) Patients with femoral neck fracture should exercise early and weight-bearing late after surgery.
2.How can patients with femoral head necrosis protect themselves?
(1) Bed rest, limit weight-bearing, reduce the pressure of the joint capsule, which helps synovial fluid to nourish the cartilage and repair the diseased tissues, and through rest, can release the pain caused by the stimulation of the hip joint.
(2) Traction prevention With the help of traction power, the muscle spasm can be relieved and the pressure on the femoral head can be reduced to the minimum, which helps to shape the femoral head.
3.How should patients with osteonecrosis of the femoral head protect themselves when the weather changes?
Most patients with osteonecrosis of the femoral head have aggravated their condition and hip pain when the weather changes. The main reason for this is the two factors of humidity and cold; humidity can cause dysfunction of skin respiration and metabolism in the hip and leg, so that the local tissue blood flow is slow and causes microvascular congestion, stasis and increased exudation, making the patient’s symptoms worse. Therefore, in humid conditions, patients should keep their working and living environment dry in addition to appropriate activities to avoid aggravation of symptoms. Cold mainly causes stasis, ischemia, edema and other blood circulation disorders in the hip through vasoconstriction of the hip and leg, which aggravates the patient’s condition. Therefore, patients should not sit or sleep in cold places for a long time, and pay attention to more activities and keep warm in winter.
4.Why do various hospitals say different things about the treatment of femoral head necrosis?
To be precise, the cause of femoral head necrosis is not yet very clear, and there is inconsistent understanding of it, leading to many different statements. However, these many statements are rooted in three types.
(1) Relying entirely on medication and guaranteeing that long-term use of this drug can cure the disease. This is an unscientific, false, bragging claims, with a certain fraudulent nature, unrealistic, not credible.
(2) Temporarily do not receive any treatment, do whatever you want, let it develop freely, and then perform joint replacement when the femoral head is completely collapsed. Or tell you that it is better to replace it later than earlier, and strongly advise you to have the artificial joint replacement as soon as possible. Such statements are irresponsible.
(3) According to the different stages of development of the disease, combined with the situation of femoral head necrosis, different methods are used in stages for limited treatment, which can slow down the development process of the disease and prolong the time of surgical treatment as much as possible, and if the femoral head is completely collapsed, it is not too late to perform femoral head replacement again. This is a more scientific program and is the treatment method we always advocate.
5.Why do some patients have less symptoms and some patients have more symptoms during the treatment?
After systematic treatment of patients with femoral head necrosis, most patients have improved their clinical symptoms and signs, but some patients complained of increased hip pain and lost their confidence in treatment due to psychological pressure, but X-rays showed improvement. In fact, hip pain does not exactly mark the aggravation of the disease, but the bone also appears in the process of repair. The necrotic bone near the joint surface is absorbed, producing enzymes and protein breakdown products, and these toxins enter the joint cavity to irritate the synovial membrane, and severe pain is produced. After the dead bone is absorbed, the pain will be reduced and disappear.
6.Why some patients’ symptoms are reduced after taking regular batch of drugs, but the X-ray performance keeps getting worse?
The treatment of femoral head necrosis is a comprehensive process. In the process of using medicine after femoral head necrosis, there is always the process of absorption of dead bone and formation of new bone inside the femoral head. After the medication is administered, the patient may experience a decrease in pain and an increase in the patient’s activity, which increases the stress on the femoral head and slows down both processes, so the patient may experience a decrease in symptoms while the signs continue to worsen. This is a normal condition and is generally less common. It is common for some people to take drugs that contain painkillers and hormones in seemingly regular medicines (including proprietary Chinese medicine preparations, ancestral secret recipes, etc.), and the symptoms are obviously reduced after taking the drugs, but in fact it is these drugs that work to make you feel no pain temporarily, but the x-ray performance keeps getting worse.
7.Why do some patients have a “clicking” sound when they move their hip joints?
When the femoral head of patients with stage III or above collapses in large pieces and is accompanied by the exposure of subchondral necrotic bone, or when there are fragments of bone in and out, there will be abnormal sounds such as “clicking” when moving the hip joint, and there may be pain and other dysfunctions, if the treatment does not disappear within a long time, it can be one of the indications for surgical treatment.
8.What is the inconsistency between the degree of femoral head necrosis and clinical manifestations?
Due to the presence or absence of fluid in the affected hip capsule, individual differences in the patient’s response to pain often show inconsistencies in the performance of the degree of necrosis. No collapse or collapse is light, but too much fluid in the joint cavity, the patient will feel heavy pain; collapse is heavy, the condition is relatively static, the patient because of the long experience of pain to improve pain tolerance, will show relatively light symptoms.
9.Will the femoral head necrosis be crippled?
Whether the femoral head necrosis will be disabled or not is significantly different from the degree, location and treatment of necrosis. If the extent of necrosis is small, the treatment is timely, and there is no obvious collapse, the possibility of eventual disability can be completely avoided; however, if patients cannot be diagnosed in time, take some hormone-containing treatment drugs indiscriminately, or continue to drink a lot of alcohol for a long time, and carry out improper activities and exercises, large area of necrosis is inevitable. Improper treatment can also appear collapse, if there is late femoral head collapse and fragmentation, the femoral head will become flattened and lose concentric structure, the joint gap becomes smaller, the limb shortening, the hip joint activity is obviously limited, and in serious cases the hip joint function is completely lost.
10.Can a non-weight bearing necrotic femoral head avoid collapse?
People’s conventional understanding is that bed rest means no weight-bearing and no stress stimulation can avoid collapse. However, this understanding is not entirely correct. Because people’s muscles are in a constant state of muscle tone contraction, it can give normal stress between the acetabulum and the femoral head. When patients perform functional exercises in bed, if they perform the wrong movements, the compressive stress on the femoral head is significantly higher under the effect of strong muscle pulling and femoral head collapse occurs. We conducted a follow-up of 219 patients with early to mid-stage femoral head necrosis under conservative treatment, and 27 patients (12.33%) developed collapse during bed rest.
11.Should patients with femoral head necrosis be absolutely bedridden?
Many patients think that they are not able to put weight on the femoral head necrosis, which means bed rest, this idea is not right. The formation of femoral head necrosis is caused by various reasons of local ischemia, necrosis formation, due to pain and other reasons to limit the activity, resulting in a series of changes such as decreased muscle contraction, joint movement disorders. On the basis of this, the activity is reduced even more, thus forming a vicious circle, which eventually leads to local blood circulation disorders and necrosis continues to develop. It seems that the idea of inactivity after the disease is wrong, through the activity not only improves the blood circulation, but also prevents complications and is conducive to the repair of the femoral head, but the functional activity should be carried out under the premise of not bearing weight, the spokes should not be too large, and the force should not be too violent.
12.Do patients with femoral head necrosis need to limit their activities?
Excessive restriction of lower limb activities can easily lead to muscle wasting atrophy and osteoporosis. This in turn is likely to aggravate the femoral head necrosis. Therefore, it is better to carry out some functional exercises without weight-bearing, such as: hip suspension exercise, air boarding wheel, swimming, etc.
13.Why should I use exercise therapy?
For patients with ischemic necrosis of the femoral head, surgical treatment can only solve the blood supply to the femoral head and fix the adaptation relationship between the head and socket. Drug treatment and some external treatments can improve blood flow and promote bone repair, but cannot restore the mobility of each joint. Joint mobility is an important indicator of the patient’s ability to live and work in the long term. Exercise therapy can promote the absorption of local hematoma and exudate, reduce edema, prevent muscle atrophy, and enhance muscle strength. The bioelectricity generated by muscle contraction helps to deposit calcium ions in bones, promote bone healing and prevent bone decalcification. Joint movement can stretch the joint capsule and ligaments to prevent their shortening, and promote the secretion and circulation of synovial fluid in joints, thus preventing intra-articular adhesions. Exercise therapy can also enhance the body’s metabolism, improve immunity, and prevent the occurrence of comorbidities. Therefore, the timely and reasonable application of exercise therapy after surgery has irreplaceable importance in the whole treatment.
14.How do patients with femoral head necrosis perform functional exercise?
The functional exercise of patients with femoral head necrosis should implement the principle of combining local and overall, movement and rest, with active activities as the main activity and passive activities as the supplement, the movement should be coordinated, gradually, from small to large, from little to much, gradually increasing. According to the stage and shape of femoral head necrosis, the degree of functional limitation of the soft tissues around the bone and joint, and the physique, a comprehensive analysis should be conducted to select the appropriate standing, sitting and lying exercise techniques and methods. Generally, non-weight-bearing exercise is the main method, and weight-bearing exercise is supplementary.
15.Why do some patients with ischemic necrosis of the femoral head have long affected limbs?
In general, patients with ischemic necrosis of the femoral head are prone to femoral head collapse, joint space narrowing and shortening of the affected limb in the late stage, but some patients have a long affected limb after a period of treatment, causing psychological panic. In fact, this kind of long affected limb is an illusion, not the real length of the affected limb has increased, but because the hip pain maintains traction for a long time, the lumbar muscles are in uncoordinated, the muscle tension and contraction force is unbalanced, making the pelvis tilt, presenting the illusion of long affected limbs, the distance from the anterior superior iliac spine to the outer ankle of the lower limbs bilaterally is still equal or a little shorter. This phenomenon does not require any special treatment, the affected limbs will be put on the ground to bear weight, and with the exercise of the lumbar muscles, the pelvis will slowly return to the normal position, and the length of the lower limbs will be restored to balance.
16.Why does the femoral neck become wider and shorter than normal after healing of pediatric femoral head necrosis?
As the ossification center and the epiphyseal plate of the femoral head epiphysis are not fully developed in children, the site of ischemic necrosis of the femoral head is usually in the ossification center, where the dead bone sinks under pressure and the epiphyseal plate becomes necrotic under pressure and then breaks up, causing the epiphysis to separate on both sides. Since the epiphysis and the epiphyseal plate are separated to both sides together with the small pressure around the epiphyseal plate and the good blood supply, the femoral neck becomes wider than normal, the normal osteogenic ability of the epiphyseal plate center is weakened or disappeared, and the neck is shortened, so it is impossible to make up for the broken epiphyseal plate, so it should be prevented early and avoid weight bearing until the disease is healed.
17.How to use crutches correctly?
Once the diagnosis of femoral head necrosis is confirmed, crutches should be used correctly to effectively avoid weight bearing or partial weight bearing. For example, when going upstairs, you should first step on the healthy side of the lower limb, then step on the affected limb, and finally go up again with both crutches, and when going downstairs, you should let both crutches go down first, then the affected limb, and finally the healthy limb. When walking on a flat road, you can first move the left crutch forward, then step on the right lower limb, then move the right crutch forward, and finally step on the left lower limb, that is, the four-point gait method. If you need to use a single crutch, remember to put the crutch under the armpit of the healthy side and walk with the affected limb at the same time, which can eliminate the fatigue of the affected hip muscle, reduce the force on the affected hip, and increase stability. If you need to use a cane, you should pay attention to the height of the cane, which should not be higher than the top of your left ridge. Choose the quality of the cane to wood (ash wood is better) and metal (aluminum) is most commonly used. To choose a cane without cracks, scars and other good quality, the handle should have sufficient sponge protection. The choice of height should be the length from the front edge of my armpit to the outer edge of the bottom of my foot plus 5 cm is appropriate, also available for my height minus 40 cm shall prevail. The crutches should be held in the horizontal handle of the crutches, so that the body weight is not pressed into the crutch area of the armpit, which can sometimes cause “crutch axillary nerve palsy”. The time to use crutches should be in accordance with medical advice.
18.When can I not use crutches?
The repair process after ischemic necrosis of the femoral head is long and complicated, and patients must have a persistent attitude. Because, there will be dead bone resorption, new bone growth and shaping stages in the process of lesion, its transformation is the change of bone substance rather than the change of symptoms. In some cases, the hip pain is relieved or disappears after a period of treatment, which does not mean that the disease is cured. The real diagnosis is assessed by imaging such as X-ray and ECT, through which the changes within the femoral head can be seen, from ischemic to stasis type, from trabecular reconstruction to plasticity, and the abduction can only be abandoned after the cystic area within the femoral head is seen to disappear and be filled with new bone, the trabeculae are arranged in an orderly manner, and the femoral head reaches a certain level of support. These signs are not determined by the patient’s own feelings, but by the identification of a physician with extensive clinical experience. Therefore, when the crutches can be discarded and how the femoral head will be effectively protected at each stage is a matter of close cooperation between the patient and the doctor.
19.Is closed-hole neurectomy effective in the treatment of femoral head necrosis?
Some people use closed-hole neurectomy to treat femoral head necrosis, which we think is inappropriate. Originally, this technique is suitable for the palliative treatment of severe osteoarthrosis, and its effect is extremely limited. If this operation is used to treat femoral head necrosis, at best, it can relieve pain, but it is not good for its necrotic pathological process, and it may be more likely to occur under the cover of “pain relief”, necrosis collapse or femoral head fragmentation, so that the whole hip joint is seriously degenerated.
20.How to take care of the patient’s diet before surgery?
(1) Alcoholic damp heat type
Clinical manifestations: history of alcoholism of more than 6 years. It is more common to have more than 10 years and more than half pound/day. Patients often feel dry mouth and bitterness, sleepless at night, and thin body shape. Some patients have liver function tests showing liver cell damage. The tongue is dark with stasis, the coating is white, and the pulse is stringent and slippery. The affected limbs showed resting pain, which was aggravated by activity. Analysis: Alcohol is a damp and turbid product. Long-term alcoholism is undoubtedly a damp and turbid flooding of the stomach, which affects the spleen and stomach’s function of transportation and transformation, followed by internal accumulation of alcohol poison, which makes it difficult for the liver to discharge poison and causes damage to the liver. The liver is the master of tendons and the kidney is the master of bones. Therefore, the lesion gradually sees ischemic necrosis of the femoral head. Dietary regimen: detoxify and permeate dampness, activate blood circulation and eliminate blood stasis, and maintain the liver and kidney. Dietary regimen: white sugar kudzu powder or white sugar rhizome powder; white sugar chrysanthemum tea; field chicken yolk with eggs; watercress with snails. Diet avoid: alcohol, smoke, fatty, sweet and thick-tasting products.
(2) hormonal kidney Yang deficiency type
Clinical manifestations: history of use of hormonal drugs, patients mostly have fat, slightly pale, asthma, spontaneous sweating, easy fatigue, weakness of the waist and knees, fear of cold in winter, fear of heat in summer. The tongue is light and fat, the coating is thin and white, the pulse is thin, and the urine is clear and long. Analysis: Improper use of hormonal drugs or the immunity of the body decreases after the use of drugs, too much drug toxicity injures the spleen and stomach and causes loss of healthy transportation, so that the essence of water and grain cannot be distributed throughout the body, causing water and dampness to gather in the body, so that fatness and weakness are seen; asthenia and other signs of qi deficiency, too much drug toxicity can also injure the liver and kidney and cause bone destruction. Dietary regimen: strengthen the spleen and dispel dampness, flattening Qi deficiency. Diet advisable: quail with gravy lentils and coic rice soup; beef fried seaweed; Huai Shan lentils and gravy with lean meat. Diet avoid: stale food, hairy, fatty and various animal offal, etc.
(3) Traumatic gas stagnation and blood stasis type
Clinical manifestations of traumatic injuries that do not heal, or femoral neck fracture neck absorption. The affected limb is obviously shortened with muscle atrophy, limping is especially bad, and cannot stand for a long time and walk for a long time. Analysis: The body is weak after a long illness and the biochemistry of qi and blood is frustrated. The spleen is the source of biochemistry, and the spleen loses its function as the master of muscles, resulting in muscle wasting, which is a sign of deficiency of qi and blood, liver and kidney. Dietary regimen: replenish Qi and blood, strengthen the spleen and benefit the liver and kidney. Diet is appropriate: Astragalus and wolfberry stewed squab; saxifrage and yucca boiled duck; papaya and ginger boiled rice vinegar; milk and vitamin-rich fruits and vegetables.
21.The purpose and significance of rehabilitation treatment?
Surgery is the treatment of choice for patients with mid- to late-stage ischemic necrosis of the femoral head, but surgical treatment also has certain limitations and inevitably produces a series of side effects, such as tissue inflammation, edema, adhesions, and scar formation. It is not only unfavorable to promote the growth of bone scabs, but also restricts the local activities, and the postoperative traction system is also prone to muscle atrophy, muscle strength, and reduced joint mobility, which is not conducive to the recovery of joint function. In order to solve these problems, postoperative rehabilitation is necessary, which both corrects the negative effects of surgery and extends the positive effects of surgery. Physical therapy is helpful in dealing with tissue inflammation, edema, adhesions, scars, and improving blood flow. Modern rehabilitation medicine’s exercise therapy can gradually restore the movement function of joints. In conclusion, postoperative rehabilitation improves the blood flow of the limb, promotes bone repair, restores joint movement function, improves the efficacy of surgery and shortens the healing period, which is an essential part.
22.How can postoperative patients perform bed exercise?
On the second or second day after surgery, you can perform isometric contraction of the quadriceps muscle, that is, patellar up and down movement exercises to maintain the muscle strength of the quadriceps muscle and prevent muscle atrophy. Flexion and extension exercises of the ankle joint can be performed to prevent early stiffness of the remote joint and to promote blood and lymphatic return to the lower extremity. One week after surgery, increase activity by slowly sitting up and placing a backrest frame on the back or raising the headrest of the bed. Tie a rope belt to the headrail at the foot of the bed for the patient to grasp to do upper body forward flexion exercise to achieve hip flexion. Patients can also perform passive exercises with the help of the doctor, but they should not rely on the doctor and must play their own initiative to lay the foundation for later functional exercises in bed.
23.How to prevent ischemic necrosis of femoral head after femoral neck fracture? What are the methods to make early diagnosis?
Generally, the earliest time of clinical appearance of femoral head necrosis after femoral neck fracture can be 2-3 months after the injury, and as late as eight years, or even longer. Therefore, postoperative observation should be continued for at least three years, and the following methods can be used to prevent it: non-displaced or abducted fractures should be treated conservatively with continuous traction or hip herringbone cast fixation to avoid excessive abduction and extreme internal rotation. Displaced fractures should be accurately repositioned with traction and fixed with 2-3 hollow screws or threaded pins in the femoral neck, with each pin preferably kept crossed. After revision traction, if the fracture is still significantly displaced, it can be repositioned by incision, while implanting the vascular bundle, without damaging the extracapsular arterial ring at the base of the femoral neck. Postoperatively, the time of weight-bearing should be postponed as much as possible, and non-weight-bearing functional exercises should be carried out early under the guidance of the doctor. X-ray films should be taken regularly for follow-up review, usually once every 3 months. After the healing of femoral neck fracture, walking is also painless, but once the painful disease appears later, this is the signal of head necrosis, and the orthogonal cavity films of bilateral hip joints should be taken for comparison. The application of ECT can make early diagnosis, which can indicate the decline of arterial blood supply, obstruction of venous return, large “cold area” or large “hot area”. If there is no metal fixation in the neck of femur, MRI (showing local or whole head low signal, fat depression with edema) can be used for early diagnosis.
24.Is it necessary to remove the metal nail immediately after healing of femoral neck fracture with ischemic necrosis of the femoral head?
When the femoral head necrosis was manifested before nail removal, some doctors thought that pulling out the fixed nail attempted to grow into the blood vessel from the nail hole, but they did not know that removing the metal nail obviously reduced the mechanical strength of the necrotic femoral head, which led to accelerated collapse of the femoral head and expanded the risk of head necrosis area. After removing the nail, we should reuse the double crutches for three months and closely observe any changes, if everything is normal, we should go to the crutches.
25.How to predict the collapse of the femoral head?
The difficulty in the treatment of femoral head necrosis is to prevent collapse. We believe that the occurrence of collapse is related to the stage of development of femoral head necrosis, the extent of necrosis (height, width and area of necrosis), the site of necrosis and the treatment method, and also related to the individual’s mobility and hip joint loading. If the area of necrosis is less than 30% on X-ray, most of them can be considered as not appearing obvious collapse; if it is between 30% and 60%, we call it critical collapse area and the chance of collapse increases significantly; if it is more than 60% and the angle of necrosis is greater than 110o on plain film, statistically, the chance of collapse is 99%. Therefore, the earlier the stage of lesion, the better the treatment effect; the smaller the scope of necrosis, the better the treatment effect; necrosis in non-weight-bearing parts, the chance of collapse is small, and the treatment result is good.
26.Why does the traumatic femoral head necrosis patient collapse more slowly?
The bone repair after trauma is more active, the bone is harder, mainly hardened, and the hard bone can play a role in supporting and preventing collapse, so it is said that patients with traumatic femoral head necrosis collapse more slowly.
27.What is contouring therapy?
Shaping therapy was mainly used for the treatment of pediatric osteonecrosis, but in recent years, it is gradually used for the treatment of adult osteonecrosis. Shaping therapy is to reduce the concentration of local stress on the femoral head by abducting and internally rotating the hip joint, so as to shift the stress point of the femoral head and make the necrosis avoid the weight-bearing surface and prevent collapse.
28.What is the anti-Drublin walking gait?
When people walk normally, the femoral head is under pressure in the direction of the femoral head, so the necrotic area of the femoral head is most likely to collapse in this area. After the occurrence of femoral head necrosis, we let the patient walk with both lower limbs fixed in the position of abduction and internal rotation, which is exactly the opposite of Chaplin’s walking gait, we call it “anti Chaplin” walking gait.
29.What is the thin shell theory of femoral head necrosis?
It is generally believed that the thin shell in the thin shell theory is a thin-walled spatial structure with a curved surface, and if the thickness of the shell is much less than the radius of curvature of the shell, it is called a thin shell. The subchondral bone plate of femoral head can meet the conditions of thin shell definition, so the thin shell theory is used in the analysis of femoral head necrosis, forming the thin shell theory of femoral head necrosis.
30.What is the coronary theory of femoral head necrosis?
In the process of femoral head necrosis, the blood vessels supplying the femoral head are blocked, resulting in the reduction of blood supply to the femoral head, which is one of the important factors causing the occurrence of femoral head necrosis, which is similar to the mechanism of coronary heart disease in the process of coronary artery blockage leading to myocardial but snow, so some people put forward the theory of coronary heart disease of femoral head necrosis.
31.How to get out of the misunderstanding of artificial joint awareness?
Artificial joints can relieve pain and correct deformity, we all have a consensus. The difference is that for younger patients, they are afraid to consider arthroplasty because they are afraid of secondary surgery.
If you are 35 years old and in the midst of a prosperous accumulation of wealth and career, do you want to be an invalid who is always in need of care, depleted of family assets and afflicted with disease? Or do you want to take the decisive step of joint replacement to relieve your pain and give yourself at least 20 years to create wealth and enjoy your life?
The value of a person’s life is not only the survival itself, but more importantly the quality of life. It is totally worthwhile to take the risk of surgery and endure the pain caused by the surgery in order to improve the quality of life. Imagine a patient who is completely bedridden and has lost his confidence in life, what is the value of his life if he continues conservative treatment, even if he lives to the age of 100? If the patient is allowed to stay in bed until the age of 60 in order to reduce the number of surgeries, then how much more meaningful is surgery? This is actually a question of cost to benefit ratio. Even after 10 to 20 years, if something goes wrong with the artificial joint, it can still be repaired. In addition, with the development of society and the progress of technology, we have every reason to believe that by that time, the artificial joint technology will be more perfect.
32.What are the factors affecting the service life of artificial total hip joint?
The technology of surgery accounts for 60%, the material of joint prosthesis 30%, and the postoperative rehabilitation and protection of the joint by the patient 10%. If all conditions are perfect, the service life will be longer than expected. Today, new prosthetic materials are available that reduce the wear and tear on the joint and extend the life of the artificial joint even more.