Should I have hip replacement surgery?

Author: Li Tao, deputy chief physician, Nanfang Hospital, Southern Medical University

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

Hip replacement is to replace the original necrotic bones and joints with artificial joints, relieve the patient's pain factors and improve joint function. Contrary to some patients who always refuse to undergo hip replacement, some patients ask doctors to replace their joints as soon as they are diagnosed with femoral head necrosis. Is this scientific?

If diagnosed with femoral head necrosis, does one need a hip replacement?

In the past, due to the lack of popularization of medical knowledge, many patients would only go to the hospital for diagnosis and treatment when they had serious conditions such as joint deformation and inability to walk. At this time, the disease had mostly progressed to the late stage of femoral head necrosis, and non-surgical treatment was ineffective, so surgical treatment (hip replacement) was the only option. Today, with the development of science and technology, the public has more ways to obtain health knowledge, and with the popularization of physical examinations, many patients with femoral head necrosis are diagnosed in the early stages, when the lesions are not serious, and non-surgical treatments such as weight reduction, physical therapy, and drug therapy can be used to relieve symptoms and delay the progression of the disease.

In summary, once a diagnosis of femoral head necrosis is confirmed, a joint replacement is not necessary immediately. First, the classification/staging must be clarified. The doctor will make a comprehensive judgment on whether hip replacement is needed based on factors such as disease stage and age. Generally speaking, early-stage femoral head avascular necrosis mainly uses non-surgical treatment to delay disease progression. If the disease progresses to ARCO stage 2-3, drilling decompression or bone grafting for hip preservation can be considered. If the disease progresses to ARCO stage 4, hip replacement is often considered as a treatment option.

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Can patients with femoral head necrosis avoid hip replacement?

For patients without femoral head collapse, hip-preserving treatment is the first choice. For patients with femoral head collapse, if they are unwilling to undergo hip replacement surgery, they can try hip-preserving treatment first, but the treatment effect may not be good.

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Hip preservation treatment includes non-surgical treatment and hip preservation surgery. Existing research data show that about 70% of patients with femoral head necrosis undergo hip replacement, while 30% of patients choose to preserve their hip joints instead of undergoing hip replacement.

1. Non-surgical treatment: including reducing weight, oral anti-inflammatory analgesics, physical therapy, etc.

2. Hip-preserving surgery: There are many treatment methods, but the effects vary. Among them, femoral head core decompression is the only treatment method that has been proven by evidence-based medicine to be effective for most patients. It can be used in conjunction with tantalum rod implantation, bone transplantation, platelet-rich plasma injection and other synergistic treatments. At present, there is still controversy about whether hip-preserving treatment can delay the progression of femoral head necrosis. However, practice has shown that many patients who receive hip-preserving treatment have pain relief and improved quality of life, thereby delaying the time for hip replacement.

What is the best age to undergo hip replacement surgery?

In the past, it was believed that 60 to 75 years old was the best age range for artificial hip replacement. With the improvement of artificial joint materials, the patient's age is no longer the primary factor affecting the implementation of artificial hip replacement. Therefore, artificial hip replacement no longer has a so-called age limit or age standard. If the disease seriously affects the quality of life, or the effect of the implemented treatment does not meet the expectations, and if you hope to improve your quality of life, you can ask a professional doctor to evaluate and then choose whether to undergo surgery.

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What are the indications for hip replacement?

About 30% of patients with femoral head necrosis never receive hip replacement surgery, which is related to individual factors and treatment effects. Of course, "when it's time to do it, do it." You can't avoid hip replacement surgery because you are afraid of surgery.

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3 indications for hip replacement.

1. The disease has caused inconvenience to the patient's daily life: for example, the patient is unable to complete simple daily activities such as going out to buy groceries, and the patient's social life is seriously affected.

2. Hip joint symptoms reduce the patient's sleep quality: for example, sleep is interrupted and turning over in the middle of the night will wake up from the dream.

3. Secondary lumbar spine problems: Due to limb imbalance or pelvic sway, the patient walks with a limp, causing secondary lumbar spine pain.

If any of the above three situations occur, it is recommended that the patient undergo hip replacement surgery. It is usually not recommended for such patients to postpone the surgery for too long, so as to avoid joint wear and tear causing bone sclerosis, which will affect the effect of the surgery (bone sclerosis will cause poor fusion of bones and joint prostheses). Patients with more internal diseases will have reduced motor ability and visceral function, so it is recommended to have surgery as soon as possible to avoid increased surgical risks.