Femoral head necrosis is mostly known as ischemic necrosis of the femoral head or aseptic necrosis of the femoral head because the main pathology is the head bone ischemia caused by the obstruction of blood flow to the femoral head and its destruction.
Why do you get osteonecrosis of the femoral head?
The common causes of femoral head necrosis are.
1, traumatic femoral head necrosis. Such as external impact caused by femoral neck fracture, hip dislocation, hip joint sprain and contusion, etc.
2, drug-related femoral head necrosis. Long-term use of hormonal drugs, resulting in the accumulation of hormones in the body and the onset.
3, alcoholic osteonecrosis of the femoral head. The accumulation of alcohol in the body due to long-term heavy drinking, resulting in increased blood lipids and damage to liver function. Elevated blood lipids, resulting in increased blood viscosity, slowing blood flow, blood coagulation changes, and thus can block blood vessels, bleeding or fat embolism, resulting in osteonecrosis.
Second, how to diagnose femoral head necrosis?
1.Symptoms
(1) pain: pain can be intermittent or continuous, aggravated by walking activities, sometimes rest pain. The pain is mostly pins and needles, dull pain or soreness and discomfort, often radiating to the groin area, inner thigh, posterior hip and medial knee, with numbness in the area.
(2) Joint stiffness and restricted movement: the affected hip joint has unfavorable flexion and extension, difficulty in squatting, inability to stand for a long time, and duck walk. The early symptoms are limited abduction and external rotation activities.
(3) Claudication: Progressive shortening claudication, due to hip pain and femoral head collapse, or late onset of hip subluxation. Intermittent claudication often occurs in the early stage, and is more obvious in children.
2.Imaging examination
X-rays, CT, MRI and other imaging examinations.
Third, what is the harm of femoral head necrosis?
Since femoral head necrosis is a complex pathological process, if early treatment is not timely and effective, it will cause the femoral head to collapse, narrow the joint space, and finally lead to osteoarthritis, making the patient disabled and paralyzed due to hip joint dysfunction. While suffering from physical pain, patients also suffer from psychological trauma, which adds a heavy burden to the family, unit and society.
How to prevent femoral head necrosis?
1. Be careful of falls, especially in winter when walking on snow and ice, pay attention to prevent slipping and falling.
2.Before sports, prepare the hip well, feel the body warm and the limbs flexible.
3, hip injuries should be treated in a timely manner, do not walk too much before the injury is healed, so as not to repeatedly damage the hip joint.
4, in the treatment of certain diseases, especially some painful diseases, try not to use or use less hormone drugs. If you have to apply hormones for related diseases, you should master the principle of short-term and moderate amount, and cooperate with vasodilators, vitamin D, calcium, etc. Do not abuse hormone drugs without listening to medical advice.
5, do not develop a long-term problem of drinking large amounts of alcohol.
6.For femoral neck fracture, seek immediate medical attention and prevent osteonecrosis through appropriate treatment. Regular follow-up should be conducted after surgery, and appropriate oral herbal medicines and calcium supplements to promote blood flow should be taken to prevent the occurrence of ischemic femoral head.
7. Occupational factors such as deep-water divers, high-altitude pilots, and people in high-pressure working environments should pay attention to labor protection and improve working conditions, and those who have fallen ill should change their job type and seek timely medical treatment.
V. How to do if you have femoral head necrosis?
1.Conservative treatment
Conservative treatment is mainly adapted to the early patients with undeformed femoral head, and its methods include.
(1) reduce the amount of hormones as much as possible.
(2) restrict weight bearing, bed rest plus traction, hip herringbone cast fixation, etc.
(3) Prevention and control of osteoporosis. (3) prevention and control of osteoporosis. Adequate supplementation of calcium and vitamin D, use of some drugs for osteoporosis such as calcitonin or alendronate, etc.
(4) Lipid-lowering drugs and anticoagulants. Some studies have reported that the use of hormones in combination with statins can prevent the occurrence of osteonecrosis.
(5) Physical therapy. Mainly through the thermal effect or mechanical stress, improve local blood circulation. Physiotherapy includes shock wave, ultrashort wave, fractional meter wave, electrical stimulation and other treatment methods.
(6) Interventional therapy. Interventional therapy is the injection of drugs directly into the blood supply artery of the femoral head, or intubation and perfusion with the injection of bone growth promoters in the local necrotic area, in order to improve the local blood supply, promote the growth of new bone and repair the necrotic femoral head.
(7) Hyperbaric oxygen therapy. By increasing the partial pressure of blood oxygen, improve the lack of oxygen in bone cells to promote the repair of the femoral head.
2.Surgical treatment
Surgical treatment is the main method for the treatment of ischemic necrosis of the femoral head.
(1) marrow core decompression + fibula grafting: it not only removes the necrotic bone but also reduces the intraosseous pressure, and at the same time provides limited mechanical support, which is suitable for the early stage, when the femoral head is still not collapsed.
(2) Total hip arthroplasty: Patients with ischemic necrosis of the femoral head, whose condition has progressed to an advanced stage, with severe destruction of the acetabulum and femoral head and serious joint dysfunction, must undergo total hip arthroplasty. For patients who have the conditions, it is recommended to use ceramic interface hip joints to achieve the purpose of reducing prosthetic reaction and wear and tear, which is applicable to patients with advanced stage.
V. What do I need to pay attention to after hip arthroplasty?
If the affected limb is excessively externally or internally rotated after hip surgery, joint dislocation may occur. The correct sleeping posture is to separate the legs properly with the toes pointing upward to prevent dislocation. At this time, your artificial hip joint should be able to be straightened and flexed 70 degrees, and can be properly abducted, and you can walk with a walker.
The correct lateral position, with the healthy side underneath and a pillow between your legs. Usually you will be able to walk without crutches 10 weeks after the joint replacement and you will be able to perform most daily activities, including using a commode, sitting in a chair, walking, biking, dancing, and swimming. You should not squat in a potty, sit on a low stool, do low and soft sofas, kneel, sit cross-legged, or cross your legs. Also be careful not to bend excessively to pick up things, do not lie with the affected limb on the lower side within 3 months, and the healthy limb should be between the lower legs when lying on the side with a pillow.