Avascular necrosis of the femoral head, an alarming disease

The article was written by Dr. Nguyen Dac Nghia - Head of Orthopedic Trauma Unit - Trauma - Orthopedic Unit - Vinmec Times City International General Hospital.

Currently, in our country, the number of young patients (< 50 years old) who need hip replacement surgery due to avascular necrosis of the femoral head tends to increase. The surprising thing: Alcohol may be the leading cause of femoral head gangrene. According to statistics of Orthopedic Trauma Centers in the country: 60 - 100% of patients with femoral head necrosis drink alcohol regularly (300 - 1500 ml of "national drink" / day).

1. Causes of the disease Professor Miguel Cabanela, Academician of the American Academy of Orthopedic Surgeons, Head of Orthopedic Surgery Department of Mayo Clinic Hospital, was also surprised when he performed total hip replacement surgery for 20 patients in Hanoi. In recent times, there are 16 male patients, aged 25 - 45, completely healthy, only one or both hip joints are severely damaged; There is no other option but to have an artificial joint replacement surgery. He asked: Why do people drink a lot of alcohol in the US or Europe but rarely get necrosis of the femoral head? Although more extensive studies are needed, the Professor also agrees with the "high-risk" nature of alcohol that has not been completely detoxified, which is consumed heavily over a long period of time. In particular, the patients are young and active, so the need for blood supply to the femoral head is very large. Alcohol can cause poisoning, embolism, infarction leading to necrosis of the femoral head.

2. Symptoms Another harmful thing about this terrible disease is: the disease appears very slowly, silently. Patients initially only feel fatigue or very vague pain in the hip area; lying down to feel less pain; Nothing to do with alcohol. Some people think that they have "rheumatism", also work hard to "combine Eastern and Western medicine" and feel less pain. After a few months, suddenly, there was severe pain from the groin to the back of the buttocks, it hurt even more when I moved my legs, it hurt even more when I drank alcohol. X-ray film shows flattened, distorted femoral head. There is no way to save the situation. Had to surgically remove the damaged joint, replacing it with a set of artificial joints.

3. Prevention and treatment of Artificial Joints ("Pseudo-joints") how to match your real joints? So can we avoid this situation of "unwillingness"? It's simple: don't drink alcohol indiscriminately. Still know the saying "prevention is better than cure" - very true; However, in everyday life, it is not easy to standardize this motto. Therefore, those who experience natural hip pain for no reason should seek an experienced chiropractor. In the early stages of the disease, conventional X-rays are barely detectable. Only Magnetic Resonance can lead to an accurate diagnosis. The American Academy of Orthopedic Surgeons also accepts Magnetic Resonance Every 6 months as a screening method for avascular necrosis of the femoral head for people at "high risk" such as heavy drinking, smoking. , have a hip or hip injury, have an old disease, use a lot of steroids (Prednisolone, Dexamethasone...), diver.

When detecting the disease at stage I, II, the surgeon can drill to depressurize the core of the head to increase blood perfusion to the "dry" area of ​​the head. This surgery is very gentle: just cut the skin about 2 cm, locate the necrotic area under the luminosity, drill a tunnel to conduct blood from the great trochanteric side through the femoral neck to the core of the head, all the way to the necrotic area. . Patients will feel relief immediately after surgery. More than 80% of necrotic head stages I and II were saved, without joint replacement surgery. Of course, the patient must abstain from alcohol and smoking. Unfortunately, the disease has reached stage III - a "very delicate" stage: because decompression drills cause further damage, bone and bone marrow transplants give very precarious results, joint replacement is too early, while the disease's painful condition The person has some help. Many doctors only give oral drugs and wait, if the disease turns to stage IV (increased pain, stiffness), then joint replacement surgery is indicated.
Although today's artificial joints are increasingly improved, able to respond to diseases, have better durability, but artificial hip replacement in young people still has many problems. . For sure results, artificial joint replacement should be performed by seasoned surgeons. Of course, experienced surgeons also need to be equipped with "a complete modern arsenal" to deal with any problems that arise during the surgical installation of the artificial joint.
Another very important thing that the patient should know: surgery contributes only 50% of the successful functioning of an artificial hip - the remaining 50% is Rehabilitation exercises that incorporate physical therapy. Proper treatment provided by well-trained professionals.