Reader inquiry 1: Recently, I saw an advertisement for the treatment of osteonecrosis of the femoral head, claiming that it advocates the treatment of osteonecrosis of the femoral head without surgery, without hospitalization, without crutches, without fear of weight-bearing exercise, and without contraindication of taking medication. Its treatment method is to use the ancestral secret agent containing a variety of traditional Chinese medicine, and the treatment of three to four courses of film shows that the new bone cells are fully regenerated, and the treatment time of most patients does not exceed one year. It is very well said, I wonder if it is credible? Answer: The earliest article describing the disease of femoral head necrosis was published in the English literature in 1948, and the disease began to receive widespread attention in the early 1960s, with more relevant English literature reporting on the situation. In China, the recognition and attention to this disease may be more recent. The understanding of this disease was based on X-rays, and later on magnetic resonance imaging (MRI) and isotope bone scans were added, which are very modern and should not be available in traditional Chinese medicine. So I don’t know from which generation this “ancestral” tradition was passed down. The treatment of femoral head necrosis is usually based on the extent of the lesion to determine the appropriate treatment plan. Conservative treatment without surgery is generally only indicated for very early lesions, where the extent of necrosis is small and the joint surface has not collapsed significantly. For patients with more obvious collapse of the joint surface or a larger lesion, surgery is the best option. As you can see, the treatment of femoral head necrosis is the same as any other disease, and the staging of the disease is the basis of the treatment plan, so patients are advised to be careful with those “cure-all” type advertisements. Reader inquiry 2: I saw a medical institution introducing the new technology of bone marrow stem cell implantation to treat osteonecrosis of the femoral head, combined with medication and other therapies, saying that this is an advanced treatment method with good results. Is this treatment mature? Which hospitals carry out this treatment? Answer: Bone marrow stem cell transplantation used to be very hot in the past few years, and all kinds of diseases could be treated with stem cells, but the fever has come down in the past two years. Our health department has not yet approved stem cell transplantation as an official clinical procedure to treat femoral head necrosis, so if there are still hospitals performing this procedure, it should still be in the clinical trial stage, requiring strict ethical approval and informed consent from patients. As with all other conservative or head-preserving treatments, stem cell transplantation for osteonecrosis has its own strict indications and is only indicated for patients in the early stages. Moreover, the isolation and proliferation of stem cells require strict laboratory conditions. It is evident that one has to be a mega university hospital to be able to still maintain such a research program. Reader inquiry 3: One institution claims to have expertise in the treatment of femoral head necrosis, and they use electromagnetic therapy, which uses electric and magnetic therapy in the hip joint locally or at the corresponding acupuncture points to achieve a cure. Is this therapy worth a try? Answer: Electromagnetic therapy for femoral head necrosis was reported in the literature in the 1980s, but the U.S. Drug and Food Administration (FDA) has not approved its official clinical application, so it has been dormant for many years. In recent years, there seems to be a resurgence of this treatment, especially in China, probably due to improvements in many parameters of electrotherapy and magnetotherapy, although clear evidence of its effectiveness is still lacking. It is recommended that the indications for its use should be more strictly controlled, and it may be possible to try it in early stage patients, where the femoral head is not significantly collapsed and the necrosis is small, because in the end, the effectiveness of most of the various conservative treatments is very low. Reader inquiry 4: I saw that the treatment of femoral head necrosis with herbal compresses and baths is effective. Can this really cure the disease? Answer: The expression “effective” is actually very vague. Many patients find that they can find many institutions or individuals who claim to have a unique method of treating or even curing osteonecrosis of the femoral head. However, it should be clarified that the more methods there are for treating a disease, the more difficult it is to treat, and the more it is clear that none of the methods have a definite effect, because only one method is needed to eliminate the others. As mentioned earlier, the indications for conservative treatment of femoral head necrosis are quite limited, because most patients may not care about the mild to moderate pain in the hip at first, and by the time they are diagnosed, they are already accompanied by the collapse of the femoral head, and there are few patients in the really early stage. And in the early stage patients, the true effectiveness of various conservative treatment methods are very limited. Moreover, momentary pain relief and long-term disease stabilization and functional recovery are completely different things.