In the treatment of femoral head necrosis, the most common question I hear patients ask is.
”Doctor, can I get rid of this crutch?”
”Doctor, can I not use crutches?”
Yes, every day with two crutches, how inconvenient; moreover, many young people use crutches for a long time, always feel affected personal image.
Today we will come together to chatter about this distracting topic.
First of all, it is necessary to clarify two crucial issues.
First, the principle of femoral head necrosis
Adult femoral head diameter of about 4-125px, femoral head necrosis is caused by long-term heavy drinking, hormone abuse, trauma and other causes of interruption of blood supply to the femoral head, followed by local bone trabeculae fracture, cartilage collapse, exfoliation within the femoral head, and ultimately serious osteoarthritis and loss of joint function.
Therefore, how to repair the blood supply to the necrotic femoral head and prevent the femoral head from collapsing has become the core problem of treatment. In clinical practice, there are many surgical methods to remove the dead bone from the femoral head and rebuild the blood supply; eventually, conditions are created to allow the necrotic area to restart the bone repair process, but of course this process is very long, which is also the root cause of long-term crutches.
To cite one of the most common phenomenon in life, home renovation house paving floor tiles, the master worker will generally be so confided: “Do not come in within 2 days, a step on the floor tiles warped, must enter the room then step in the middle of the floor tiles.” The reason why the master worker can accurately say the use of floor tiles matters, because the cement, floor tiles are mass-produced out of the factory, the performance is basically the same; construction process is also the process, so workers are very clear about the concrete solidification time.
But the doctor is not as much confidence as the master worker because.
1, the patient’s age varies, each person’s physique is very different, some people have high blood lipids some do not, some are caused by long-term hormone use, while another part of the people may be caused by drinking alcohol, and others for unknown reasons; even the same person, both sides of the femoral head necrosis are not the same;.
2, doctors according to the specific circumstances of necrosis, the choice of treatment method also has a great difference, the late recovery time is naturally different.
Second, how much weight does the femoral head bear in different states of motion?
1, when the human body is standing still, the two femoral bones bear half of the weight pressure each.
2, slow walking, one leg bearing the weight and one foot off the ground for a moment (single-leg weight bearing), the weight-bearing side of the femoral head to bear 1.5-2 times the weight pressure.
3, fast walking, single leg weight-bearing, the femoral head on the weight-bearing side is subjected to more than 2 times the weight pressure.
4.When walking up and down the stairs and bearing weight on one leg, the femoral head on the weight-bearing side is subjected to more than 3-4 times the weight pressure.
After reading the above data, are you more or less shocked? Is the idea that each leg bears half of the weight turned upside down? The femoral head is under tremendous pressure in different states of motion, especially when it is in a necrotic state and is subjected to weight-bearing motion similar to “pounding garlic”, so it must not be fully weight-bearing until the necrosis is completely repaired!
So, how do you determine the time to use crutches?
The doctor will make an assessment taking into account the patient’s age, weight, etiology, stage of the disease, site of necrosis, treatment modality, what was seen intraoperatively, and dynamic changes in the review films. Generally speaking, more than 6 months and more than 3 consecutive X-rays and CT examinations show increased bone density, increased bone trabeculae and thickening; the patient can consider losing the crutches when he/she feels no pain or sleepiness in walking. Therefore, for patients with non-traumatic osteonecrosis of the femoral head, if the condition is mild and the consultation is timely, they may be able to lose their crutches six months after the operation if they have a simple surgery; some patients have a very large area of necrosis, obvious osteoporosis and high blood lipids, so it is particularly difficult to repair the bone, and they may need medication and crutches for more than 2 years; however, most of them need to use double crutches for about 1 to 1.5 years.
For patients with traumatic femoral head necrosis, such as patients with femoral neck fracture and acetabular fracture, fracture healing and femoral head necrosis do not occur simultaneously, and most patients have femoral head necrosis within 6 months-2 years after fracture healing; there is no sign before necrosis occurs, and the best way to prevent necrosis is to use crutches for a long enough time, at least 1 year or more, and do MRI every 6 months-1 year. The best way to prevent necrosis is to use the crutches for a long enough time, at least 1 year, and to do MRI examination every 6 months-1 year, so as to achieve early warning and early treatment.
Femoral head necrosis is a chronic disease, the treatment of femoral head necrosis, prevention of femoral head collapse is a protracted war, the battle, the patient must be prepared for a long-term battle; crutches is like the logistics of the rear of the battlefield, is an important part of the treatment of the disease, must listen to the doctor’s advice, do not throw crutches prematurely without permission.