Femoral head necrosis treatment and rehabilitation knowledge Q&A
Q: Which femoral head necrosis is suitable for conservative treatment?
A: Those who have not yet collapsed and have been confirmed by specialists that collapse may not occur, i.e., stage I and II femoral head necrosis, and the extent of necrosis is small, and the necrotic area deviates from the weight-bearing area below or is located in the center of the femoral head, can be treated conservatively on a trial basis. In addition, conservative treatment can be applied to relieve the symptoms if the systemic condition is not suitable for surgery, such as accompanied by serious medical diseases. The function of the hip joint should be preserved as much as possible.
Q: What are the commonly used conservative treatment methods?
A: The so-called conservative treatment is non-surgical treatment, including drug treatment (internal, external, interventional and other routes), hyperbaric oxygen, electrical stimulation and so on. So far, there is no exact efficacy of Western medicine used in clinical practice. Chinese medicine is the advantage of our country, more research in the past 10 years, and initially showed a unique curative effect on the disease, such as the development of my department, Professor Yuan Hao, etc., the raw pulse into the bone tablets, by tens of thousands of patients, the effect is remarkable, and has won the national patent, and successfully applied for a new drug – Tongluo bone capsule, now by the listed company Haizheng Pharmaceutical production. Hyperbaric oxygen, electrical stimulation and other methods are usually used as an auxiliary treatment.
Q: What are the problems to be noted during the conservative treatment?
A: The repair of femoral head necrosis is very slow, and the course of conservative treatment usually lasts 3—5 years, or even longer, so the following points should be noted during the treatment to ensure the efficacy.
(1) Take the medication as required by the doctor, never intermittently.
(2) Receive regular follow-up visits from the specialist, including blood tests, X-rays and magnetic resonance imaging (MRI) when necessary, and submit the results to the specialist for safe keeping, so as to understand the changes in the condition in time and adjust the treatment measures accordingly.
(3) In order to prevent the femoral head from collapsing, the doctor will ask the patient to hold a double crutch or even sit in a wheelchair, and the patient must cooperate.
Q: Which femoral head necrosis requires surgery?
A: Most of the conservative treatments are not satisfactory for those who have collapsed or are at risk of collapse of femoral head necrosis, i.e., those with stage III or above, stage I or II but with large necrosis and necrosis below the weight-bearing area, need surgery.
Q: What are the commonly used surgical methods?
A: Surgical treatment can be divided into two main categories, namely surgery to preserve one’s own hip joint and artificial hip joint replacement. At present, it is generally believed that it is wise for young and middle-aged patients to choose the surgery that preserves their own hip joints first. The reason is that artificial hip arthroplasty for femoral head necrosis is significantly less effective than other hip diseases, with a shorter maintenance time and more chances of needing revision. The artificial joint revision is not only technically difficult, but also far less effective than the initial replacement, and expensive. Therefore, avoiding or postponing the artificial joint replacement is of great significance to young and middle-aged patients with femoral head necrosis. Of course, if the patient is older and has severe femoral head necrosis, artificial joint replacement can be considered.
There are many surgical methods to preserve one’s own hip joint, and the most reasonable method needs to meet the two requirements of correcting necrosis and correcting or preventing collapse. In addition, the damage should be small and the recovery after surgery should be fast. At the same time, in view of the diverse characteristics of different stages and types of femoral head necrosis, there should be a variety of surgical procedures to choose from, instead of using only a single procedure to treat femoral head necrosis.
The basic principle is to fully resolve the ischemia of the femoral head through vascular grafting to promote the repair of femoral head necrosis, and to correct or prevent various forms of femoral head collapse through various kinds of hematopoietic bone flap implantation. After nearly 20 years of clinical use in nearly 8000 cases, the excellent rate has reached more than 75%, which is at the international advanced level.
In the past five years, our department has been gradually carrying out minimally invasive hip preservation surgery for non-traumatic femoral head necrosis in the peri-collapse period. The main procedures include: (1) modified medullary core decompression, cancellous bone compression graft, free fibula graft, and internal stabilization with hollow compression screws; (2) modified Watson-jones small incision, head and neck cartilage opening, lesion removal, structural bone graft and vascular bundle graft bundle or bone flap graft with vascular tip; (3) tantalum rod internal Stabilization. At present, we have accumulated nearly 600 cases, with an overall excellent rate of over 82%, and for the pre-collapse period, the excellent rate is over 90%.
Q: Why do I need rehabilitation treatment after femoral head necrosis surgery?
A: Strictly speaking, any joint surgery requires appropriate rehabilitation treatment to achieve the maximum ideal result. For a serious joint disease such as femoral head necrosis, and a more complex surgical treatment, post-operative rehabilitation is especially important.
Most of the femoral head necrosis has preoperative hip dysfunction of varying degrees, and surgery can solve or partially solve a series of pathological changes affecting hip function rehabilitation, such as femoral head necrosis, collapse, hyperplasia and deformation, and hip subluxation. However, surgical trauma inevitably increases the difficulty of functional recovery from another perspective, so it is almost impossible to obtain ideal recovery without targeted post-operative rehabilitation treatment.
Rehabilitation treatment has the following main purposes.
1.Promote tissue repair.
2.Maximum restoration of hip joint range of motion.
3.Promote the repair of articular cartilage and promote the relationship between the femoral head and the acetabulum to achieve the best possible match. Prevent or slow down the occurrence of osteoarthritis.
4.Enhance muscle strength and improve gait.
Q: What is the process of post-operative rehabilitation treatment for femoral head necrosis?
A: The post-operative rehabilitation of femoral head necrosis should begin after the elimination of post-operative anesthesia until complete recovery, and can be roughly divided into the following 3 stages.
1, early stage: postoperative to the removal of bone traction, usually 6—8 weeks, the first two weeks for the surgical wound healing stage, on the one hand, to prevent wound infection, on the other hand, the upper body can be made to sit up movement and muscle isometric contraction exercise, to lay the foundation for joint function recovery. In the latter 4—6 weeks, local massage, physiotherapy and external application of traditional Chinese medicine can be used to further reduce the reaction after surgical trauma, while actively practicing sitting up and moving the lower limbs under traction to improve the function of the hip joint and prevent or reduce tissue adhesions.
2.Middle stage: from the 9th week after surgery to about half a year after surgery, that is, remove the bone traction to support double crutches. At this stage, in addition to further passive and active activities of the hip joint, rehabilitation can also be carried out by means of drug fumigation, physical therapy and auxiliary equipment training to achieve basic recovery of hip joint range of motion and muscle strength, so as to prepare for supporting single crutches.
3.Later stage: 7 months to about one year after surgery, mainly to exercise muscle strength training gait, to prepare for the complete abandonment of abduction.
In the above 3 stages, the first two weeks of the early stage should be hospitalized, after 4—6 weeks and the first 4—6 weeks of the middle stage should be carried out to the rehabilitation center for specialized rehabilitation, while the middle stage after 4 – 6 weeks can be carried out at home after rehabilitation.
Of course, the above rehabilitation plan is only for the general situation, because each patient has different etiology, disease duration, condition, age, gender, surgical method, their own rehabilitation ability, etc. Therefore, we must analyze each case specifically, and do different treatment for each person in order to achieve the best rehabilitation effect.
Q: Why should patients with osteonecrosis of the femoral head be reviewed regularly after treatment?
A: Since the repair process of femoral head necrosis is long, there is a possibility of collapse or re-collapse during the repair process. Therefore, whether it is conservative treatment or surgical treatment, regular re-examination is necessary so that doctors can understand the changes in the condition and adjust the treatment and rehabilitation plan accordingly. Usually, after discharge from the hospital, the patient will receive a review at the specialist clinic every 3 months for 2 years, and from the third year onwards, the review can be done once every 6 months, and after 5 years, once a year, and on and on. If foreign patients are not in a position to come to Guangzhou for review, they should go to the local hospital photos regularly and send them to the hip center in the form of registered mail (not in the form of parcels), and they should leave their permanent mailing address, postal code and telephone number to the doctor during their hospitalization, and when the mailing address, postal code and telephone number change, they should notify the doctor in time so that the doctor can write to them for review or ask for review by telephone to ensure that your hip joint can You should inform your physician of any changes in your mailing address, postal code or telephone number so that he or she can review your hip by letter or telephone to ensure that you are receiving the best possible use of your hip or timely and correct treatment.