A. Misconceptions: necrosis of the femoral head is “immortal cancer”
There is a folk saying that necrosis of the femoral head is “immortal cancer”, incurable, more than 20 years ago there is indeed such a saying, and now there are some patients who are convinced of this, thus creating a psychological fear, the disease is not yet treated that lost confidence in overcoming the disease, the next is anxious to seek medical help, blindly believe in a variety of ancestral secret recipes And special treatment methods, mistaken beliefs and misconceptions, and ultimately mislead the disease, take a detour, and suffer a lot. On the contrary, another understanding is that the incidence of femoral head necrosis is very low, the general public will not get this disease, and therefore have hip pain is not early to the hospital serious examination and treatment. According to incomplete statistics, there are about 30 million people suffering from this disease in the world, about 4 million in China, and in the United States and Western Europe, there are more than 100,000 new patients with this disease every year. Every year, 500,000 cases of artificial hip replacement are completed worldwide, and the latest statistics show that the survival rate of 20~27 years is 95~97%.
What is femoral head necrosis?
Insufficient blood supply to the femoral head caused by various reasons, resulting in necrosis of the subchondral bone under the femoral head, which cannot withstand the pressure of weight or activities on the femoral head, followed by deformation of the femoral head, joint surface collapse, pain, and gradual restriction of joint function until loss.
What kind of people are vulnerable to femoral head necrosis?
1, long-term use of glucocorticoid patients: with the widespread use of hormonal drugs in the clinical and irregular applications, such as traumatic brain injury, certain skin diseases, and the “SARS” in 2003 need to use hormones, combined with hormonal necrosis of the femoral head cases are also increasing
2, long-term heavy drinkers: drinking can cause necrosis of the femoral head, probably the first time you heard it? But it is true. The study found that within 10 years of taking more than half a pound of alcohol per day, the incidence of femoral head necrosis has a significantly higher. The femoral head necrosis may occur in 5 to 6 years of socializing.
3, a history of hip trauma: various causes of femoral neck fracture, hip dislocation and injury around the hip joint can make the blood supply to the head of the femur is damaged and secondary to the necrosis of the femoral head. The incidence of femoral head necrosis due to femoral neck fracture is the highest, accounting for about 30% of such fractures. The rate of ischemic necrosis of the femoral head caused by femoral neck fracture in young adults is significantly higher than that of the elderly group, because the postoperative activity of young adults is more than that of the elderly.
4, other: diving, flight personnel, obesity, hypertension, diabetes, atherosclerosis, gout, those who need to receive radiotherapy, after burns, etc., are also at high risk of femoral head necrosis.
Second, the diagnosis of misunderstanding: hip pain is mostly femoral head necrosis.
Femoral head necrosis is also an invalid disease, mostly seen in young and middle-aged patients, in the early stage of the disease can be asymptomatic or feel hip pain after activity, mostly in the inner thigh root; late in the course of the disease can be manifested as persistent hip pain, hip joint activity is limited, causing severe disability and loss of ability to work. Therefore, early diagnosis and early treatment of osteonecrosis of the femoral head is extremely important. In fact, there are many diseases that cause hip pain, not all hip pain is osteonecrosis of the femoral head, and even some lay doctors may misdiagnose some hip pain patients as osteonecrosis of the femoral head. Some patients with hip osteoarthritis, rheumatoid arthritis and ankylosing spondylitis are also often misdiagnosed as osteonecrosis of the femoral head. In fact, these are two completely different diseases, the former is mainly joint surface destruction, the course of the disease from the surface to the inside, while femoral head necrosis is the first joint subchondral bone necrosis, the course of the disease from the inside to the surface. In the early stage of osteonecrosis, the head of femur may even show only knee pain but not hip pain, so once hip and knee pain is found, it is necessary to go to a regular orthopedic hospital for examination. The most common auxiliary examination means to diagnose femoral head necrosis is X-ray examination, most of the femoral head necrosis can be diagnosed through X-ray examination, but the X-ray performance often lags behind, that is, when the bone tissue occurs obvious necrosis and repair response, the X-ray can show, therefore, the most sensitive and reliable means of early diagnosis is magnetic resonance imaging (MRI) examination.
Third, the treatment of misconceptions: necrosis of the femoral head always have special drugs or methods
The treatment of femoral head necrosis is often related to the course of the disease, in general, the earlier the diagnosis, the earlier the effect of treatment, the better. But there is not a special treatment or special drugs can cure all of the necrosis of the femoral head. Because the treatment of osteonecrosis of the femoral head is still controversial, there are many false advertisements that take advantage of the patient’s eagerness to cure the disease and exaggerate the treatment effect, which not only cheats the patient’s money, but also delays the timely treatment of the disease. There are many people who spend hundreds of thousands of dollars on medication and are not cured. For this reason, my mentor, Professor Zhou Yixiong, director of the Orthopaedic Department of Beijing Jishuitan Hospital, published an article in Health News in 2002, “Avoid Abusing Drugs for Femoral Head Necrosis”.
Early treatment
In fact, patients in the early stage, we can use conservative treatment, the main thing is to reduce the amount of weight-bearing activities, this is very critical, femoral head necrosis is a self-healing disease, that is, the development of the disease process to the end of the necrosis and repair process, since the self-healing, and how will lead to the loss of hip function and disability? In fact, the most crucial thing is the decrease of bone tissue support strength caused by femoral head necrosis and the collapse of subchondral bone fracture, so this determines that the early treatment is mainly to reduce weight bearing, such as walking with crutches or riding in a car to prevent the collapse of femoral head necrosis, which is also a watershed of symptom change, and patients often feel increased pain suddenly, and the pain is not relieved by medication as it was in the past. Other treatments include non-steroidal anti-inflammatory drugs (e.g., fenbid, mobicort, etc.) and lipid scavengers (e.g., lovastatin, clofibrate) therapy, blood and bone activating herbs, and hyperbaric oxygen therapy, combined with regular x-rays to observe the progression of the disease.
If conservative treatment is ineffective and signs of progressive disease development are found, some surgical interventions are needed.
1.Marrow core decompression surgery: It is currently believed that the increased pressure in the marrow cavity of the femoral head is one of the pathogenesis of femoral head necrosis, and drilling in the marrow cavity of the femoral head is conducive to relieving the high-pressure state in the femoral head. This procedure is generally used to treat early cases of femoral head necrosis (no obvious necrotic bone formation and no femoral head collapse), but the safety and effectiveness of medullary core decompression has been debated. Current studies have concluded that medullary core decompression alone provides significant relief of hip pain associated with early femoral head necrosis, but is not effective in preventing femoral head collapse. Therefore, some scholars are currently performing bone grafting after marrow core decompression to prevent femoral head collapse and have achieved certain clinical results.
2. Necrotic bone removal + bone graft with blood vessels: This surgical method is mainly for patients who have produced obvious necrotic bone in the femoral head but the femoral head is not collapsed or slightly collapsed. The main purpose is to remove the necrotic bone to relieve pain and to prevent collapse of the femoral head and repair the bone in the area of femoral head necrosis by bone grafting and bone grafting with blood vessels. There are many types of vascularized bone grafts, but the most recognized one is the vascularized iliac bone graft, which has been widely carried out and promoted in our hospital and has achieved very good clinical results.
3.Hip prosthesis replacement: Since femoral head necrosis is mostly seen in middle-aged and young people, while prosthesis replacement has a certain service life, therefore, hip prosthesis replacement is often a remedial method of last resort. However, for patients with femoral head necrosis older than 60 years old, it is currently the most certain method of treatment. For young and middle-aged patients, if the disease of femoral head necrosis is already in an advanced stage (severe collapse of the femoral head, narrowing of the joint space, formation of “bone spurs”) and the pain cannot be relieved by conservative treatment, the use of hip prosthesis replacement can significantly improve the quality of life. Hip prosthesis replacement for femoral head necrosis can be divided into femoral head surface replacement and total hip replacement. The surface replacement is suitable for young patients, and the prosthesis is only installed on the surface of the hip joint, while preserving as much bone and the normal shape of the femoral head as possible, which makes the joint stable and mobile after surgery and facilitates future revision surgery. The efficacy of total hip replacement is more certain, but it requires the best possible prosthetic material and excellent surgical technique to prolong the life of the prosthesis.
How should the patient cooperate with the surgeon?
For a patient diagnosed with osteonecrosis of the femoral head, the first thing is to build up the confidence to overcome the disease, neither to fear it as cancer, nor to think that there must be some kind of special medicine or treatment and blindly try it. As the saying goes, the best treatment is prevention. Changing some habits can greatly reduce the occurrence of osteonecrosis of the femoral head, such as using corticosteroids with caution; not drinking alcohol, smoking and eating too greasy food; avoiding obesity and preventing falls, etc. It must be emphasized here that we must prevent from seeking medical help in a hurry, we must be good at recognizing some false advertisements, and we suggest that patients go to regular hospitals to seek medical treatment from specialists.
In conclusion, osteonecrosis of the femoral head has become a very common disease, and seriously affects people’s quality of life. However, as long as early diagnosis, early treatment and correct treatment are achieved, patients with osteonecrosis of the femoral head can still achieve very satisfactory clinical results.