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Author: Xiao He, attending physician at Nanfang Hospital, Southern Medical University

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

The symptoms of femoral head necrosis are often hidden and easily overlooked. The most obvious symptoms include hip pain, especially when bearing weight, which may be accompanied by lameness, poor flexion and extension, and difficulty squatting. If not treated in time, the condition will gradually worsen. As necrosis progresses, the structure of the femoral head changes and collapses, the joint function is seriously impaired, and it may even lead to disability, greatly affecting the patient's life and work.

1. What are the most obvious symptoms of femoral head necrosis?

The most obvious symptom of femoral head necrosis is pain in the hip or groin area. Pain is not only an alarm, but also reflects the severity of the disease to a certain extent.

In the early stages of femoral head necrosis, patients generally have no pain symptoms, or the pain is mild and can generally be relieved after rest. When the bone marrow is edematous and the pressure in the femoral head increases, the pain will be further aggravated and the joint movement will be limited, but the pain can still be relieved after rest. During the edema period, the trabeculae are broken and the pain will continue to intensify. If effective treatment is received at this time, the pain can be relieved; if not treated in time, the condition will continue to progress to the collapse of the femoral head, the pain will progressively worsen, and the joint movement will become worse and worse.

In the late stage of femoral head necrosis, patients feel pain when they move, but no pain when they don't move. The pain makes patients miserable and unable to move. In some patients, at a certain stage, the pressure in the femoral head is released as the femoral head collapses, and some patients feel that the pain is suddenly relieved, but in fact, the condition of femoral head necrosis is still progressing.

2. How will femoral head necrosis develop if left untreated?

Clinically, the course of most femoral head necrosis is irreversible. If left untreated, the disease will continue to worsen and may even cause disability.

1. Early stage: The blood supply to the femoral head is blocked, and it cannot get enough nutrients. The femoral head is ischemic and hypoxic, and edema occurs. The pressure in the femoral head increases, resulting in obvious hip pain. At this time, if not treated, 80% of patients will experience joint surface collapse and joint damage within 48 months, which will lead to difficulty in walking and limping when walking. Daily life activities are restricted, for example, it is difficult to squat when going to the toilet and the legs cannot be lifted when putting on socks.

2. Late stage: Hip joint movement is limited, pain occurs when moving, and patients may even be unable to walk independently. Patients use crutches or sit in a wheelchair to travel, which seriously affects their quality of life. Reduced exercise may cause some diseases, such as obesity, osteoporosis, cardiovascular and cerebrovascular diseases, etc.

3. How to detect femoral head necrosis early?

To detect femoral head necrosis early, you can make a judgment through 3 steps and 7 actions.

Step 1: Pay attention to the early symptoms of femoral head necrosis, namely hip pain.

Step 2: Use 6 movements to determine whether the hip joint is flexible. If pain occurs in the groin (hip) during these 6 movements, it indicates that the joint movement is limited.

Figure 1 Copyright image, no permission to reprint

Step 3: If you feel pain in the groin (hip) when you cross your legs, it may be femoral head necrosis. If you can't do this movement, it's best to go to the hospital as soon as possible for professional examination.

Figure 2 Copyright image, no permission to reprint

4. How to prevent femoral head necrosis?

Prevention should be targeted at the causes of femoral head necrosis. Femoral head necrosis is caused by obstruction of blood supply to the femoral head due to various reasons. Common causes of obstruction of blood supply to the femoral head include drinking, trauma, and the use of large amounts of glucocorticoids.

Therefore, if ordinary people do not want to suffer from femoral head necrosis, they must not allow the femoral head to suffer from ischemia. If they do not want to suffer from ischemia of the femoral head, they must abstain from alcohol and smoking, avoid damaging the femoral head, and avoid using large doses of hormones.

In recent years, the abuse of drugs containing glucocorticoids is one of the reasons for the increasing incidence of femoral head necrosis. Therefore, it is necessary to avoid the use of some Chinese patent medicines with unknown ingredients, which may contain a large amount of glucocorticoids.

5. How can high-risk groups prevent femoral head necrosis?

People with high-risk factors for femoral head necrosis should be detected, diagnosed and treated early. Those who use hormones for a long time, drink a lot of alcohol and have a history of femoral neck fracture should go to the hospital for regular check-ups.

In the early stages of femoral head necrosis, the bone structure has not changed and patients often have no obvious symptoms. Especially for patients with hip discomfort (high-risk group), regular pelvic X-rays and hip MRI examinations should be performed, which will help detect lesions early and improve the effectiveness of treatment.