Basics
1.What is ischemic necrosis of the femoral head?
The so-called osteonecrosis refers to the process of interruption of bone tissue nutrition and death of bone cells for various reasons. Osteonecrosis is divided into two categories: one is osteonecrosis caused by bacterial infection, osteomyelitis, bone tuberculosis, etc., which can cause inflammation and necrosis. The other category is osteonecrosis caused by ischemia, necrosis occurs under aseptic conditions, there is called aseptic necrosis, bone ischemic necrosis can occur in many parts, occurring in the femoral head is called ischemic necrosis of the femoral head.
2.What causes ischemic necrosis of the femoral head?
There are many causes of femoral head necrosis, which are summarized into two categories: traumatic and non-traumatic. Traumatic mainly refers to hip fracture and trauma, such as femoral neck fracture, hip dislocation, acetabular fracture, inter-rotor fracture, etc. Non-traumatic mainly includes alcohol, hormone, diving decompression disease, radiation therapy, gout, osteoporosis, etc.
3.How are the clinical symptoms of ischemic necrosis of femoral head?
The disease starts slowly, has a long course, and can be asymptomatic at the early stage of onset. The most common early symptom is mild pain and coldness in the hip, and the pain is aggravated after a long walk, and many patients only feel pain and discomfort in the knee in the early stage, and then the symptoms of the hip appear, and with the prolongation of the disease, the symptoms of claudication appear, and the later stage can be manifested as shortening of the affected limb, muscle atrophy and inability to walk.
4.Can ischemic necrosis of the femoral head be cured?
After years of clinical summary in our department, nearly 1000 cases have been observed, the femoral head necrosis can be clinically cured, but the condition is that different treatment methods must be chosen according to the different stages of femoral head necrosis, and the joint functional exercise must be carried out according to the doctor’s instruction. It is important to note that the shape of the collapsed femoral head cannot be restored to normal.
Treatment
1.What are the treatment methods for ischemic necrosis of the femoral head?
The purpose of treatment is to reduce pain and maintain the function of the hip joint. According to the stage of femoral head necrosis, the pathological changes in each stage have different treatment methods, mainly: conservative treatment and surgical treatment. Surgical treatment includes: drilling and decompression, minimally invasive medullary core decompression and compression implant fibula support and hollow screw stabilization, osteotomy, artificial joint replacement, etc.
2.What is minimally invasive medullary core decompression and compression implant with hollow screw stabilization?
Minimally invasive medullary core decompression and peroneal support with hollow screw stabilization is a method of treating femoral head necrosis created by Dr. Wang Lihe, the deputy chief physician, by synthesizing a variety of hip preservation surgical treatment methods, which has been clinically verified by more than 200 patients in the past 7 years, with an efficiency of 98% and a cure rate of over 90%. This treatment method can effectively prevent the femoral head from collapsing, promote the growth of new bone in the femoral head and promote the repair of necrotic bone.
3.When is minimally invasive medullary core decompression and compression implantation with hollow screw stabilization suitable?
The indications for minimally invasive medullary core decompression and peroneal support with hollow screw stabilization are: early stage of ischemic necrosis of the femoral head (stage I and II), short duration of the disease, the femoral head is still in good shape, and there is no obvious collapse. Relatively young age, generally less than 60 years old. The doctor should decide what is suitable for the surgery according to the specific situation of the patient.
4.What is “duplex therapy” and “triple therapy”?
”Duplex therapy” and “triple therapy” are effective methods of treating femoral head necrosis, which are based on years of clinical experience of the bone and joint disease treatment center of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. It is characterized by the combined application of minimally invasive, Chinese medicine, drilling and decompression treatment methods according to different stages of necrosis. In particular, we have formulated a series of Chinese medicine prescriptions according to the etiology, pathogenesis and classification of the disease. Practice has proved that these two treatment methods for femoral head necrosis can relieve joint pain, improve joint function, increase the treatment rate, repair osteonecrosis, and avoid or delay the artificial joint replacement.
5.Conservative treatment includes those contents?
(1) Pharmacological treatment, according to the TCM diagnosis and typing, a series of Chinese herbal medicines are formulated, and the treatment is carried out through two ways: internal and external. (2) Traction and crutches are used to reduce the pressure on the femoral head, reduce muscle spasm, and provide a good environment to promote the repair of the femoral head. (3) Rehabilitation and exercise therapy, such as massage and guided functional exercises for the hip joint.
6.How can I prevent the femoral head from collapsing?
Avoid or reduce weight-bearing and walk with double crutches.
7.How can patients with ischemic necrosis of the femoral head carry out functional exercises of the hip joint?
(1) Pedal air flexion and extension method: Patients lying on their back, hands on the side of the body, both lower limbs alternately flex the hip and knee, so that the lower leg hangs in the air, like pedaling a bicycle for 5-10 minutes, mainly flexing the hip joint, the amplitude and number of times gradually increase.
(2) Knee hugging method: the patient is in supine position, the injured limb flexes the hip and knee, and holds the proximal front of the lower leg with both hands together, increasing the force and amplitude of hip flexion for 3-5 minutes, the amplitude and number of times gradually increase.
(3) affected limb swing method: supine position, both lower limbs straight, hands on the side of the body, the affected limb straight leg elevation or elevation to a certain degree after doing inward and outward movement.
(4) Internal and external rotation method: supine position, both lower limbs straight, hands on the side of the body, with the heels as the axis, the tips of both feet and lower limbs do internal and external rotation activities for 5-10 minutes, mainly on the functionally restricted side.
(5) Posterior extension method: The patient is in prone position, both lower limbs are straightened, and the affected limbs are posteriorly extended for 5-10 minutes, with the amplitude and frequency gradually increasing.
Joint replacement
1.What is artificial hip arthroplasty?
Artificial joint replacement is a surgical method to replace part or all of the damaged joint by an artificial joint prosthesis.
2.What is the purpose of artificial hip arthroplasty?
To relieve pain. To improve joint function and quality of life.
3.What are the diseases for which artificial hip arthroplasty can be performed?
Artificial hip replacement is feasible for hip joint damage, hip joint pain and loss of function caused by femoral head necrosis, osteoarthritis, ankylosing spondylitis and rheumatoid arthritis. Femoral neck fracture in elderly patients is also feasible. However, whether or not hip replacement is needed must be judged by the doctor according to the surgical indications.
4.After the artificial hip replacement surgery, how many days can I walk on the ground?
Generally speaking, the hip joint with good bone quality and cemented can be walked on the ground three days or more after the surgery, and the time of walking on the ground and the degree of weight bearing are decided by the doctor according to the surgery, the artificial joint fixation method and the patient’s own condition.
5.What should I pay attention to after the artificial hip joint replacement surgery?
(1) The postoperative position should be kept in abducted neutral position, i.e. with the toes pointing upward, and a triangular pillow can be placed between the legs; (2) The joint mobility should not be extremely flexed and the hip joint should not be extremely internally rotated, otherwise it will cause joint dislocation; (3) If you need to lie on your side, the non-operated side should be underneath and a pillow should be used to prevent it from being placed between the legs. (4) When defecating in bed, use a flat bedpan; when defecating on the floor, use a tall toilet.
6.What postures and movements can cause hip dislocation?
The action of excessive hip joint inversion and flexion such as cross-legged, side-lying, crossing legs, sitting on a low stool and squatting can easily cause hip joint dislocation, which should be paid attention to in daily life.
7.How to protect the hip joint after surgery?
After the artificial hip joint surgery, you need to develop good habits of life and activities to maintain the stability of the joint. After surgery, you can ride a bike, walk, dance, swim, play golf, etc., but you should not run, jump and other strenuous sports, long-distance walking, climbing, etc.
8.Do I need regular review after surgery? What conditions should I see the doctor?
Three months after discharge from the hospital, you should go to the hospital to review and take x-ray to understand the position and stability of the joint prosthesis. Six months after surgery, you should have another review, and then you should have a review every year. When there is redness and swelling of the joint, pain, difficulty in movement or injury to the hip joint due to an accident, you should go to the hospital for a review in time.