Ischemic necrosis of the femoral head is not exclusive to the elderly. In snowy and icy weather, the elderly are most afraid to go out because the soles of their feet are slippery and they easily fall, and once they land on their hips, a fracture of the neck of the femur (at the root of the thigh) often occurs. As the saying goes, it takes 100 days to break a bone, and even after the fracture is healed, ischemic necrosis of the femoral head often occurs secondarily. Is ischemic necrosis of the femoral head only the “patent” of the elderly? After ischemic necrosis of the femoral head, how to scientifically face the pain that comes with it? The elderly should be careful against femoral head necrosis after fracture Q: Why is the elderly prone to femoral head ischemic necrosis after a fracture at the root of the thigh? A: The uppermost part of the femur in the human thigh is the femoral head, and the weight of the upper body is all borne by the two femoral heads. The femoral head and the acetabulum of the pelvis form the hip joint, which is the most weight-bearing joint in the human body. Since the elderly are often accompanied by osteoporosis, this can lead to a significant decrease in bone strength at the femoral neck below the femoral head. Therefore, in the event of a hip injury, it can easily cause a fracture of the femoral neck. Since the blood supply to the femoral head is provided through the blood vessels at the femoral neck, when the femoral neck is fractured, especially when it is fractured below the femoral head and accompanied by dislocation, the blood supply to the femoral head is easily blocked, which means that the blood supply to the femoral head will be impaired. The lack of blood supply to the femoral head results in ischemia, bone resorption, destruction, and collapse of the femoral head. Ischemic necrosis of the femoral head is more common in middle-aged and young people Q: Can ischemic necrosis of the femoral head occur in young people? A: Ischemic necrosis of the femoral head is a common disease in orthopedics, mainly occurring in young adults, more men than women. If 80% of patients do not receive proper and effective treatment, the femoral head will collapse in about one to four years, which will seriously affect the function of the hip joint and eventually necessitate joint replacement surgery. Q: What are the common causes of femoral head necrosis? A: There are many causes of femoral head necrosis, which can be summarized into traumatic and non-traumatic. Traumatic, such as the above-mentioned femoral neck fracture in the elderly, etc. Non-traumatic causes include alcoholic osteonecrosis and pharmacogenic osteonecrosis (e.g., after extensive hormone therapy). According to outpatient statistics, the number one cause of ischemic necrosis of the femoral head is alcoholism, which accounts for about 40% of non-traumatic femoral head necrosis. After long-term heavy drinking, alcohol causes fatty saponification in the femoral head, which increases pressure and affects the blood supply situation. However, individual differences are great, some people drink half a pound to a pound a day without developing the disease, while others drink 1-2 taels a day and necrosis occurs. The second major cause is the use of steroids (what the people call hormones), which accounts for about 30% of patients. After using a lot of hormones, the blood vessels in the femoral head become thrombosed, the fat cells increase in size, and finally the pressure on the blood vessels becomes too high and ischemic necrosis occurs. For example, one of my male patients, Lin Yongjun, a 29-year-old man from Changzhi, Shaanxi Province, suffered extensive burns in 1999 when a sugar boiling pot fell on his body in his hometown workshop. In the late stage, the function of the joint was completely impaired, and with financial support from various parties, the hip joint was replaced with an artificial one. Hip disease sometimes manifests as knee pain Q: What are the early symptoms of femoral head necrosis before the obvious pain? A: Early stages of femoral head necrosis can have no obvious clinical symptoms, or only vague or dull pain in the hip joint and its surrounding tissues, as well as in the inner thigh and groin, and the symptoms worsen after activity. Special attention should be paid to the fact that femoral head necrosis sometimes manifests itself as pain in the affected knee and lateral thigh, which is called “hip and knee pain”, also known as ectopic pain, which is often overlooked because it is “far” from the hip joint and is easily misdiagnosed as knee arthritis or joint injury, and in some patients Because of the radiating pain, it is treated incorrectly as lumbar disc herniation sciatica for a long time, as I have recently had several patients with such pain, which is actually a kind of radiating pain caused by femoral head necrosis. For people at risk who drink more alcohol or have used hormonal drugs, they should be highly alert to the occurrence of osteonecrosis of the femoral head and must go to a regular hospital for further examination once they have uncomfortable sensations in the joints. Q: Can I know if I have femoral head necrosis by taking a film? A: Ischemic necrosis of the femoral head is divided into stages 1-4. Patients with stage 1 cannot be detected on ordinary X-rays and need to be diagnosed by MRI. patients with stage 2 or above can be clearly diagnosed on ordinary X-rays. Since the early stage of femoral head necrosis is not obvious on X-ray and CT, the sensitivity of magnetic resonance imaging (MRI) examination is higher, so MRI is usually used as the first choice for early stage femoral head necrosis. Artificial joint replacement is only applicable to the advanced stage of femoral head necrosis Q: Is it necessary to do artificial joint replacement if the femoral head ischemic necrosis? A: There are two main types of treatment for ischemic necrosis of the femoral head, conservative treatment and surgical treatment. The patient’s condition can be treated conservatively within the first and second stage. The most fundamental method is that the affected side cannot bear weight and can support crutches or use a walker to reduce the pressure of the body on the hip joint. If both hips are involved at the same time, the patient should be bedridden or in a wheelchair. Hyperbaric oxygen, physical therapy and Chinese herbal medicine can also be used to improve local blood circulation. Treatment takes 6-24 months, and should be reviewed regularly during treatment until the lesion is completely healed before weight holding. At stage 3, conservative treatment is no longer possible and surgical treatment, such as core drilling and decompression, free iliac or fibula bone grafting with vascular tip, artificial hip replacement, etc. Patients with collapsed femoral head at stage 3 and 4 should consider artificial joint replacement if they have severe hip pain and obvious dysfunction, which affects normal daily life. Q: How long is the life span of an artificial joint? A: People have always had the idea that something created by nature cannot be replaced by artificial means; after the artificial joint is installed, the limb is like a robot, stiff and unnatural. In fact, today, the design and manufacturing process of the prosthesis have been greatly improved, and the range of motion of the artificial joint is similar to that of a normal person, which has benefited thousands of patients with the further improvement of surgical results. The statistics of large sample of cases provided by some famous treatment centers at home and abroad show that 90% – 95% of people who have used the artificial total hip joint prosthesis normally for more than 10 years and 80% of people who have used it for more than 20 years. However, the younger, more active or heavier the person is, the more likely the artificial joint is to wear out and loosen. Since most patients with ischemic necrosis of the femoral head are very young, when considering the type of artificial joint you should choose a combination of joint surfaces with good wear resistance, such as ceramic to ceramic joint surfaces, in order to improve the service life of the artificial joint. The old faucet used to tick tick tick drip, why? It is because of the plastic or rubber plug, and now the faucet, ceramic plug switch countless times is still very wear-resistant, wear how many million times does not matter.