Patient: Description of condition (time of onset, main symptoms, hospital visited, etc.): Patient, male, now 64 years old, had a fall on a bicycle in 1995, resulting in a fracture of the femoral neck. He recovered from the orthopedic surgery at Wuhan Third Hospital. For more than 10 years, the condition was still good, so no review was done. In the past six months, he began to have some pain in the hip joint area, but thought it was a meridian problem, so he did not pay attention to it and insisted on walking activities. When the pain was severe, I used squatting to relieve the symptoms. Sitting and sleeping are not painful. Recently, he underwent an MRI at Wuhan General Hospital of Guangzhou Military Region and was diagnosed with “femoral head necrosis”. At present, he is taking oral medications prescribed by the doctor: “Bone Yu Ling capsule” and “Diclofenac sodium extended-release tablets” to seek the best treatment plan for femoral head necrosis. Qu Tiebing, Department of Orthopedics, Beijing Chaoyang Hospital: Femoral head necrosis is medically divided into 4 stages (stage I/II/III and IV), and each stage has sub-stages. To put it simply, when the necrotic area can be seen on ordinary X-rays, it is already stage II or above; when the femoral head collapses, it is stage III; and when the acetabulum is damaged, it is stage IV. Since the treatment and effect of each stage is different, the professional doctor must understand the specific stage of the patient before treatment can be carried out. The treatment of osteonecrosis should not be based on random medication, and you should not listen to any “prescriptions”. Because once the femoral head is necrotic, it is irreversible, and there are several generally accepted theories (the theory of microvascular obstruction in the bone, the theory of increased pressure in the bone, etc.). The early stage is stage I, and the treatment method at that time is to interrupt the above-mentioned causes, so the drugs used are those that unblock microcirculation and lower intraosseous pressure; in the first two stages of stage II (stage II is divided into stage IIa, IIb and IIc), in addition to “unblocking” and “decompression In the first two stages of II (IIa, IIb and IIc), in addition to “sparing” and “decompression”, we should also promote bone growth (commonly known as “bone strengthening”), so we also use some “bone strengthening” drugs to promote bone growth. From stage IIc onwards, irreversible osteonecrosis occurs, which may be useless to use drugs exclusively and needs to be treated with some “decompression” and “bone grafting” surgery. Advanced osteonecrosis of the femoral head requires total hip replacement. From your films, your condition should be at least stage IIb. Therefore, the best treatment for you is to have decompression bone graft surgery. Patient: First of all, I would like to thank Professor Qu for his warm welcome and considerate service! Now I will send you the X-rays and hope you can give me more specific treatment guidance. Thank you! Qu Tiebing, Department of Orthopedics, Beijing Chaoyang Hospital: According to your age, you can also choose to receive artificial hip replacement surgery. Patient: Thank you again, Professor Qu, for suggesting a suitable treatment plan for my age and condition. Now I would like to share my specific situation and ideas with Prof. Qu, and I hope he will also give me guidance. Although I am 64 years old, my mental age is still relatively young and I am usually active. Due to my partner’s poor health and my children’s busy work schedule, I am the main laborer in the family. Now my left leg is not afraid to bear the weight, but with double crutches can still be busy with household chores. I feel that with the care of the crutches, there is no physical pain now. In order to prevent my legs from decreasing in function, I often squat my legs and move my knees and hips while sitting and sleeping, in order to protect the existing femoral head and delay the “artificial hip replacement”. The main reason for this conservative view is the fear of complications and sequelae of the replacement. Now, I cannot participate in the normal functioning of our family, and my 88-year-old father is still alive and well, and my children’s responsibilities are not yet fulfilled. In addition, our family has a history of longevity, and if we undergo replacement surgery now, we fear that we will face the same surgery before the end of my life. The main reason I sent the X-rays last time was to facilitate Professor Qu’s observation of my condition from multiple tests, so that I could understand how far my condition has reached. Is there any conservative treatment available? Also, how long can I maintain my activities with the help of crutches? In the last resort, should I have “artificial femoral head replacement” or “total hip replacement”? Professor Qu! I am embarrassed that I have to ask so many questions from you in your busy schedule. Let me thank you once again and give you my highest respect! Beijing Chaoyang Hospital Orthopaedic Department Qu Tiebing: Hello! The answer is as follows: 1, modern artificial joint technology is not the year, the service life of biological prosthesis at least more than 20 years (but need experienced joint surgery experts), even if there are problems in the future can be “repaired”, so do not worry; 2, according to your case, is already a mandatory surgery period. If you are now 40 years old, you can first consider joint preservation decompression implantation. The advantage of this surgery is that the joint can be temporarily preserved, but usually you still need to receive joint replacement in the future, which is commonly known as “spending money to buy time”. The disadvantage is that the post-operative recovery period is long, the surgery is no less invasive than a joint replacement, and the chances of success are low. The advantages of joint replacement are a quick recovery, a high success rate, and good function. Your age is suitable for the latter; 3, because you are no longer the problem of the femoral head, the hip socket has also been destroyed, pure “artificial femoral head replacement” is wrong. Therefore, if you receive a joint replacement, it will be a total hip replacement, not an “artificial femoral head replacement”. Total hip replacement has fewer post-operative comorbidities and the prosthesis lasts longer. Patient: Prof. Qu: I am very grateful for your treatment guidance! Judging from the time of your reply, you have analyzed my condition and answered my questions several times late at night when you were resting. I am impressed by your good medical ethics of responding to all requests, answering all questions, caring for your patients and being responsible! It seems that my femoral head disease is not light anymore, some conservative treatments are powerless to me, and total hip replacement has become an inevitable trend, sooner or later I will face it. Now the question for me is whether to choose “early” or “late”? My idea is to choose “as late as possible”, so as not to face the problem of “revision” after surgery. I wonder if my idea is feasible? My next question is: How long will I be able to maintain my joint for 3-5 years with my current method, i.e., no weight bearing and mobility with the help of crutches and functional exercises? Will the Chinese medicine “Bone Healing Capsules” and “Di Zhong Bone Strengthening Capsules” that I am currently taking be of any help? Do I still need to keep taking them? I look forward to your reply. Thank you! Qu Tiebing, Department of Orthopedics, Beijing Chaoyang Hospital: In your case, joint replacement is not necessary for the time being. It is estimated that you can use it for at least 1 year, but you cannot operate too late, because the acetabular lesion will be aggravated at too late a stage of the disease, and then even the operation will affect the effect. Because the prosthesis needs a relatively good “bone bed”, the late acetabular bone bed will be severely damaged, which will affect the postoperative results and the life of the prosthesis. Do not believe in drugs, because no drug has no essential effect on osteonecrosis. It is recommended that you take a film every six months to keep an eye on the progress of the disease and do it whenever you should have surgery, so as not to miss the best surgery period. I have already explained the precautions. You can also refer to the article I wrote on science. I wish you a happy Dragon Boat Festival! Patient: Professor Qu: Happy Dragon Boat Festival! I have benefited a lot from reading your reply. I will follow your advice: I will not rush the surgery nor postpone it blindly, I will take a film every six months and observe the progress of the disease at any time and make a decision when it is time to do so. With your prompting, I read all the articles published in your personal website. Reading the articles is like seeing a person, which further deepened my understanding of your medical skills, medical ethics and character. You are really worthy of our time, and I am very lucky to have met you on my way to seek medical help! Also, reading through the article was very helpful and inspiring to me. Here are a few more questions I would like to seek answers to, and I hope Professor Qu will give me another chance. After the fracture of the left femoral neck was healed more than 10 years ago, I could not move my left hip fully, i.e., I felt pain when I held my knee close to my chest and when I increased the angle of movement to the left side, and I still do. Now I insist on moving the joint with slight pain every day, I wonder if this is correct. I hope you can advise me! 2. When I walked too long in the previous stage, my hip joint was a bit uncomfortable and I always wanted to squat down and rest for a while, which felt good. So now I often use this way to exercise the hip joint, I do not know if it is correct? 3. I learned from an article you wrote that the joints of Chinese people are different from those of Westerners. So, is it better to use domestic or imported materials for joint replacement in the future? What material is less likely to break the femoral stem? What material is resistant to wear and tear on the femoral head and acetabulum? 4. My biggest concern about hip replacement is postoperative infection. Will there be any blood transfusion since this is a major surgery? If there is a blood transfusion, it will increase the chance of infection. It is said that there is always the possibility of infection after discharge from the hospital, and if it happens, the consequences will be unthinkable. Can you explain to me in this regard? Finally, let me salute you! Qu Tiebing, Department of Orthopedics, Beijing Chaoyang Hospital: 1. According to the level more than ten years ago, it is normal that the hip joint cannot be fully in place after the healing of the femoral neck fracture, and it is very good that you have delayed it for more than ten years. It is right for you to insist on moving the joint every day, but you should do it when you are not carrying weight, and swimming is the best way to exercise. 2. You “had some discomfort in the hip joint when I walked for a long time in the previous stage, and I always wanted to squat down and rest for a while”. This may sometimes be a sign of lumbar spinal stenosis, so we suggest you go to the hospital to take a film and see a spine surgeon. 3. from the written about the Chinese and Westerners joints are different, refers to the physical differences of the human race. Not the difference in parameters between domestic joint prostheses and imported prostheses! At present, all domestic sales of prosthesis (whether imported or domestic), are manufactured in accordance with the parameters of the Western physique, in other words, the domestic prosthesis is a “copy” of the imported prosthesis “cottage” products. However, in terms of technology and materials, of course, the imported ones are good. Therefore, I call for the study of the national physique data as soon as possible, to create a real national prosthesis. I’m already doing it now. 4. Worry about infection is a problem that every patient and doctor will consider, please think about the doctor in this issue: which doctor will be willing to find trouble for himself? There is a risk of infection in any surgery, but joint replacement surgery has the lowest infection rate of any surgery due to the highest level of surgical sterility!