At present, in the field of orthopedics, osteonecrosis of the femoral head is one of the diseases most known to the general public. The reasons for this are, of course, related to the characteristics of the disease itself, such as
1, femoral head necrosis is a progressive disease, if left untreated, it will eventually lead to the complete destruction of the hip joint, seriously affecting the patient’s joint function and quality of life, making him/her lose the ability to work and even unable to take care of himself/herself.
2, because the age of onset of femoral head necrosis is usually very young, generally between 20 and 50 years old, when the patient is rich and strong, the patient is the main labor force and pillar of the family, so this disease will have a huge impact on the patient, family and society.
3. There is no ideal and effective treatment for femoral head necrosis, and many patients will eventually undergo joint replacement treatment, which is less accepted by this group of young patients because of its service life. It is for these reasons that osteonecrosis of the femoral head has become a common concern.
It is good for a disease to be taken seriously for early diagnosis and early treatment. However, we find that there is an excessive fear of osteonecrosis of the femur. Many patients and families feel that the sky is falling when they hear the diagnosis of osteonecrosis of the femoral head. Many outpatients hear that the head of the femur is necrotic and immediately feel as if they cannot go on with their lives. Due to fear, many patients go around seeking medical treatment, do not believe in the treatment recommendations of doctors in regular hospitals, and try various treatment methods indiscriminately with the mentality that a dead horse is a living horse, especially some fabulous methods that are advertised, which not only delay the correct treatment of the disease, but also lead to some results that should not happen, such as increased costs and wrong medication. On the contrary, as long as the doctor informs that it is not osteonecrosis of the femoral head, regardless of the diagnosis of the disease (some diseases are more difficult to deal with than osteonecrosis of the femoral head, such as ankylosing spondylitis, rheumatoid arthritis, etc.), some patients immediately rejoice and no longer have a very worried feeling, creating a misconception of contempt for the treatment of the disease.
Why does this phenomenon occur. I think it is related to the large amount of inappropriate propaganda and unregulated diagnostic treatment. There is no particularly effective treatment for femoral head necrosis, especially no effective way to control femoral head collapse. Therefore, there are many informal treatment methods, which usually exaggerate the serious consequences of femoral head necrosis, while claiming that their methods can cure femoral head necrosis without surgery or incision, soliciting patients and grabbing huge profits through such means. In essence, these methods have neither a scientific theoretical basis nor scientific verification. They often cost patients a lot of money and delay the diagnosis and treatment of the disease. For example, many diseases that are not osteonecrosis of the femoral head are diagnosed as osteonecrosis of the femoral head and treated inappropriately for a long time; osteonecrosis of the femoral head is treated ineffectively for a long time, etc. In the process of treating osteonecrosis of the femoral head, we often see this phenomenon: the patient goes around to seek medical help and spends a lot of money, but eventually the femoral head collapses and forms osteoarthritis, requiring joint replacement treatment, but the patient cannot afford the cost of joint replacement because the initial treatment has already cost a lot of money.
Therefore, it is necessary to standardize the diagnosis and treatment of osteonecrosis of the femoral head.
The following aspects of the diagnosis and treatment of femoral head necrosis are currently more confusing.
First, the prevention of femoral head necrosis femoral head necrosis pathogenesis, although still unclear, but its causative factors are more clear. The two most common causes are hormone application and excessive alcohol consumption.
There are some diseases such as rheumatoid, lupus erythematosus, etc. that really need hormone therapy, and the monitoring of such high-risk groups should be strengthened to strive for early diagnosis and early treatment to avoid femoral head collapse as much as possible. However, it should be noted that hormone abuse is still serious, such as using hormones to relieve pain or mixing hormones in drugs to show their efficacy, etc. This should be monitored more closely.
Alcoholism is the most common cause of femoral head necrosis in China, which should be taken seriously by vigorously promoting the dangers of alcohol consumption and educating people not to abuse alcohol for a long time.
Doing well in these two aspects will have a great effect on reducing the incidence of necrosis of the femoral head.
Second, early and correct diagnosis diagnosis of femoral head necrosis should be both correct and early.
When femoral head necrosis develops to the stage of collapse, the best stage to preserve the femoral head is missed. Therefore, early diagnosis is very necessary. At present, there are MRI, nuclear scan and other means, early diagnosis of femoral head necrosis is not difficult, the focus is that when the patient has symptoms of hip pain and discomfort, should be carefully examined, carefully analyzed, and through appropriate examination to determine or exclude femoral head necrosis. Among them, careful physical examination is very important. In clinical practice, we often see patients with osteonecrosis of the femoral head misdiagnosed as lumbar disc herniation and lumbar muscle strain because the doctor did not conduct careful physical examination. Some patients even underwent lumbar spine surgery for this reason, which delayed the correct treatment. If the doctor who initially received the patient could have examined the patient carefully, it should have been easy to detect the abnormal function of the hip joint and avoid misdiagnosis, which is directly related to the carelessness of the clinician and the lack of careful examination.
It is also important to note that the diagnosis of femoral head necrosis should also be correct. At present, there is a tendency to diagnose femoral head necrosis regardless of the type of hip joint disease. Clinically, we find that diseases that are misdiagnosed as femoral head necrosis usually include: arthritis due to acetabular dysplasia, ankylosing spondylitis, rheumatoid joints, sequelae of trauma, sequelae of infection, etc., to name a few. Some doctors simply give the diagnosis of femoral head necrosis when they see abnormalities in the hip joint without carefully analyzing the X-rays, which sometimes leads to patients undergoing a long period of wrong treatment. The differential diagnosis of the above-mentioned misdiagnosed diseases and femoral head necrosis is not difficult, as long as more study, careful questioning of the medical history, careful study of the imaging data, aided by some simple tests, usually can obtain the correct diagnosis.
Third, the correct choice of early treatment method so-called early treatment is to treat the articular cartilage before it collapses, the purpose of which is to be able to delay or stop the progress of the disease process before the subchondral bone collapses, and also has the effect of relieving the symptoms.
There are many treatments that claim to be effective whose efficacy is evaluated by the patient’s lack of pain, which is somewhat misleading. We know that during the natural progression of femoral head necrosis, pain usually decreases after collapse, lasts for an unequal period of time, and reappears when osteoarthritis develops, and this pain gradually worsens and cannot be relieved. Therefore the so-called effectiveness of many conservative treatments is nothing more than a stage in the natural progression of the disease process and does not have any effect at all on the progression of the disease or the relief of symptoms.
The correct choice of early treatment requires correct and accurate staging of the patient. Make sure that the patient’s femoral head necrosis has not progressed to an advanced stage (collapse stage), because progressive osteoarthritis is irreversible once subchondral bone collapse and loss of joint space has occurred.
There are no very effective methods to stop the progression of osteonecrosis before subchondral bone collapse or to slow down the destruction of the femoral head and hip degeneration after subchondral bone collapse. Commonly used methods with proven efficacy in early femoral head necrosis include: drilling and decompression, bone grafting (mainly fibular bone grafting with blood vessels), and rotational osteotomy. The results reported in the literature for these methods vary widely. However, there are still indications for selecting appropriate patients for these treatments.
Recent studies including BMP implantation, bone marrow stromal stem cell implantation, metal tantalum rod implantation of bone trabeculae, and memory alloy metal tennis ball implantation also offer new hope for early treatment, but their effectiveness remains to be confirmed by more in-depth studies.
Although some studies have suggested that alendronate has a certain effect on inhibiting the development of femoral head necrosis, it is still not very certain.
Early treatment of femoral head necrosis depends on early diagnosis and correct staging, and at the same time, the method with more definite efficacy should be selected to avoid unnecessary treatment of patients.
Fourth, the correct treatment and selection of arthroplasty due to joint replacement surgery is expensive, requires surgery, has a service life, may appear complications and other reasons.
Many patients are afraid of this and are reluctant to undergo joint replacement treatment. From the current results, it seems that joint replacement surgery is still the most effective way to treat advanced femoral head necrosis.
First of all, the fears and misconceptions about joint replacement should be eliminated. Clinical results prove that arthroplasty can effectively relieve pain, improve joint function, and enhance patients’ quality of life.
However, it should be noted that joint replacement for femoral head necrosis has special features that distinguish it from other joint replacements: the patient is young, has a long life expectancy, is active, and the patient’s underlying diseases affect the quality of bone, such as rheumatoid and lupus erythematosus, while the use of hormones for the treatment of these diseases also affects the quality of bone, and the consumption of alcohol can cause damage to bone quality. Therefore, it has an impact on the fixation of the prosthesis, whether cemented or uncemented. The results of early clinical applications proved that the service life of joint replacement in patients with osteonecrosis of the femoral head is lower than that of osteoarthritis. Therefore, it should be done as late as possible in the selection of indications.
However, if advanced osteonecrosis has seriously affected the patient’s quality of life, it should not be delayed indefinitely. New cementing techniques, new non-cemented prostheses and new articular surfaces are now available to extend the service life of the joint and should allow appropriate advancement of the operation, but strict limitation of indications is still necessary.
Options for joint replacement include: surface replacement, hemiarthroplasty, and total hip replacement. The hemiarthroplasty is not used as much as possible, and the surface replacement can be applied with careful patient selection but without blindly expanding the indications.
Total hip replacement is suitable for the majority of patients, but the traditional joint surface matching long-term in situ rate is not very satisfactory. The selection of new joint surfaces such as ceramic, metal, and ultra-high cross-linked polyethylene is expected to improve long-term service life.
In general, the diagnosis and treatment of osteonecrosis of the femoral head still needs a lot of in-depth research and urgent solutions. However, if doctors fail to standardize its diagnosis and treatment, it is bound to bring unnecessary harm and loss to patients. Therefore, it is very important to standardize the diagnosis and treatment of osteonecrosis of the femoral head.