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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

Femoral head necrosis is an orthopedic disease that seriously affects people's quality of life. It causes structural changes and collapse of the femoral head, leading to joint dysfunction and causing great pain to patients. Femoral head necrosis is not uncommon in clinical practice, but many ordinary people do not know about it or have never even heard of it. It is very important to understand the relevant knowledge of femoral head necrosis.

1. Under what circumstances should you suspect that there is a problem with the femoral head and seek medical attention as soon as possible?

1. Persistent pain in the hip, buttocks, or groin.

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2. The walking posture is unnatural, with a limp, or the two legs seem to be of different lengths.

3. About 30% of femoral head necrosis is related to trauma. Therefore, people with the following history of trauma should be more careful: ① History of hip dislocation/subluxation caused by strenuous exercise; ② History of femoral neck fracture caused by falls; ③ History of open trauma of the lower limbs (especially the thigh).

The above-mentioned trauma can suddenly interrupt the blood supply to the femoral head, leading to ischemia or even necrosis of the femoral head. Patients with a history of hip trauma should pay special attention to subsequent problems.

4. Others. ① Alcoholics; ② Patients with kidney disease, systemic lupus erythematosus, etc. who need to use glucocorticoids for a long time. These two groups of people are more likely to suffer from femoral head necrosis than the general population.

In short, if people who have hip trauma, are addicted to alcohol, or use glucocorticoids for a long time experience hip discomfort, they must consult or examine a specialist.

2. Which department should I go to in the hospital for hip pain?

The scope of orthopedic treatment covers a variety of sports system diseases, and femoral head necrosis is a common and difficult-to-treat disease in orthopedics. When hip or groin pain has persisted for a period of time, or if you feel that you are walking unsteadily or even limping, and your hip joint is not moving freely, and you suspect that there is a problem with your hip joint, it is recommended to go to the orthopedic or joint surgery department for treatment. Some hospitals will also open a specialist clinic for femoral head necrosis. In addition, you can also pay more attention to whether the hospitals in your city have experts with rich experience in the diagnosis and treatment of femoral head necrosis.

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3. What are the questions that outpatient doctors must ask when treating patients?

When seeing a doctor in an outpatient clinic, do you always feel that you have to think for a long time before the doctor asks you questions, but you never have the chance to say what you want to say? Patients should prepare answers in advance to make the doctor's consultation more efficient. If the doctor suspects that there is a problem with your femoral head, he may ask you the following 8 questions. Are you ready to answer them?

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1.Where does it hurt?

Pain is usually the reason that prompts patients to seek medical treatment, and "where it hurts" is also the most direct way to reflect the condition. Common pain sites for femoral head necrosis often occur in the hip, buttocks or groin. Therefore, before seeing a doctor, patients can carefully recall where the pain occurs.

For patients with hip pain, the doctor may also ask, "Do you have lower back pain? Do you have pain in the back of your thigh? Do you have pain in your calf?" These questions can help the doctor diagnose whether there are problems with the spine, nerves, and soft tissues.

2. What is the degree and method of pain?

Do you think it is difficult to express the degree of pain in words? The visual analogue scale (VAS) is a method for assessing the degree of pain. It is widely used in clinical practice because it is simple, objective and sensitive. A 10 cm long straight line is usually used, with "no pain (0)" and "worst pain (10)" marked on both ends. The patient makes a mark at a certain point on the straight line according to the degree of pain he feels. The distance from the starting point to the mark indicates the degree of pain. 1 to 3 points indicate mild pain, 4 to 6 points indicate moderate pain, and 7 to 10 points indicate severe pain. "How it hurts" refers to the nature of the pain, such as sharp pain, dull pain or tearing pain.

3. Under what circumstances does it not hurt, or not hurt as much?

In addition to the nature and degree of pain, doctors will also pay attention to the pattern of pain occurrence to help with differential diagnosis. You can also describe the pain by whether it affects walking, standing, or whether it hurts when lying down to rest. For example, pain caused by intramedullary hypertension will not be significantly relieved after rest in a short period of time; while pain caused by early osteoarthritis lesions can usually be relieved after rest, local application of blood-activating and blood-stasis-removing drugs, etc.

4. Is the pain related to weather changes?

Many people may believe that some joint pains are related to weather changes. The pain often worsens on rainy days, just like the weather forecast at the weather station. This phenomenon can help doctors identify whether the pain is osteoarthritis or rheumatoid arthritis.

5. Do you have a history of drinking?

Patients must answer this question accurately: "No drinking", "Occasionally drinking", or "Drinking every day"? How much do you drink each time? How many years have you been drinking? Are you drinking red wine, white wine, or beer? "When you are happy in life, you should enjoy yourself to the fullest, and don't let the golden cup face the moon empty", but if the golden cup is empty, the femoral head may also be "broken". Among the many causes of femoral head necrosis, heavy drinking is an important cause, and the more you drink, the greater the risk of femoral head necrosis.

6. Any history of other diseases?

Doctors ask about other medical history to find out whether the patient has been using glucocorticoids for a long time and in large doses. Is it because of an acute disease that has caused glucocorticoids to be used once or twice, or is it because of a chronic disease that requires long-term use? If the patient does not know whether the drug he is using is a glucocorticoid, it is recommended to remember the name of the disease and the name of the drug in advance. Long-term and large-dose use of hormones can cause some adverse reactions, one of which is femoral head necrosis.

However, don't worry too much, as using hormones does not necessarily lead to femoral head necrosis. Long-term, high-dose use of hormones is associated with a greater risk of femoral head necrosis. For example, patients with systemic lupus erythematosus, ankylosing spondylitis, rheumatoid arthritis, and nephrotic syndrome who need to use hormones for a long time should observe whether the femoral head has lesions.

7. What is the patient’s occupation?

The blood vessels in the femoral head can be damaged in a rapid decompression environment. Therefore, people who work in an environment with changing pressures for a long time, such as pilots and divers, are more likely to suffer from femoral head necrosis.

8. Is there any history of trauma?

For example, a fall may result in a hip fracture or dislocation, or a traffic accident may result in a hip injury. The patient needs to recall the circumstances of the injury and how they handled it.

It is recommended that patients prepare answers to the above 8 questions before seeing a doctor, so that the doctor can learn more effective information within the limited consultation time, so that the subsequent diagnosis and treatment can be more targeted.