Health Information

All About Femoral Head Necrosis

Release Date:

2023-07-31 20:41

A few days ago, I saw a patient who limped into the clinic, favoring the left leg and unable to put any weight on it, complaining of low-back pain.

 

However, we all know that low-back pain alone does not typically cause this type of limping; on examination, the lumbar symptoms were mild. Upon palpation of the hip joint, marked tenderness was noted in the left groin, with significant pain on both internal and external rotation. We therefore recommended a pelvic radiograph, which revealed avascular necrosis of the left femoral head.

 

01

What is femoral head necrosis?

 

Osteonecrosis of the femoral head is a pathological process that initially occurs in the weight-bearing region of the femoral head, where stress-induced damage to the trabecular bone architecture—manifested as microfractures—leads to subsequent repair processes targeting the injured bone tissue.

If the underlying causes of osteonecrosis are not eliminated and repair is incomplete, the cycle of injury and repair persists, leading to structural changes in the femoral head, femoral-head collapse and deformity, joint inflammation, and functional impairment.

 

02

Why does femoral head necrosis occur?

 

There are broadly three causes of femoral head necrosis:

 

The first category is trauma: when the hip joint sustains traumatic injury, particularly femoral head dislocation that remains unresolved for a prolonged period, ischemia of the femoral head often becomes irreversible, leading to avascular necrosis. Moreover, repeated, repetitive stress injuries to the hip joint can also result in ischemia of the femoral head, ultimately culminating in avascular necrosis.

 

The second category involves heavy alcohol consumption, particularly when the alcohol is of poor quality and contains numerous impurities. Such excessive drinking can disrupt the blood supply to the femoral head, leading to microcirculatory obstruction, ischemia of the femoral head, and ultimately, osteonecrosis.

 

The third category involves the unavoidable use of hormones during the treatment of various diseases; one of the side effects of these hormones is ischemic necrosis of the femoral head.

 

03

How is femoral head necrosis detected?

 

Patients with high-risk factors for femoral head necrosis can undergo the following methods to determine whether the condition has developed.

 

First, attempt to palpate the midpoint of the groin to determine whether there is any obvious tenderness on palpation.

 

Second, gently tap and percuss the greater trochanter of the femur—the lateral aspect of the hip joint—to assess for any associated hip pain.

 

Third, have the patient sit with legs crossed and observe for any hip pain.

 

Fourth, stand on one leg and observe for any hip pain.

 

If you experience significant pain in the hip or knee during the aforementioned examination, you should promptly seek evaluation and treatment at an orthopedic department of a Grade II or higher hospital.

 

04

How can femoral head necrosis be prevented?

 

First, it is essential to enhance awareness of hip joint protection. When walking, pay close attention to your footing and take precautions against falls, especially during winter when walking on icy or snowy surfaces—be sure to use anti-slip measures to prevent slips and falls.

 

Second, before engaging in physical activity, be sure to perform thorough hip warm-up exercises until your body feels warm and your limbs are sufficiently flexible.

 

Third, hip injuries should be treated promptly; under no circumstances should one engage in excessive walking before the injury has fully healed, to avoid repeated damage to the hip joint.

 

Fourth, when treating certain diseases—particularly pain-related conditions—hormonal medications should be avoided or used as sparingly as possible.

 

Fifth, try to avoid developing the habit of drinking heavily over the long term.

 

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