Staging of femoral head necrosis
Staging of femoral head necrosis (currently doctors generally stage it based on X-ray evaluation):
Stage I femoral head necrosis can only be detected on MRI examination, it is not visible on X-ray, and the patient does not feel any pain.
Stage II femoral head necrosis is visible on X-ray, and at this stage, the patient may experience some discomfort, such as pain in the hip joint.
Stage III femoral head necrosis, as seen on X-ray, shows fractures in the femoral head, or the previously round femoral head is no longer round. At this point, the patient will feel pain when moving, and rest does not significantly relieve the pain.
Stage IV femoral head necrosis, as seen on X-ray, shows the femoral head is clearly not round, and the acetabulum matching the femoral head also becomes irregular, along with severe osteoarthritis.
For Stage I and II femoral head necrosis, most cases do not require joint replacement. Only when the necrosis area in Stage II is very large, joint replacement may be considered. Additionally, as seen in my previous articles, the success rate of preserving the hip joint in Stage I and II is 82.7%.
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If one discovers through X-ray that their femoral head is not round and experiences pain, especially nocturnal pain, then joint replacement may be considered. However, for some patients whose X-rays show a non-round femoral head but do not feel pain, joint replacement may not be necessary. Furthermore, in cases where femoral head necrosis leads to unequal leg lengths, if the use of heel lifts can equalize the lengths without causing pain to the patient, joint replacement may not be needed. Joint replacement is only necessary when femoral head necrosis leads to osteoarthritis, causing pain during movement and affecting daily life.
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