Can femoral head necrosis be inherited?

In the early stages of bone necrosis, there may be bone pain and even local pressure, which will have a certain impact on the body. Therefore, when bone necrosis occurs, it is a very critical step to choose an appropriate method of treatment. In addition, it should be noted that other auxiliary examinations can identify the cause of bone necrosis, which is generally not hereditary.

Disease diagnosis

This disease should be differentiated from early metastatic cancer of the femoral head, osteosarcoma, osteophyte disease, slipped capital femoral epiphysis or necrosis of the capital femoral epiphysis combined with severe joint degenerative changes.

Inspection method

Laboratory tests:

Hemodynamic examination and intramedullary pressure measurement: Under local or general anesthesia, a cannula needle is directly inserted into the medullary cavity of the intertrochanteric region of the femur to measure the intramedullary pressure in the lesion area. This method can detect abnormal changes in bone tissue earlier than conventional X-ray and radionuclide bone scanning examinations, and has certain value in the early diagnosis of femoral head necrosis. Normal intramedullary pressure is less than 4 kPa (30 mmHg), while it is often greater than this value in patients with femoral head necrosis. If an appropriate amount of normal saline is injected into the medullary cavity at the same time and the pressure changes are observed (impact test), it will help to further discover potential pathological changes.

Other auxiliary examinations:

1. Intramedullary venous X-ray photography: Contrast agent is injected into the medullary cavity through a cannula for measuring intramedullary pressure. Continuous X-rays are taken to observe the course and emptying of the contrast agent in the medullary cavity, thereby examining the course of blood vessels and providing a basis for the early diagnosis of femoral head necrosis. Like intramedullary pressure measurement, its disadvantages are poor specificity and invasiveness.

2. Histopathological examination can be used as a basis for the diagnosis of femoral head necrosis. In the early stage, plasma stasis, interstitial edema, and occasionally foam cells and small areas of eosinophilic reticular necrosis in yellow bone marrow can be seen. Subsequently, the area of ​​eosinophilic reticular necrosis expands, all the bone marrow cavities are filled with necrotic tissue, and trabecular necrosis occurs. Finally, the bone marrow partially becomes fibrotic, the number of necrotic trabeculae further increases, and new bone cells surround them.

3. Imaging examination

(1) X-ray examination: It is the simplest and most practical method for diagnosing femoral head necrosis. In the early stages of femoral head necrosis, the bone tissue may be normal or slightly porous. Some patients may experience a relatively uniform increase in bone density in the lesion area due to disuse and atrophy of the surrounding normal bone tissue. Subsequently, a wedge-shaped sclerotic band or cystic lesions of bone tissue may be seen in the weight-bearing area, and a "crescent-shaped translucent band" equal to the articular surface may appear. The joint space may widen, indicating a fracture and collapse of the cancellous bone supporting the subchondral bone plate of the articular cartilage. Finally, the subchondral bone plate and articular surface collapse, the bone contour changes, the step-like discontinuity occurs, and the bone compression increases. At the same time, the acetabular articular surface is also damaged, the joint space is narrowed, osteophytes are formed, and the entire joint shows degenerative arthritis changes (Figure 1).