What is osteonecrosis of the femoral head and what are its risks?
Femoral head necrosis, also known as ischemic necrosis of the femoral head, as the name implies, refers to various causes of ischemia of the femoral head, causing bone cell death. It is an extremely difficult disease to cure clinically.
The main causes of femoral head necrosis include traumatic fracture, long-term use of hormones and alcoholism. According to a large-scale survey in Japan, long-term high-dose hormone use and alcohol abuse are the two main risk factors, which are associated with about 90% of patients. Recent studies have shown that the occurrence of ischemic necrosis of the femoral head may also be associated with elevated cholesterol.
The most frequent symptom of femoral head necrosis is pain mainly at the root of the thigh and hip, occasionally accompanied by knee pain. The pain may manifest as paroxysmal or persistent pain that gradually worsens. MRI is the “gold standard” for diagnosing osteonecrosis of the femoral head and can detect abnormalities in the early stages of the disease.
In the past, femoral head necrosis was difficult to detect at an early stage, and when pain and limited movement were seen, the femoral head might already be in the middle to late stage, resulting in collapse and deformity of the femoral head, limp, difficulty in walking, and even loss of mobility leading to disability. Not only do patients suffer physically, but also cause unbearable economic and mental stress to the whole family. The application of MRI makes it possible to detect femoral head necrosis at an early stage, and our clinical practice in recent years has proved that early femoral head necrosis can be completely cured through active and appropriate treatment. Therefore, the timely use of MRI to examine early lesions of femoral head necrosis provides a valuable window of time to cure the disease.
Why does osteonecrosis of the femoral head appear as claudication with very severe pain?
Limping after femoral head necrosis is mainly due to the collapse and deformity of the femoral head, which leads to shortening of the affected limb and manifests as limping. The very severe pain is due to the destruction of the normal joint anatomy after femoral head necrosis, which causes severe pain due to bony friction when walking or bearing weight, the mechanism of which is similar to that of severe pain after fracture.
Misconceptions of femoral head necrosis treatment?
1, some patients do not actively look for the cause of the pain, but abuse hormones, which will aggravate the progress of femoral head necrosis.
2, once the diagnosis of femoral head necrosis, more patients do invasive treatment, early necrosis to take palliative surgery, such as: open decompression, bone stenting, etc.. These treatments are not only painful, high cost, long recovery period, but more importantly, they do not address the real cause of ischemic necrosis of the femoral head, causing changes in the surrounding vascular tissue after the incision, further aggravating the ischemia and hypoxia of the femoral head, which in turn aggravates the process of femoral head necrosis.
3, late inevitable artificial joint replacement surgery. However, hip replacement is not a permanent solution. Ten years or even less may be required to operate again, causing great physical trauma to the patient and great mental and economic pressure.
What is the most common treatment method for femoral head necrosis and how does it work?
There are more treatment methods for femoral head necrosis, mainly non-surgical treatment and surgical treatment.
1, non-surgical treatment is mainly applicable to patients with early stage of femoral head necrosis
(1) Protective weight-bearing: the use of double crutches can effectively reduce pain, but the use of wheelchairs is not advocated.
(2) Drugs: aspirin, low molecular heparin, etc. have certain therapeutic effect on the early stage of femoral head necrosis.
(3) Physical therapy: electrotherapy, magnetic therapy, hyperbaric oxygen, etc.
(4) Braking and appropriate traction.
2, for the femoral head necrosis in the middle and late stage patients, the clinical general use of surgical treatment, including the preservation of the patient’s own femoral head surgery and artificial hip joint replacement two categories. Preservation of the femoral head surgery includes decompression, bone grafting, osteotomy and so on.
The above methods cannot fundamentally solve the causes of ischemic necrosis of the femoral head, but may only slightly relieve the symptoms of pain and activity limitation. Some invasive surgical treatments, such as decompression surgery, may cause further ischemia and hypoxia of the femoral head and aggravate the symptoms. Hip arthroplasty is not only a great physical trauma, but also a great mental and financial pressure, and in a few years, it may be necessary to undergo a second or even third surgery. Moreover, the trend of femoral head necrosis is getting younger in recent years, and the disadvantages of hip arthroplasty are further revealed.