Patient: Director Liu: Hello! I had a fibula graft for bilateral femoral head necrosis and walked for six months, but at ten months, my left leg suddenly started to have pain. Previously, although the left leg had necrosis, it was relatively mild and had not experienced pain. Recently, the left leg was slightly deformed and the neck of the femur and the trochanter were edematous. I have already had a fibula graft, how can this still happen? Is it possible to get better now? Will the edema of the femoral neck and trochanter go away? MRI imaging opinion: patchy abnormal signal shadow is seen under the joint surface of femoral head bilaterally, T2W1 shows bilinear sign, T1W1 shows inhomogeneous lower signal, T2W/STIR shows mixed low and high signal, left femoral neck and rundown show high signal; limited collapse of joint surface, right side is predominant, postoperative orbital sign change is seen from femoral head to rundown bilaterally, small amount of synovial bursa fluid signal, left side is predominant, acetabulum No abnormal signal was seen. Opinion: Both right and left are stage III, but the right side is stage B and the left side is stage A. The left femoral neck and trochanter are edematous. Liu Shaojun, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: According to clinical experience, the repair of femoral head necrosis after hip preservation surgery is generally divided into three stages, the first stage, 6-12 months, through surgical intervention and weight-bearing control, collapse did not continue to develop, the femoral head was relatively stable, necrosis began to repair, and new bone was formed, at which time the hip pain was relieved, but the femoral head had not yet returned to normal mechanical properties, which was not enough to At this stage, the hip pain is relieved, but the femoral head has not yet returned to normal mechanical properties and is not sufficient to meet the needs of daily activities, so weight bearing must be strictly limited during this stage; otherwise, the femoral head will collapse again and hip pain and bone marrow edema around the necrotic area will occur. In the second stage, 12-24 months after surgery, the new bone of the femoral head starts to be shaped and gradually restores the mechanical properties of support, and the arrangement of bone trabeculae starts to be clear and orderly. However, at this stage, the intra-femoral head plasticization is not yet completed, and walking long distances can lead to accumulated stress injury, bone marrow edema within the femoral head and severe hip pain. According to your MRI, it is considered that less than 12 months after surgery, local collapse is more likely. From the X-rays, the degree of collapse should be slight, and you need to control weight-bearing walking, appropriate lower limb skin traction, and use pulsatilla intravenous drip, which can quickly relieve hip pain. In the long-term observation of hip preservation surgery cases, the patient’s femoral head collapses again at the peak and high-risk period 10 months after surgery, so weight-bearing must be strictly controlled to pass the high-risk period of collapse. Patient: Director Liu: Thank you so much! I feel that your answer to my case is right on the mark! I feel that your answer is very thorough! At that time, Shanghai Sixth Hospital said that I could walk for six months. Maybe Director Zhang Changqing was more considerate of patients’ feelings and said that I could walk without crutches, but I had to ride a bike if the road was far away. At that time, I was very happy and thought I was recovering well, but I didn’t know there were so many dangerous periods. I really regret that I should have just walked. How long will it take for the bone marrow edema in the femoral head to disappear if I try not to put any weight on it now? Is it possible to meet the needs of daily life even at 12 months in my current condition? Or do I have to wait a little longer than others because I was not protected before? Liu Shaojun, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Generally, in this episode of pain, it can be identified as another collapse and the treatment period needs to be extended. According to experience, the calculation should be re-calculated from the beginning and can be increased or decreased appropriately according to the clinical situation. For example, in a patient with a fracture, the bone scab is attached after the fracture, but due to another fall the fracture site is fractured again, the calculation of its fracture healing time needs to be recalculated from scratch according to the degree of re-injury.