Therapy of femoral head necrosis
The therapy of femoral head necrosis depends on how far the disease has already progressed. The cause of the deficient blood supply to the femoral head is also decisive. If, for example, high nicotine and alcohol consumption leads to femoral head necrosis, the therapy of femoral head necrosis can consist of dispensing with both stimulants in order to ensure sufficient blood supply to the bone.
If the patient is still in stage one, the most suitable therapy for femoral head necrosis is drilling. In this case, a small operation is performed by drilling a small canal to ensure that new blood vessels are formed above the femoral head, which then ensure that the bone is sufficiently supplied with blood again and is therefore not degraded. At a more advanced stage, an advanced therapy for femoral head necrosis must be sought.
In this case, it may be necessary to cut through the bone in a larger operation (osteotomy) so that it can then be adequately reassembled and can bear the weight of the hip. Furthermore, even in advanced stages, partial reaming can be considered as therapy for femoral head necrosis. Another possibility for the therapy of femoral head necrosis are reverse plastics and cancellous bone fillings.However, since reverse plastic surgery is very rarely performed, patients in an advanced stage of the disease are more likely to resort to a hip prosthesis as a therapy for femoral head necrosis, as this ensures that the patient can fully re-integrate the hip within a few weeks without feeling pain.
Step-by-step scheme Therapeutic procedure
Stage of necrosis, extent of necrosis, aetiology of femoral head necrosis (cause), pain, age of the patient, level of suffering, concomitant diseases The measures listed below are treatment options, suggestions, so to speak. However, the treating physician must always take individual circumstances into account in order to achieve the best possible treatment. The criteria mentioned above must always be taken into account.
In these stages of femoral head necrosis, it is possible to drill the necrosis site in order to achieve bleeding and, in the longer term, the formation of new blood vessels. The aim is to supply blood to necrotic areas of the hip joint. Postoperatively, a six-week relief period must be expected, which should be followed by a partial weight bearing period of about the same length.
Full weight bearing can be expected after 10 to 12 weeks, although individual differences may occur. In these stages of femoral head necrosis, a more intertrochanteric repositioning osteotomy is usually chosen. The aim is to rotate the necrotic focus away from the load.
Appropriate further treatment measures can also be taken. The postoperative relief period is in the range of 4 to 5 months. As a rule, only a total endoprosthesis of the hip joint can help here.
As a rule, non-cemented prostheses are used for this purpose. Since the disease usually occurs quite early, a total endoprosthesis is one of the last measures to be taken. Artificial joints cannot be replaced indefinitely.
Therefore, further treatment methods must first be considered. Drilling of the femoral head necrosis is particularly indicated in the first stage, as the patient has no bone loss at this stage. Drilling of the femoral head necrosis in stage 1 and 2 is performed under general or regional anesthesia.
In order to see exactly where the doctor has to drill the femoral head, it is necessary to perform the operation with the help of a mobile X-ray machine, whereby the radiation exposure is kept as low as possible. During the drilling of the femoral head necrosis, the patient is in a supine position, whereby the leg on which the drilling is performed should be freely movable. Drilling of the femoral head necrosis is performed with wires and is intended to promote blood circulation to the bone.
Since the bone is already partially dead in the case of femoral head necrosis, it is possible that parts of the bone cannot be preserved and are degraded even after the cannulation. The hope, however, is that new blood vessels will be formed by the drilling of the femoral head necrosis, which will then ensure that the old dead bone is broken down and new, healthy bone is rebuilt instead, so that the hip joint can be loaded again and no longer hurts. In the first stage, the drilling of the femoral head necrosis represents the standard therapy, as this is where the greatest success is achieved.
Drilling can also be helpful in stage 2 or 3, but it is usually not sufficient as the only treatment. Overall, the success of the drilling of the femoral head necrosis depends very much on the extent to which the patient is cooperative after the operation (shows compliance). If a patient suffers from femoral head necrosis due to his heavy nicotine consumption, the drilling of the femoral head necrosis will only help if the patient stops smoking.
In general, however, the cannulation procedure shows good results. However, since many patients only discover femoral head necrosis at an advanced stage and classify it as a disease, the hip often has to be replaced completely (hip joint replacement with endoprosthetics). As a rule, femoral head necrosis is only operated on in an advanced stage. The operation serves to relieve the damaged part of the femoral head or to enrich it with bone substances. Surgical methods include the drilling of the femoral head, a repositioning osteotomy, bone grafts and, as a last resort, the use of an artificial hip joint.
