Due to its slow onset and chronic duration, patients with AVN of the femoral head may be asymptomatic for a long period of time. Most characteristic symptoms include discomfort or pain in the hip that aggravate upon fatigue or long hours of walking and alleviates after rest. During the pathological process of AVN of the femoral head, lumbosacral or knee pain in some patients are often misdiagnosed as lumbar intervertebral disc herniation, stenosis of the spinal canal, sciatica, rheumatic arthritis and bursitis. The most distinctive feature of this condition is disproportion between the severity of subjective symptoms and necrotic degree of the femoral head. Over time, patients may experience limp, aggravated pain and restricted hip joint function. This indicates a decompensation phase of the mechanical property of the femoral head, i.e., patients may have femoral head collapse or deformity, fibrous connection within the joint space or passing of trabecular bone through the joint space. In later stages, patients may have joint rigidity and disability.
- Computerized image analysis system can help with quantitative analysis, architectural identification, prognosis prediction and early morphological diagnosis.
- The treatment device for AVN of the femoral head can adjust electric potential difference and improve intraosseous bioelectrochemical environment as well as intraosseous stress.
- Release effective components of Zheng Qi San (qi-circulating and blood-invigorating powder), Hong Bao San (stasis-resolving and bone-strengthening powder) and Sheng Gu San (bone-regenerating powder) to specific points.
- Cheng Zai Wan (kidney yang-warming and meridian-unblocking pills) can improve bone structure and increase mechanical property of the femoral head.
- Chinese herbal diet can reinforce healthy qi and boost the immune system.
- Dynamic modeling of the head and acetabulum can reconstruct and remodel the hip joint.
- Pelvic balance adjustment can improve gait and coordinate gluteal muscles.
- Build a mechanical environment for bone repair by reasonable distribution between constant stress and intermittent stress. According to the Wolff's law, it's of great significance to balance external stress and internal stress (induced by muscle contraction) for trabecular distribution, bone shape and structure and repair the hip joint.
According to Chinese medical theory, the kidney dominates bones, growth and marrow. As a result, kidney-tonifying herbs can increase growth, development, calcification and metabolism of bone cells and organism, thus enhance the bone repair and reconstruction.
According to the Wolff's law, intraosseous stress state determines bone reconstruction.
According to the electromechanical property of the bone and cartilage, stress-generated potentials (SGP) can trigger cell reaction, induce bone growth and improve bone reconstruction and bone architectural repair.
According to meridian theory, the treatment device can work on different points to improve electric potential difference and bioelectrochemical environment within the hip joint, remove dead bones and regenerate new tissues, and speed up the repair of necrotic area. In addition, this can allow effective components of Chinese herbs and trace elements to be released to specific points around the hip joint to increase bone density and weight bearing ability of the trabecular bone. The Cheng Zai Wan (kidney yang-warming and meridian-unblocking pills) can increase estrogen level, improve intraosseous circulation, clear lipid droplets and perfect bone reconstruction and repair ability.
Based on biomechanics and ultrastructure of bone injury and effect of stress on bone repair, dynamic modeling of the hip joint can reconstruct bone structure and head-acetabulum molding, strengthen the elastic cartilage and weight bearing ability of fibrous cartilage, improve trabecular density and intensity per unit volume, perfect bone structural repair and restore the hip joint function.
The AVN of the femoral head can damage the tendons, bones and marrows. According to the academic idea of 'transforming necrotic tissues into new ones and culture pus for the sake of fresh tissue regeneration', the treatment strategy is to reinforce qi, nourish blood and fill up essence and marrow, thus strengthening bones, softening tendons and lubricating joints.
The new classification criteria for AVN of the femoral head have been established on the basis of national and international classification methods.
The criteria were based on the pain, limping, dysfunction, severity of bone structural destruction, computerized image processing analysis on radiographic findings and information-enhanced imaging of ultrastructure.
Factors related to classification principle also include architectural damage of the femoral head, head contour fragmentation, cystic degeneration, collapse, sclerosis, hypertrophy, structural disintegration, pathologic fracture, necrosis/sclerosis of acetabular cartilage, hip joint space narrowing, hip joint structural damage and later stage AVN of the femoral head complicated with osteoarthritis, since these factors may have a great impact on repair and reconstruction of the necrotic femoral head. It's necessary to analyze from the perspectives of microanatomy, pathology and ultrastructure injury.
The classification criteria were also based on retrospective studies and clinical observation on treatment of more than 9,400 patients with the novel therapy according to how Chinese medicine understands the AVN of the femoral head.
The computerized image analysis system can help with quantitative analysis on necrotic femoral head, improve identification using the naked eyes and reproduce a wealth of information that cannot be identified with the naked eyes on radiographs. In addition, this system can help with early identification of bone ultrastructure damage, analyze pathological changes during treatment and repair and thus set up a scientific treatment protocol. For instance, radiographs of the fig.2-1a shows a large cystic degeneration around the femoral head and neck, coupled with unclear trabecular bone structure. This indicates insufficient evidence for hip joint modeling and weight bearing exercise and concerns for head collapse and deformity. However, information-enhanced computerized image processing (fig. 2-1b) shows dense, regular alignment of trabecular ultrastructure and a gray value of approximately 120 in cystic degeneration area. According to these findings, the patient was encouraged to conduct dynamic modeling and exercise.
Traditionally, doctors often diagnose AVN of the femoral head with limited visual performance and clinical experience. They lack sufficient proof for damage degree of the bone structure. It's a breakthrough to employ computerized color image analysis in scientific and accurate diagnosis of AVN of the femoral head.
Dynamic hip joint modeling allows the hip muscles, femoral head and acetabulum to engage in movement. Experiments on intraosseous stress generating potential have found that piezoelectric effect and electrokinetic phenomenon can trigger cell reactions, i.e., bone reconstruction depends on intraosseous stress.
Because of simultaneous bearing of stretching, compression, shear force, twisting and bending, the hip joint stress is more complicated and stronger than other joints.
To maintain a relatively stable stress for the femoral head, it's essential to conduct functional hip joint modeling and avoid significant acceleration and impact force, i.e., to remodel the hip joint and at the same time minimize the weight bearing stress for the damaged bone tissue.
Dynamic modeling of the hip joint aims to repair and reconstruct the structure of the femoral head and acetabulum, improve physiological function of the hip joint and increase the patients' quality of life.
Along with advance in medical science and technology and increased awareness of health preservation, people tend to choose nonsurgical, noninvasive and pain-free therapies. As surgery damages the tissues, organs and structures, it should be the last option for both patients and doctors.
Generally, surgery is selected when it's the only option. It's advisable to choose non-surgical therapy for conditions that can be managed by both surgical and non-surgical methods.
As for AVN of the femoral head, some patients are happy to receive artificial joint replacement and some patients prefer nonsurgical noninvasive therapies. The novel therapy in this text has broadened the clinical means for AVN of the femoral head.
Instead of repairing the necrotic femoral head in geometric specifications (anatomy, histology and morphology), the nonsurgical therapy for AVN of the femoral head aims to improve or restore physiological functions of the hip joint.
Multiple factors need to be taken into consideration in an overall treatment protocol for AVN of the femoral head. These include subtypes, degree of destruction to the femoral head and hip joint structures, severity of functional loss, patient's age, occupation, physical condition and expectation for hip joint repair. Only by coordination between patients and doctors, can the rehabilitative aim be achieved.