First, the misconception: necrosis of the femoral head is “immortal cancer” There is a folk saying that necrosis of the femoral head is “immortal cancer”, incurable, some patients are convinced of this, thus creating fear, the disease has not yet been treated that lost the confidence to overcome the disease Some patients are so convinced of this that they become fearful and lose confidence in overcoming the disease before it is cured, and then they blindly believe in all kinds of ancestral recipes and special treatment methods. On the contrary, another understanding is that the incidence of femoral head necrosis is very low, the general public will not get this disease, and therefore have hip pain is not early to the hospital serious examination and treatment. According to incomplete statistics, there are about 30 million people suffering from this disease worldwide, about 4 million in China, and in the United States and Western Europe, there are more than 100,000 new patients with this disease every year. So what is osteonecrosis of the femur? What kind of people are vulnerable to femoral head necrosis? 1, long-term use of glucocorticoid patients: with the widespread use of hormonal drugs in clinical practice, the number of cases of combined hormonal necrosis of the femoral head is increasing, and there are reports of patients who ingest a total dose of more than 200mg of prednisone, the incidence of necrosis of the femoral head is significantly higher. 2, long-term heavy drinkers: drinking can cause femoral head necrosis, probably the first time you heard of it, right? But it is true. From a Japanese research study, it was found that femoral head necrosis is related to the amount of alcohol intake. They found that those who took more than 3,200 grams of alcohol per year, or more than 320 grams of alcohol per week for 10 years, had a significantly higher incidence of femoral necrosis. 3, a history of hip trauma: various causes of femoral neck fracture, hip dislocation and injury around the hip joint can make the blood supply to the femoral head is damaged and secondary to the necrosis of the femoral head. The incidence of femoral head necrosis due to femoral neck fracture is the highest, accounting for about 30% of such fractures. The rate of ischemic necrosis of the femoral head caused by femoral neck fracture in young adults is significantly higher than that of the elderly group. 4, other: diving, flight personnel, obesity, hypertension, diabetes, atherosclerosis, gout, those who need to receive radiotherapy, after burns, hemoglobinopathies, etc., are also at high risk of femoral head necrosis. Second, the diagnosis of misunderstanding: hip pain is mostly femoral head necrosis: Femoral head necrosis is also a kind of invalid disease, mostly seen in young and middle-aged patients, in the early stage of the disease can be asymptomatic or feel hip pain after activity, mostly in the inner thigh root; late in the course of the disease can be manifested as persistent hip pain, limiting the movement of the hip joint, causing severe disability and loss of ability to work. Therefore, early diagnosis and early treatment of femoral head necrosis are extremely important. In fact, there are many diseases that cause hip pain, and not all hip pains are osteonecrosis of the femoral head, and even some primary care doctors may misdiagnose some patients with hip pain as osteonecrosis of the femoral head. In my clinical work, I often encounter some patients with hip osteoarthritis, rheumatoid arthritis and ankylosing spondylitis in the field who are misdiagnosed as osteonecrosis of the femoral head. In fact, these are two completely different diseases, the former is mainly joint surface destruction, the course of the disease from the surface to the inside, while the femoral head necrosis is the subchondral bone necrosis in the joint first, the course of the disease from the inside to the surface. In the early stage of osteonecrosis, the head of femur may even show only knee pain but not hip pain, so once hip and knee pain is found, it is necessary to go to a regular hospital for examination. The most common auxiliary examination means to diagnose femoral head necrosis is X-ray examination, most of the femoral head necrosis can be diagnosed through X-ray examination, but the X-ray performance often lags behind, that is, when the bone tissue occurs obvious necrosis and repair response, the X-ray can show, therefore, the most sensitive and reliable means of early diagnosis is magnetic resonance imaging (MRI) examination. Third, the treatment of misconceptions: necrosis of the femoral head there are always special drugs or methods of treatment of necrosis of the femoral head is often related to the course of its disease, in general, the earlier the diagnosis, the earlier the effect of treatment, the better. But there is not a special treatment or special drugs can cure all of the necrosis of the femoral head. Because the treatment of osteonecrosis of the femoral head is still controversial, there are many false advertisements that take advantage of patients’ eagerness to cure the disease and exaggerate the treatment effect, which not only cheats patients’ money, but also delays the timely treatment of the disease. In fact, patients in the early stage, we can use conservative treatment, the most important of which is to reduce the amount of weight-bearing activities, which is very critical, femoral head necrosis is a self-healing disease, that is, the development of the disease process to the final necrosis and repair process terminated, since the self-healing, and how will lead to loss of hip function and disability? In fact, the most crucial thing here is that femoral head necrosis causes a decrease in the strength of bone tissue support and the collapse of subchondral bone fractures, therefore, this determines that the early treatment is mainly to reduce weight bearing and prevent the collapse of femoral head necrosis, collapse is also a watershed in the change of symptoms, patients often suddenly feel increased pain, and the pain is not relieved by medication as it was in the past. Other treatments include non-steroidal anti-inflammatory drugs (e.g., fenbid, mobicort, etc.) and lipid scavengers (e.g., lovastatin, clofibrate) therapy, herbal medicines to invigorate blood and bone, and hyperbaric oxygen therapy, combined with regular x-rays to observe the progression of the disease. If conservative treatment is ineffective and signs of progressive disease development are found, some surgical interventions are needed. 1.Marrow core decompression surgery: It is currently believed that the increased pressure in the marrow cavity of the femoral head is one of the pathogenesis of femoral head necrosis, and drilling in the marrow cavity of the femoral head is conducive to relieving the high-pressure state in the femoral head. This procedure is generally used to treat early cases of femoral head necrosis (no obvious necrotic bone formation and no femoral head collapse), but the safety and effectiveness of medullary core decompression has been debated. Current studies suggest that medullary core decompression alone provides significant relief of hip pain arising from early femoral head necrosis, but is not effective in preventing femoral head collapse. Therefore, some scholars are currently performing bone grafting after marrow core decompression to prevent femoral head collapse and have achieved certain clinical results. 2. Necrotic bone removal + bone graft with blood vessels: This surgical method is mainly for patients who have produced obvious necrotic bone in the femoral head but the femoral head is not collapsed or slightly collapsed. The main purpose is to remove the necrotic bone to relieve pain and to prevent collapse of the femoral head and repair the bone in the area of femoral head necrosis through bone grafting and bone grafting with blood vessels. There are many types of vascularized bone grafts, but the most recognized technique is the use of vascularized free fibula graft, which has been widely carried out and has achieved very good clinical results (Figure 1a,b). 3.Hip prosthesis replacement: Since femoral head necrosis is mostly seen in middle-aged and young people, while prosthesis replacement has a certain service life, therefore the use of hip prosthesis replacement is often a remedy of last resort. However, for patients with femoral head necrosis older than 60 years old, it is currently the most certain method of treatment. For young and middle-aged patients, if the process of femoral head necrosis is already at an advanced stage (severe collapse of the femoral head, narrowing of the joint space, formation of “bone spurs”) and the pain cannot be relieved by conservative treatment, then hip prosthesis replacement should be considered. Hip prosthesis replacement for femoral head necrosis can be divided into femoral head surface replacement and total hip replacement. The femoral head surface replacement (Figure 2) is suitable for young patients, as it only places the prosthesis on the surface of the hip joint, while preserving as much bone and the normal shape of the femoral head as possible, resulting in a stable and mobile joint after surgery and facilitating future revision surgery. The efficacy of total hip replacement is more certain, but it requires the best possible prosthetic material and excellent surgical technique to prolong the life of the prosthesis. How should the patient cooperate with the surgeon? For a patient diagnosed with osteonecrosis of the femoral head, the first thing is to build up the confidence to overcome the disease, neither to fear it as cancer, nor to think that there must be some kind of special medicine or treatment and blindly try it. As the saying goes, the best treatment is prevention. Changing some habits can greatly reduce the occurrence of osteonecrosis of the femoral head, such as using corticosteroids with caution; not drinking alcohol, smoking and eating too greasy food; avoiding obesity and preventing falls, etc. It is important to emphasize here that we must prevent from seeking medical help in a hurry, we must be good at identifying some false advertisements, and we suggest patients to go to a specialist doctor in a big hospital for consultation and treatment. In conclusion, osteonecrosis of the femoral head has become a very common disease and seriously affects people’s quality of life. However, as long as early diagnosis, early treatment and correct treatment are achieved, patients with osteonecrosis of the femoral head can still achieve more satisfactory clinical results.