There is a good doctor for a butt disease, but can a broken head also be rejuvenated?

Author: Liu Weilu, attending physician at Nanfang Hospital, Southern Medical University

Reviewer: Wang Jian, Chief Physician, Nanfang Hospital, Southern Medical University

Femoral head necrosis, a troubling disease, is affecting the quality of life of many people. It is like a "time bomb" hidden in the body, bringing endless pain and inconvenience to patients. Femoral head necrosis is not an incurable disease, although it is called "immortal cancer", but with the continuous advancement of medical technology, we have more and more effective treatments.

1. How to treat femoral head necrosis?

The principle of treating osteonecrosis of the femoral head is to implement a step-by-step treatment strategy based on staging/grading. After accurately staging/grading osteonecrosis of the femoral head, the corresponding treatment can be carried out. At present, osteonecrosis of the femoral head is divided into stages 1 to 4 according to ARCO. These 4 stages represent the progression of the entire disease, and different treatments are carried out in roughly 3 stages.

1. Stage 1: The patient's condition is in the early stage, i.e. stage 1 to 2. At this stage, the scope of femoral head necrosis is small and the morphology is basically normal. Generally, non-surgical treatments such as medication, weight reduction, and physical therapy are used to improve symptoms and prevent the femoral head from continuing to develop to collapse.

2. Stage 2: The patient's condition has developed to stage 2-3, with extensive femoral head necrosis. The symptoms of this stage are more obvious, and surgical treatment is required according to the patient's condition, such as core decompression. If the cavity in the femoral head necrosis area is relatively large, in order to avoid collapse, the doctor will use vascularized bone grafting (vascularized bone transplantation) method.

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3. Stage 3: The patient's condition has progressed to stage 4, with severe femoral head deformation. At this point, according to the guidelines, the doctor will consider using artificial joint replacement for surgical treatment.

2. What is non-surgical treatment? What is surgical treatment? What is hip preservation treatment?

Treatments for femoral head necrosis include non-surgical treatment and surgical treatment.

1. Non-surgical treatment: including protective weight-bearing, drug therapy, traditional Chinese medicine treatment, physical therapy, immobilization and traction.

Protective weight-bearing: Avoid impact and confrontational exercises. Using crutches can effectively relieve pain, but using a wheelchair is not recommended. If a wheelchair is used for a long time, the patient will become dependent on it and the willingness to walk will gradually decrease.

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Drug treatment: Anticoagulants, fibrinolytics, vasodilators, and lipid-regulating drugs can be used in combination to improve blood supply to the femoral head, and drugs that can increase osteogenesis and inhibit osteoclasts can be used to maintain femoral head bone mass.

Traditional Chinese Medicine Treatment: Generally, drugs that promote blood circulation, remove blood stasis, strengthen the kidneys and bones are given (you should go to a regular medical institution for early standardized treatment).

Physical therapy: extracorporeal shock wave, electromagnetic field, hyperbaric oxygen therapy.

Immobilization and traction: For patients with large-scale (area > 30%) femoral head necrosis, immobilization and traction treatment can be used in the early stage of collapse; patients with necrosis area < 30% only need to stay in bed and do not need traction treatment.

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2. Surgical treatment: When femoral head necrosis progresses rapidly and non-surgical treatment is ineffective, surgical treatment can be chosen. Surgical methods include repair and reconstruction surgery that mainly preserves the patient's own femoral head (commonly known as "head-preserving surgery") and artificial hip replacement.

Head-preserving surgery: including core decompression, osteotomy, bone transplantation with or without blood supply, etc., suitable for patients with early and middle stage femoral head necrosis. If the above treatment methods are effective, artificial hip replacement can be avoided or postponed.

Artificial hip replacement: also known as "joint reconstruction", is the use of artificial materials to replace the original damaged joints, so that the joints can restore their normal function. Artificial hip replacement is the only option for terminal diseases.

3. Hip-preserving treatment: Among the methods for treating femoral head necrosis, except for artificial hip replacement, other treatments (including non-surgical treatment and surgical treatment) are all hip-preserving treatments.

3. What is head-saving surgery? Which ones have been eliminated in clinical practice?

Head-preserving surgery refers to a repair and reconstruction surgery that mainly preserves the patient's own femoral head. In the early and middle stages of femoral head necrosis, head-preserving surgery can effectively prevent and limit the progression of femoral head necrosis. Common head-preserving surgeries for femoral head necrosis include simple core decompression, core decompression and bone grafting, core decompression combined with tantalum rod implantation, core decompression combined with vascularized free fibula or iliac bone flap transplantation, and transtrochanteric rotational osteotomy.

Interventional surgery, hip synovectomy, hip cleaning, soft tissue release around the hip, vascular bundle implantation, etc. are also head-preserving surgeries, but with the development of medical technology, the above surgeries have gradually been eliminated in clinical practice.

4. What is the effectiveness of core decompression in treating early and mid-stage femoral head necrosis?

At present, core decompression is a widely accepted and proven head-preserving surgical method for treating early and middle-stage femoral head necrosis. It is suitable for femoral head necrosis ARCO stages 1 to 2.

Femoral head necrosis leads to increased intramedullary pressure in the femoral head. Core decompression relieves the high intramedullary pressure in the femoral head by drilling to improve the blood circulation in the femoral head. At the same time, the blood supply in the drilling tunnel is restored, and joint pain is rapidly relieved.

Initiating trauma repair and bone healing processes can help treat early and mid-stage femoral head necrosis.

Core decompression has been used in clinical practice for a long time and has good efficacy. It is mainly divided into fine needle hole drilling decompression and large channel core decompression. The difference between the two lies in the diameter of the decompression channel. The diameter of the channel of fine needle drilling decompression is 3.0 mm, 3.5 mm and 4.0 mm, and the diameter of the channel of large channel core decompression is above 6.0 mm.

Simple core decompression is mostly used to treat early-stage femoral head necrosis (no obvious necrotic bone formation, no femoral head collapse). Although this procedure can significantly relieve the hip pain caused by early femoral head necrosis, it cannot effectively prevent the progression of femoral head necrosis.

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At present, the clinical trials of core decompression combined with stem cell transplantation in domestic medical institutions have shown good results. However, so far no related product has obtained national approval and is limited to clinical research.