Treatment of Femoral Head Necrosis

  According to the common Ficat staging of femoral head necrosis, stage 0 means: there is cytological osteoclastic necrosis, but no pain, no lesion is seen on X-ray, this stage rarely attracts patients’ attention; stage 1 means: there is pain and other symptoms, no obvious lesion on X-ray, at this time it may be found by MRI; stage 2 means: there is pain and other symptoms, and cystic necrosis of the femoral head is seen on X-ray. Stage 3 refers to the enlargement and connection of the necrotic cystic lesion on X-ray, forming a large “crescent-shaped” lesion under the joint surface of the femoral head, at which time the mechanical strength of the femoral head has been significantly reduced and the pain symptoms have increased, even affecting the rotational movement of the hip joint.  Stage 4 refers to the collapse, deformation and cartilage debridement of the femoral head under the pressure of weight-bearing and walking, but the clearance of the hip joint is not yet affected. On the basis of stage 4, the deformed femoral head rubs severely on the cartilage on the acetabular side, resulting in the wear and tear of the cartilage on the acetabular side, the narrowing of the joint space seen on X-ray, and even the appearance of cystic lesions in the bone on the acetabular side, with severe pain in this stage, the patient’s joint basically unable to move, muscle atrophy, shortening of the lower limb compared with the opposite side, and contracture of the ligaments around the hip joint.  Femoral head necrosis is an incurable disease, and the treatment is mainly related to the stage of the lesion. Early stage treatment is more effective, while later stage can only be done basically by joint replacement surgery.  In early stages (0-2), bone flap transplantation with vascular tips, bone drilling and decompression of the femoral head, and autologous bone grafting can be used to slow down the progress of femoral head necrosis, and even stop the development of femoral head necrosis if the effect is good. The effect of these surgeries was found to be very poor. Eventually, stage 4 and 5 can only be replaced by joint replacement. Joint replacement is an effective method to solve the pain and joint movement disorders caused by late stage femoral head necrosis, but because the artificial joint is like an artificial part, it will wear out and its service life is about 15 years (the more expensive ceramic to ceramic type joint can extend the service life of the artificial joint), so when the artificial joint wears out to the extent that it cannot be used, it needs to do a revision surgery, which is more expensive and the service life of the repaired joint is shorter. The life span of the joint is even shorter.