Femoral head necrosis is a common difficult and complicated disease in orthopaedic field. It is widely called a non-fatal cancer. In clinical practice, we found many patients misunderstood this disease. Such misunderstandings have resulted in a range of ill consequences. In order that patients can have a correct look at femoral head necrosis, we specially invited Prof. Xiao Zhengquan of Beiya Orthopaedics Hospital to write this article. Wish it can be some help on patients.
Misunderstanding 1: femoral head necrosis is incurable
The early diagnosis and timely treatment of femoral head necrosis is of the most importance to the prognosis of femoral head necrosis. In the early stage of femoral head necrosis, hip joint is only in the stage of aseptic inflammation, blood congests and seeps out of joint capsule, the internal pressure of the capsule increases and femoral head is in a state of ischemia, but the bone trabecula of femoral head is yet to become broken and femoral head is yet to collapse into deformity，inflammatory and necrotic tissue can still be repaired without deformity, so the key to the treatment of femoral head necrosis is early diagnosis and timely treatment. All patients with suspect femoral head necrosis shall undergo early conservative treatment by regarding it as early-stage femoral head necrosis, for example: restrain movement, avoid carrying heavy objects, and internally and externally take TCM.
Therefore, we believe femoral head necrosis can be cured provided it is discovered and diagnosed in early stage. Moreover, with scientific and regular treatment, femoral head necrosis in the middle and late stages can also realize a clinical cure, i.e.: pain disappears, the condition doesn’t deteriorate, joint functions are retained and the expensive replacement of femoral head is avoided.
Misunderstanding 2: the only way out for femoral head necrosis is replacement of femoral head
Prof. Lu Houshan with the People’s Hospital of Peking University said, the use life of artificial joint is 20-30 years in general provided no infection, loose prosthesis and other complications take place. Therefore, the optimal age for artificial joints is above 60 years old. However, if a patient aged below 60 does suffer so serious joint disease that his/her daily life is affected, artificial joint can also be a feasible solution, only he/she must face an even longer test.
Femoral head necrosis is divided into four stages. Different stages have different treatment methods. Replacement of femoral head is a solution suggested only to aged patients whose condition has developed to the late stage and is also a choice of no choice. It should be noted that the replacement of femoral head is expensive and has many complications and a use life of about 10 years in general. Many patients fall into an abyss of repeated replacement of femoral head due to lack of scientific treatment. At present, many hospitals or doctors have started this “very difficult operation” and ballyhoo the advantage for replacement of femoral head, but actually, such operation not strictly complying with indications is a kind of over-treatment.
In medical world, there is a classic word which is “heteropathy”. It is applicable to femoral head necrosis, too. Clinical doctors shall adopt different treatment methods for different stages of femoral head necrosis, strictly understand the indications for replacement of femoral head, do their best to lessen patients’ economic and psychological burden and improve their life quality.
Misunderstanding 3: the curative effect for the treatment of femoral head necrosis with TCM can’t be evaluated
In order to overcome femoral head necrosis, this hard nut in the world, more and more domestic and foreign scholars are devoting their energy to it and various kinds of treatment methods are introduced, for example: total hip replacement, bone grafting, vascular implantation, interventional operation, and “Beiya Eight-Combination Integrated Therapy” under the guidance of “3 Tonified and 1 Promote” theory. These methods have achieved good curative effect and relieve most patients with femoral head necrosis from pain.
But, every treatment method has its limitation and pros and cons. How to correctly evaluate these methods and scientifically analyze their curative effect has once again become an attention focus of medical workers and the biggest concern of vast patients. At a number of influential national academic meetings for femoral head necrosis, experts made special discussion on how to evaluate the curative effect on femoral head necrosis and formulated some standards for evaluation of curative effect. However, they are not widely spread so far.
Beijing Beiya Orthopaedics Hospital has made in-depth research on the treatment, prevention and healthcare of femoral head necrosis. It introduced a new theory named “3 Tonifies and 1 Promote” for treatment of femoral head necrosis in Guangming Daily in 1993. The theory won municipal first prize for science advancement for the hospital. At the same time, President Xiao Zhengquan also worked out “Xiao’s Nine-type Stage Treatment Methodology for Third-stage Femoral Head Necrosis” and “Xiao’s Evaluation Standard for Curative Effect on Femoral Head Necrosis”. This standard scientifically evaluates and judges the clinical curative effect on femoral head necrosis in line with international practice from four aspects, i.e.: “cure, obvious effect, with effect, and without effect”. At present, this standard has widely recognized by academic circle of orthopaedics.
In order that patients can clearly understand the treatment they receive, Beiya Hospital further introduced a brand new concept named “digital evaluation" on the basis of the “evaluation standard for curative effect on femoral head necrosis”. We believe that the curative effect shall neither be the feeling of patients nor the subjective judgment of individual person or doctor. Instead, it shall be concluded based on the scientific data obtained from various kinds of examination and assay, because number is the most understandable expression. From 1 to 2, or 2 to 1, the simple change can be understood even by a 3-year-old child, but just such simple digital change reflects a trustworthy attitude at patients and medical science.
At Beiya Orthopaedics Hospital, no doctor is allowed to make blind diagnosis or treatment merely after pulse feeling and a few simple functional checks. The hospital owns high-precision X-ray film machine, dual-energy narrow-angle fan-shaped bone densitometer, automatic immunity analyzer and other modern detection equipment. After accurate diagnosis, we will provide characteristic treatment with priority given to TCM, and then compare and analyze examination data and X-ray photos before and after treatment. If the effect is not good, patients can immediately know it after a simple look at the photos!
Therefore, at Beiya Orthopaedics Hospital, through digital evaluation, both doctors and patients are very clear of the curative effect.
Misunderstanding 4: femoral head necrosis is local pathological change and there is no need for whole-body holistic treatment
Femoral head necrosis is a systemic disease, but manifested locally. In this context, it is similar to miocardial infarction triggered by cardiovascular disease and cerebral infarction triggered by cerebrovascular disease.
For example: femoral heads on both sides are necrotic and even multiple bone necrosis occurs on a same body; after femoral head necrosis, the micro circulation and blood rheology of the whole body will change. In addition, femoral head necrosis will be followed by limb cold, radiation pain and a range of changes on muscle, joint capsule and ligament. All these indicate it is a systemic disease. Some patients undergo artificial joint replacement due to femoral head necrosis on one side, but before long, the femoral head on the other side becomes necrotic, too. It also explains femoral head necrosis is not a local disease.
Since femoral head necrosis is a systemic disease, measures for systemic treatment shall be adopted, for example, using drugs that can dredge and expand blood vessels, promote blood circulation, remove stasis, tonify and nourish liver and kidney and strengthen bone and tendon. Measures for systemic treatment shall be taken while giving local treatment. Likewise, local treatment shall be provided according to patient’s actual condition while giving systemic treatment so as to improve local joint function.
All in all, as long as we properly combine local treatment and systemic treatment and spurn the unilateral treatment like treating the head when the head aches and treating the foot when the foot hurts, we will surely achieve a desirable curative effect.
Misunderstanding 5: patients with femoral head necrosis must stay in bed and shall not make movement
A traditional approach to the treatment of femoral head necrosis is to keep patients in bed and apply traction on the affected limb, thus limiting patient’s activity and their burden carried, reducing the load of femoral head and achieving curative aim. However, staying in bed and extraction will have some side effects, such as: muscle atrophy, contracture of joint capsule and ligament, and stiff joint. These side effects will add more misery on the affected limb and further deteriorate its dysfunction.
Therefore, we advocate to the utmost that patients should strengthen functional exercises on the precondition of limited load and walk. This can not only prevent complications of movement organs resulting from immobility but also dredge channels, promote blood circulation, maintain and improve joint function and create condition for treatment.
In medical practice, we often see that the more the pain is, the less the movement will be made by patients, whereas the less the movement is made by patients, the more the pain will be and the more contractive the joint will become. This forms a vicious circulation. On the contrary, if the patients can overcome pain and actively do functional exercises, the pain will be abated and limb function will be improved.
Therefore, we advocate a combination of restrained movement and functional exercises. In other words, patients should actively carry out functional exercises on the precondition of not carrying weight. In combination with whole-body systemic treatment, a desirable curative effect will be achieved.