News has confirmed that singer Liu Huan underwent surgery for femoral head necrosis. After the news came out, many people became interested in this disease. What kind of disease is osteonecrosis of the femur? Why did it come to the “good man” Liu Huan? What are the ways to effectively prevent it in daily life? For this reason, we selected some questions of interest to our readers and asked orthopedic experts to answer them for us. Q: What is femoral head necrosis? What are the characteristics of its development? A: The femoral head is a component of the hip joint and is spherical in appearance, named “femoral head” because it is the “head” of the femur. Femoral head necrosis, also known as “ischemic necrosis of the femoral head”, is a pathological process that affects the blood supply to the femoral head for various reasons, leading to the degeneration and necrosis of the bones, and eventually leading to the destruction of the structure of the bones. According to statistics, the number of new cases of femoral head necrosis in China is between 150,000 and 200,000 every year. In the United States and other developed countries, the number of new cases is much less, about 10,000-20,000 cases per year. The age of prevalence is between 30 and 50 years old, and the ratio of men to women is about 7:3. 5-12% of the patients who undergo artificial hip replacement each year are patients with osteonecrosis of the femoral head. Femoral head osteonecrosis causes severe hip pain and restriction of joint movement, ranging from limping in mild cases to complete loss of walking function in severe cases. As the age of onset of femoral head necrosis is relatively young, and most of them are young and strong men, the disability seriously affects the quality of life and working ability of patients, which makes families bear a great economic burden, and some families even lose their economic resources, resulting in poverty due to the disease and return to poverty due to the disease. Q: What exactly causes osteonecrosis of the femoral head? A: The direct cause of femoral head necrosis is the destruction of the blood supply to the femoral head. Trauma, long-term heavy alcohol consumption and the application of corticosteroids are the most common causative factors in clinical practice. Other diseases such as hemophilia and other blood disorders, ulcerative colitis and other digestive diseases, and endocrine disorders such as hyperthyroidism can also directly or indirectly affect the blood supply to the femoral head, which in turn leads to femoral head necrosis. In addition, smoking, radiation exposure, decompression sickness of diving staff, and hemodialysis are all high-risk factors. Therefore, all of the above groups should be alerted to the occurrence of osteonecrosis of the femoral head. Q: What are the specific early clinical manifestations of femoral head necrosis? A: The early manifestation of femoral head necrosis is mainly hip joint pain and discomfort, sometimes intermittent pain. The pain is mostly vague and dull, and radiates to the groin area, the back of the hip or the inside of the knee. The pain is obvious when moving and relieved after resting; the hip joint is stiff, weak, and limited in mobility; the leg is inflexible, and it is difficult to lift the leg, cross the leg, skim the leg outward, and squat; the affected limb does not dare to put weight on it when walking, which is manifested as limping. If you have a history of trauma such as hip fracture, dislocation or sprain, or if you have used a lot of hormones for a long time or a short time, or if you often drink a lot of alcohol, and you have the hip pain described above, it is possible that you are suffering from femoral head necrosis, and you need more careful clinical observation and examination to exclude or confirm the diagnosis. Q: How can early diagnosis be made? A: Usually in early stage of femoral head necrosis, it is difficult to make a clear diagnosis through physical examination and plain X-ray examination only because the lesion is mild. And early diagnosis is crucial for the treatment of femoral head necrosis. Doctors may recommend an MRI or isotope scan examination. In general, MRI or isotope scan can detect possible femoral head necrosis at least six months earlier than plain X-ray, and MRI is more significant than isotope scan for the diagnosis of necrosis. Due to the limitation of medical development, it is difficult for doctors to make correct judgment in time for early stage of femoral head necrosis. For those patients with high suspicion of femoral head necrosis but lack of objective clinical evidence, a period of careful clinical observation and follow-up is required. During this process, doctors usually advise patients to change their lifestyle, reduce weight bearing on the affected hip, apply some preventive drugs to improve blood rheology, and perform relevant imaging examinations regularly. This process is very important for early detection and exclusion of femoral head necrosis, and requires good communication and cooperation between patients and doctors. In addition, there are many cases of osteonecrosis of the femoral head that are usually bilateral. Statistics show that 72% of patients initially diagnosed with unilateral femoral head necrosis had necrosis found in the opposite femoral head over the next 2 years. Therefore, patients who have been diagnosed with osteonecrosis on one side should be closely monitored clinically and followed up. Q: How to prevent it effectively? A: For the main causes of femoral head necrosis, the main preventive measures in daily life include: avoiding trauma, being aware of self-protection in daily life; promoting less or no alcohol consumption in life, avoiding alcohol abuse; and trying to avoid inappropriate use of hormonal drugs. Doing the above, many of the femoral head necrosis can be avoided. In addition, proper weight control is needed. Excessive obesity and high blood lipids are also risk factors for osteonecrosis of the femur. For some high-risk groups, such as patients who have to apply hormonal drugs because of other diseases, and divers, regular medical observation is required. Q: What are the effective treatments for osteonecrosis of the femoral head? A: There are different treatment options for patients depending on their age, occupation, lifestyle and the degree of femoral head necrosis. Conservative treatment, hip preservation surgery and artificial hip replacement each have their own indications and can help most patients get rid of the disease and return to normal life and work. Early stage patients At this time, necrosis has not really formed yet, so you can avoid strenuous activities, long hours or long distance walking by taking proper rest and changing your lifestyle. At the same time, appropriate application of drugs to help relieve pain, as well as physical therapy to relieve pain and the progression of the disease. In terms of surgical treatment, drill decompression has proven to be an effective method to alter the local environment and halt the progression of the disease. In cases where necrosis is already evident and there is a deformation or localized collapse of the femoral head on radiographs, simple drilling and decompression therapy is less effective. Young adult patients It is very smart to remove localized necrotic bone and implant normal cancellous bone in the defective space and try to provide blood supply to the reconstructed area. Examples of such techniques are iliac bone block grafting with anastomosis, fibula grafting, and musculoskeletal flap grafting. The disadvantage is that the surgery is more invasive and requires good repair and regeneration ability of the patient, so it is not suitable for older patients, such as those over 45 years of age who have a higher failure rate. Patients who are slightly older and have a small necrotic area – surgical treatment for hip preservation such as metal built-in support and implantation of normal cancellous bone in the space after removal of dead bone, as well as drilling and decompression with tantalum rod implant can be considered. At this age, osteotomy orthopedic surgery can also be considered to get the purpose of reducing pain and slowing down the progression of the disease by changing the position of the femoral head and reducing the load on the already necrotic area. However, these methods are difficult to completely avoid the possibility of further development of necrosis into advanced collapse, but they can improve clinical symptoms and slow down the disease progression for a certain period of time, and buy valuable time for artificial joint replacement. Of course, artificial joint replacement can be considered for patients with severe pain, severely limited function, and high requirements for joint function recovery. Advanced patients Artificial joint replacement has been proven to be an effective treatment for end-stage hip diseases including femoral head necrosis, which can effectively relieve pain while maximizing the restoration of joint mobility and improving the quality of life of patients, helping them return to normal life and work. The key problem with joint replacement is that joint prostheses always have a certain life span. According to clinical studies, the average service life of artificial hip prostheses is 15-20 years. Therefore, in general, the clinical tendency is to choose artificial joint replacement for people over 60 years of age. Of course, with the maturity of surgical techniques, advances in prosthesis design and material science, the service life of artificial hip joints has been greatly improved. Some relatively young patients are increasingly inclined to choose this treatment option in order to obtain a better quality of life. In addition, for younger patients with severe osteonecrosis, the femoral head has collapsed and deformed to form severe arthritic symptoms, and there are still serious problems with conservative treatment or other hip preservation treatments, this treatment option is also used clinically. In conclusion, femoral head necrosis is not terrible, it can be prevented and treated. For people at high risk, the incidence can usually be reduced if proper preventive measures are actively taken to prevent the problem before it occurs. For patients with high suspicion of femoral head necrosis, early diagnosis is crucial, and early and aggressive treatment can significantly improve the quality of life of patients, while for patients with advanced femoral head necrosis, artificial hip replacement surgery can also achieve good treatment results.