Three main causes of femoral head necrosis in daily life
Reporter: Director, as a well-known orthopedic specialist in China, you have always been committed to the research of various joint diseases and surgical treatment of joint surgery, especially in the treatment of femoral head necrosis in the past two years has won the unanimous praise of patients, can you please give us a brief introduction of what is femoral head necrosis?
Doctor: Femoral head necrosis is called aseptic necrosis of the femoral head, or ischemic necrosis of the femoral head, which is a lesion caused by interruption or damage of the local blood supply to the femoral head for various 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 a rare disease to a frequent and common one. Especially since the introduction of hormones and their widespread use, the incidence of osteonecrosis of the femoral head has gradually increased. In addition, the change of people’s lifestyle and the increase of traffic accidents after the change of transportation have made the number of patients with this disease increase dramatically. The latest survey shows that the disease can affect any age, but is most common in young and middle-aged people between 30 and 50 years old, with more than 60% of cases being bilateral, and the ratio of men to women being about 4:1. The incidence of the disease is significantly higher in people with a history of hormone abuse, hip trauma, alcoholism and other related diseases.
This disease is mostly manifested as hidden pain or dull pain in the hip joint or its surrounding joints at the beginning, which is aggravated after activities. Further development can lead to dysfunction of the hip joint, which seriously affects the quality of life of patients and loss of working ability, and can also lead to lifelong disability if not treated in time, so it should be given wide attention.
Reporter: From the data I have collected so far, the majority of patients suffering from this disease are male, does this indicate that this disease has the sign of “male preference for female”?
Doctor: The cause of femoral head necrosis itself does not have much to do with gender. From the disease profile I introduced earlier, we can see that the three main causes of this disease are hormone abuse, traffic accidents and long-term excessive alcohol consumption. From the perspective of our social structure, men between the ages of 30 and 50 are still the main force in society, and they are significantly more likely than women to drive and socialize in daily life, and therefore have a higher chance of being involved in traffic accidents and excessive alcohol consumption than women. This is why the illusion of “male preference for female” has emerged. According to our survey results, the incidence of femoral head necrosis is significantly higher in the north than in the south, which has a lot to do with the fact that people in the north of China like to drink alcohol, especially high alcohol.
Reporter: You said that the cause of femoral head necrosis has a lot to do with people’s daily living habits, does it mean that improving one’s living habits can avoid the occurrence of this disease?
Doctor: Improving one’s lifestyle habits is of course of great benefit to prevent the occurrence of the disease, but it does not mean that this prevention method is absolutely effective. Because in addition to the three main causes of the disease I described above, there are some cases of femoral head necrosis without clear causes, called idiopathic femoral head necrosis, accounting for 15-20% of femoral head necrosis.
The most effective treatment method in the initial stage – porous metal tantalum rod implantation Reporter: So what are the current domestic treatment methods for femoral head necrosis?
Doctor: The domestic treatment of femoral head necrosis has undergone a long evolutionary process, and from the current state, there is no proven method to eradicate or prevent this disease. Nowadays, the state advocates the treatment of Chinese medicine, but from the cases I have come across, the treatment of osteonecrosis of the femoral head is still at the stage of activating blood circulation and removing blood stasis, which is only applicable to the initial stage of osteonecrosis of the femoral head and has an uncertainty factor. This is because our TCM theory advocates individualized treatment, which means that each patient’s condition will not be exactly the same and the treatment will be different and difficult to grasp. On the contrary, Western medicine emphasizes a universality, and any kind of treatment will be supported by a data. Currently, there are two main treatments for femoral head necrosis in Western medicine, one is conservative treatment and the other is surgical treatment.
Conservative treatment is mainly carried out through drugs, the effect is not very obvious, the cure rate is less than 50%. The surgical treatment differs according to whether the patient’s femoral head is collapsed or not. Generally speaking, for patients who have not collapsed before stage II of femoral head necrosis, I would recommend them to undergo tantalum rod implantation surgery, which does not require replacement of the patient’s hip joint and has a small incision, quick recovery and preserves the patient’s own hip joint, which can quickly reduce the patient’s physiological and psychological pressure. For patients who have already collapsed, it is best to undergo hip replacement surgery, which can effectively prevent further deterioration of the condition.
I would like to remind you that, as I said earlier, there are no drugs that are particularly effective for femoral head necrosis, not only in China, but also abroad.
Reporter: You have just recommended the porous metal tantalum rod implantation surgery as the best method for the treatment of initial femoral head necrosis, why is that?
Doctor: There are many ways to treat ischemic necrosis of the femoral head. For patients with early stage femoral head necrosis, many hospitals in China have used surgical methods such as femoral head drilling and decompression, femoral head drilling and decompression implantation, bone grafting, etc., but the results are not ideal, and there is the possibility of further necrosis and collapse of the femoral head. Therefore, the medical profession has been looking for a stronger substance that can be closely integrated with the human body and replace its own bones. Tantalum rods are a kind of bone trabecular metal – femoral head necrosis reconstruction rods developed successfully in the United States for the treatment of early femoral head necrosis.
Bone trabecular metal reconstruction rod is made of metal tantalum, with the characteristics of human cancellous bone structure, large pores, close to the human bone trabecular pore distance, its elasticity is also close to the elasticity of human bone, with good biocompatibility, so it is also known as “metal bone”. It can make human bone tissue grow well into the pores of tantalum metal rods, so that human bone and tantalum metal rods become one, which has a good supporting effect on the femoral head that will collapse. This is something that no replacement material has been able to do so far.
The procedure of taking the Femoral Head Necrosis Reconstruction Rod is minimally invasive, requiring only a small incision in the lateral thigh, guided by fluoroscopy, to accurately place the tantalum rod into the desired area, achieving excellent biological fixation and mechanical support. It can provide structural support of the subchondral bone and enable the repair of necrotic tissue; it can also delay or even avoid the collapse of the femoral head and postpone or even avoid total hip replacement surgery. The 5-year follow-up rate abroad is as high as 87.5%, which has doubled compared to the previous 3-year follow-up rate of less than 50% in China. However, the tantalum rod is patented in the United States and has been in the Chinese market for less than two years. From the results of the 42 surgical follow-up cases that have been done in our hospital, the results are relatively satisfactory.
Reporter: Just now you mainly introduced the surgical treatment method before the stage II femoral head necrosis, is there any good method for the treatment after the femoral head collapse? Can tantalum rods also be used for this treatment?
Doctor: There is no need to be pessimistic for patients with a collapsed femoral head, as the success rate of artificial hip replacement surgery is getting higher and higher with the improvement of medical standards, and the materials used are getting better and better. From metal-to-metal, ceramic-to-ceramic to the use of tantalum now, our medical technology is always improving.
Just in November 2009, at a very influential international orthopedic forum at the National Orthopedic Annual Meeting, or COA for short, which I attended, there was an in-depth discussion about the use of bone trabecular metal, or what we call tantalum rods, in the treatment of femoral head necrosis. In terms of the follow-up results of previous cases, none of the complications such as infection and dislocation of the hip joint on the operated side occurred during the artificial total hip arthroplasty with the trabecular metal cups, and the radiographs taken 24 weeks after the operation showed the disappearance of all the gaps, and all the radiographs did not show any translucent zone around the prosthesis, osteolysis or bone resorption, which laid a good foundation for the application of porous metal tantalum rods in the later treatment of femoral head necrosis in the future This is a good basis for the future application of porous tantalum rods in the later treatment of femoral head necrosis.
Necessary maintenance and exercise after surgery Reporter: In the past, people have the impression that it takes 100 days to break a bone, but the cases you provided show that the two patients who had tantalum rods implanted were able to walk on the ground about 3 to 4 days after surgery, does this mean they were cured?
Doctor: The biggest advantage of tantalum rod implantation is that it can quickly relieve the patient’s pain, and because of its small incision and the low average age of the patient, you can generally walk on the ground 4 to 7 days after the surgery, but you cannot take off the crutches. Because there is still a gap between the newly implanted tantalum rod and human bone, the fixed position is not yet stable, so it can not withstand the large pressure, the crutches can help the patient share part of the weight, which is conducive to the growth between the tantalum rod and the bone, so the crutches are necessary.
Reporter: So when can we get off the crutches?
Doctor: In general, you can get off the crutches in 2 months, and you can return to normal life after 6 months. But because of individual physical differences, the time may vary more or less, depending on the patient’s bone growth.
Reporter: Are patients who return to normal living conditions the same as ordinary people, and are there any areas that need attention?
Doctor: At present, the treatment of femoral head necrosis in China can only ensure that patients return to a normal state of life and reduce pain, but it is still necessary to maintain and care for the lesion. Generally speaking, patients should not walk for a long time, do strenuous exercises or heavy physical work even if they recover their health.
This is not to say that the patient cannot do it, but that it will be a burden on the hip joint of the patient. In our previous case, the female patient was fat because of the use of hormones, which put a heavy burden on the hip joint. If she did not take proper maintenance after surgery, the life span of the tantalum rod she had implanted would be lower than that of the male patient. Similarly, male patients who engage in heavy physical labor for a long time will have the same result.
Reporter: How should I maintain and care for it in my daily life?
Doctor: Moderate exercise is good for physical and mental health, but patients with femoral head necrosis should pay attention to the way they choose to exercise. It is better not to do sports that increase the burden on the hip joint, such as treadmill, weightlifting, etc. But cycling and swimming will not increase the hip joint. However, cycling and swimming do not increase the burden on the hip joint and can exercise the leg muscles, so it is recommended that patients recovering from osteonecrosis of the femur can try these two exercises.
Reporter: Besides sports maintenance and care, do you have any advice on daily diet?
Doctor: In the end, the treatment of osteonecrosis of the femoral head has a lot to do with the human body’s own bones. The above-mentioned high-risk groups are prone to osteonecrosis of the femoral head, so it is recommended that people drink less alcohol in their daily diet and consume more substances that can help people’s bones grow, such as soy products and milk.