What is osteonecrosis of the femoral head?
Femoral head necrosis, known as aseptic necrosis of the femoral head or ischemic necrosis of the femoral head, is a lesion caused by localized poor blood flow to the femoral head for a variety of reasons, resulting in further ischemia, necrosis of bone cells, fracture of bone trabeculae, and collapse of the femoral head. Since 1888, when the disease was first recognized by the world medical community, osteonecrosis of the femoral head has been transformed from an uncommon disease to a common and frequent disease. Especially since the introduction of hormones and their widespread use, the incidence of femoral head necrosis has gradually increased. In addition, the increase in the number of accidents after the change of transportation and the change of people’s life style have made the number of patients with this disease increase dramatically. According to incomplete statistics, there are about 30 million people suffering from this disease worldwide, and about 4 million in China. The latest survey shows that there is no significant gender difference in the occurrence of the disease, and the disease can occur at any age, while the chance of developing the disease increases significantly in people with a history of hormone application, hip trauma, alcoholism and related diseases.
Staging of femoral head necrosis.
Femoral head necrosis stage I (ultrastructural variant stage).
Femoral head necrosis stage II (sensory stage).
Femoral head necrosis stage III (necrotic stage)
Femoral head necrosis stage IV (disabling stage)
Clinical manifestations: The first conscious symptom of femoral head necrosis is pain, which is around the hip joint, inner thigh, anterior side or knee. In the early stage, the pain is vague, dull or intermittent, and the pain is aggravated by more activities, and can be relieved or reduced by rest. However, there are also cases of persistent pain, whether it is from exertion or rest, or even when lying in bed. In the early stage, the pain is mainly accompanied by functional limitation; in the late stage, the functional impairment is mainly accompanied by pain.
Since osteonecrosis often involves both sides, most patients end up with joint deformity and secondary osteoarthritic changes. Although there are numerous treatment methods, the efficacy of all of them is not certain, so the treatment is quite tricky. However, it has been proven that the earlier the treatment, the better the results.
Which groups of people are vulnerable to femoral head necrosis?
Through years of research, bone disease experts in the high-risk group of femoral head necrosis research concluded that those prone to trigger the symptoms of femoral head necrosis factors.
1, long-term application of glucocorticoids
Patients whose long-term conditions are not controlled or treated effectively need to take large amounts of glucocorticoids for a long time to control their conditions.
2, long-term heavy drinkers
Osteoporosis caused by alcoholism is also one of the causes of femoral head necrosis. Friends with long-term heavy drinking habits, such as the two hip joints or hip pain, groin area, etc., and age in the 30 to 50 years old (drinking triggered by necrosis of the femoral head more age), must be careful, go to the hospital as soon as possible to do CT or MRI examination, can see some subtle changes in bone quality. Femoral head necrosis has become clinically common and has become a frequent disease that affects people’s health and has a high disability rate. In recent years, the incidence of femoral head necrosis caused by alcoholism has been on the rise, and in some hospitals has accounted for 1/3 of all inpatients with femoral head necrosis, causing very serious harm.
3.People who have a history of hip trauma
Femoral neck fracture, hip dislocation or hip trauma without fracture dislocation caused by carelessness in life, work and sports can cause damage to the blood vessels supplying the femoral head, laying a great hidden danger for future femoral head necrosis. Among them, femoral neck fracture with femoral head necrosis is the most common, accounting for about 30% of such fractures.
4.People suffering from rheumatic diseases (SLE, rheumatoid, etc.)
Rheumatic diseases refer to a large group of diseases with different etiologies but common to involve the joints and surrounding soft tissues, including muscles, ligaments, bursae and fascia. In addition to pain, joint lesions are accompanied by swelling and impaired movement, with a chronic course of alternating episodes and remission, and some patients may experience joint disability and visceral failure, making the bone loose, thus triggering bone changes and leading to femoral head necrosis.
5.Other
Diving, flight crew, obesity, hypertension, diabetes, atherosclerosis, gout, radiotherapy, post-burn, hemoglobinopathy, etc. are also high-risk groups prone to femoral head necrosis.
What are the conventional treatments for femoral head?
The treatment methods of femoral head necrosis are
1.Conservative treatment
(1) Avoid weight-bearing It is possible to rely on canes, axillary canes and other supports to strictly limit weight-bearing, which can restore blood supply to ischemic tissues and protect them from pressure to control the development of lesions, prevent collapse and promote self-healing of ischemic necrosis of the femoral head. However, it is generally believed that weight-bearing restriction cannot save the development of femoral head necrosis. This method is mainly applied to elderly patients who are not suitable for surgical treatment, poor general condition, progressive ischemic necrosis and patients with poor prognosis. The possibility of self-healing is related to the size of the lesion and the distance from the joint surface: if the lesion is small or far away from the joint surface, it can mostly heal by itself; if the lesion is adjacent to the joint surface or if the lesion is large in scope, the possibility of self-healing is extremely small even without weight-bearing.
(2) Electrical stimulation has an osteogenic effect and can promote fracture healing. Electrical stimulation can be used as an independent treatment for osteonecrosis or as an adjunct to surgery.
2.Surgical treatment
(1)Treatment of preserved femoral head, applicable to early osteonecrosis of femoral head.
(1) Borehole decompression It can reduce intraosseous pressure, promote venous reflux, release trophoblastic vascular spasm, so that the new blood vessels can grow along the bone hole to the ischemic area. It is mainly used for patients without joint surface collapse in the early stage, and is the simplest surgical method to treat osteonecrosis.
Bone grafting is also called drilling and decompression bone grafting because it is necessary to drill holes before bone grafting. It involves both drilling and decompression, bone grafting to provide mechanical support, and bone grafting with myotome to increase the blood supply to the femoral head.
(3) Osteotomy By changing the corresponding position between the femoral head and the femoral stem, it can increase the weight-bearing area of the femoral head, reduce the pressure on the femoral head, and move the necrotic lesion out of the weight-bearing area, thus reducing the local stress, and at the same time, osteotomy opens the medullary cavity, which can reduce the intraosseous pressure and improve the blood circulation of the femoral head.
(2) Arthroplasty Applied to patients with collapsed femoral head necrosis, metal cup arthroplasty, joint surface replacement, femoral head replacement, total hip replacement, etc. are feasible.
How does stem cell transplantation treat osteonecrosis of the femoral head?
Stem cell therapy for femoral head necrosis is an interventional method to transplant stem cells into the necrotic area of the patient’s femoral head. Through in vivo differentiation of stem cells to generate vascular epithelial cells, new blood vessels are generated and blood circulation in the necrotic area is reshaped, thus solving the cause of femoral head necrosis. It can quickly help patients with osteonecrosis of the femoral head to solve the pain caused by osteonecrosis of the femoral head and thus control the progression of the disease.