Necrosis of the femur

Necrosis of the femur's disease overview

Bone necrosis is a condition of nurturing anemia, which leads to bone tip , although this phenomenon can occur in any bone in the body such as a boat bone, Slug bone, arm bone. However, the most common is the femur, called femoral necrosis . This disease can be seen on one side, sometimes both sides, commonly seen between the ages of 30 - 50. According to the American Orthopedics Association, about 10,000 to 20,000 people have this disease every year, accounting for about 10%. Total number of artificial joint replacement cases.

Most cases of femoral necrosis occur after a strong injury such as a thigh neck fracture, hip dislocated. Injury injury directly nourished blood vessels leads to the femoral tip of the femur. Bone cells are necrotic due to lack of oxygen and nutrients. Or due to some other causes such as alcohol abuse, long -term corticoide, gas disease (in divers, mining workers), sickle cell disease, spontaneous clogged ...

Causes of Necrosis of the femur's disease

The cause may be due to injury (fracture or dislocated) or not due to injury:

  • Due to trauma: Dislines or by the thigh bone fracture or dislocated joints, pinching blood vessels due to turbocharger in the hip joint. Normally necrotic appears after an injury about 2 years and does not affect much to the age and gender.
  • No injury: Most of the cause of necrosis is not due to injury is due to:
  • Drink lots of alcohol, smoke: the main culprit causing early femoral necrosis in the South, this is the main factor that hurt, Chronic inflammation and clogging of capillaries (small blood vessels) raise the femoral head, leading to the cartilage bone cells in the head of anemia and necrosis. 

    • Use high doses of corticosteroids

  • Gout
  • Blood diseases: Crescent blood cells
  • Patients with cancer are treated with chemotherapy or radiotherapy
  • Gas disease (divers, mining workers)
  • Sickle blood cell disease

    • Collagen disease such as lupus erythematosus

    Agency transplantation

  • Pathology increases frozen and spontaneous vascular obstruction.

    • In which, alcohol and the use of corticosteroids to treat joint diseases, accounting for two -thirds of the thigh necrosis causes of no injury.

    Symptoms of Necrosis of the femur's disease

  • In the early stages of the disease, the symptoms are very discreet, the patient may not see any symptoms.
  • When the disease progresses worse, you may feel pain in the hip, pain can spread to the thigh, initially pain when walking, later pain even when resting. The late stage when the bone is damaged, will reduce the amplitude of the hip joint. Patients with legs are very difficult, many people cannot be formed to step on their own motorcycles. The patient has a limited gait, sometimes the legs are staggered. The time from the beginning to the loser of the hip function can be from a few months to more than a year depending on the different patients. 
  • There are many cases where patients only have knee pain without hip pain, so it is easy to be mistaken for knee osteoarthritis. During this stage, X -rays may not see any unusual manifestations so patients go to the doctor in many places but have not found the disease. 

    • Therefore, patients should think of femoral necrosis when they find themselves in a high risk group as stated and accompanied by expression Special or special hip pain, especially when squatting, hip closed, rotating in the hip, pain when walking a lot or long standing and decreasing when resting or having persistent knee pain without finding but not looking for Causes of damage at the knee joint. Patients need to see a large hospital with musculoskeletal specialist for early diagnosis and treatment.

    People at risk for Necrosis of the femur's disease

    The disease is mainly in men (accounting for about 80%) and an average age of 40 - 50. But currently the disease is tending to gradually rejuvenate especially in a group of young men about 30 years old, which has manifested the disease. femoral necrosis.

    Common disease in people with risk factors of the above -mentioned cause.

    Prevention of Necrosis of the femur's disease

    Therefore, the prevention of femoral necrosis requires each of us need to set up a healthy, physical and physical daily life regime. Remove such as alcohol, tobacco, corticosteroids

    Diagnostic measures for Necrosis of the femur's disease

    After asking for medical history, history and exam search, the doctor will appoint imaging means to diagnose and determine the stage. Like many other diseases, the sooner the diagnosis, the higher the chance of successful treatment. 

  • X-ray: is the first diagnostic means that most doctors suggest to the patient, this is the simplest and least expensive means. X-rays can be seen but the bone pocket in the femur, the shape of the femur are collapsed, the joint surface collapses. The earliest sign of seeing on X-rays is the crescent moon mark. However, X-ray is not sensitive enough to detect the early stage of the disease.
  • Magnetic resonance imaging (MRI): is the most sensitive, most effective means to detect femoral necrosis in the early stage. Unlike X -ray or CT scanner, MRI detects chemical changes inside the bone marrow, so it can detect the femoral necrosis in the stage very early, even before symptoms of joint pain. groin. 
  • Computerized tomography (CT Scan): CT Scan can bring 3 -dimensional image of the femur. However, it is not more sensitive than MRI so many doctors do not agree to use CT to diagnose the disease.
  • Biopsy or thigh pressure measurement are meant to diagnose the disease. However, it is rarely applied because they are an invasive procedure like a surgery. 

    • Necrosis of the femur's disease treatments

    The purpose of treating femoral necrosis is analgesic, improves the function of diseased joints, prevents bone destruction. Treatment may be conservation or surgery. To decide the appropriate treatment plan for each patient, the doctor will consider the following important factors:

  • The age of the patient
  • Disease stage
  • Location and size of the damaged area on the femur. 
  • Causes and associated risk factors. 

    • Effective and thorough treatments, especially hip surgery, besides eliminating possible risk factors (smoking, alcohol, corticosteroids). Other methods such as painkillers, calcium, combined medical treatment, pressure drilling, etc. are only methods to delay surgery.

    Non -surgical methods: medication, joint exercise, electrical stimulation, ... as directed by the doctor. Conservative treatments should only be applied before the femoral head collapses.

    Surgery

    There are many surgical methods to treat thigh bone necrosis depending on the stage of the disease, and the age of the patient.

    This surgical drilling drill will remove the dead bone core inside the femur, reducing the pressure in the bone, increasing perfusion, helping to regenerate more blood vessels.

    Effective pressure reduction surgery in the early stages of the disease before the crop collapse. This surgery sometimes reduces pain symptoms and slows down the progression of the disease.

    This surgical shaft opaque is very effective for early stage diseases and small necrotic bone area. However, recovery time after surgery lasts about three months.

    Use a pelvic or bone bone with a pelvic bone with a blood vessel to be grafted into the femur. After scraping, remove all dead bones in the thigh bone, the doctors will pair into a pelvic crested piece of the pelvic bone or a pieces of blood vessels. Thanks to the new blood vessel will increase blood supply for the femur.

    The recovery time is still slow, from 6 to 12 months, the problem of this method is still controversial. 

    Artificial joint replacement

    If the patient's bone tip has been damaged or other treatments do not bring effect, the artificial joint replacement is the best solution. So far, many studies in the world have published monitoring results after changing artificial hip joints, good results about 90%, the patient found reduced pain symptoms clearly, traveling almost normal.

    Depending on the age of the patient, the femoral tip, the stage of the disease, the doctor will choose which matching method is suitable for you. 

    There are many methods of artificial hip replacement that is applied to femoral necrosis such as changing the joint surface, replacing the whole hip joint. Replacing the joint surface and replacement of total hip joints often bring high efficiency. The patient has no symptoms of pain, the hip function recovers almost normal. Patients can return to daily activities, the durability of these two joints usually lasts long, on average 10 years, sometimes lasting up to 20 years. However, that durability also depends on the bone quality of the patient, the artificial joint surgery technique of the surgeon.

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