There is a minimally invasive treatment for femoral head necrosis called decompression.
Why decompression ? Because to improve the blood circulation
There is edema inside the necrotic femoral head and the pressure is so high that blood circulation cannot get in. After decompression surgery, the pressure comes down and blood can get in.
When to do decompression? : Only in the early stage
Decompression can only be done in the early stages of femoral head necrosis, stage 1 or some stage 2 patients. We usually choose.
1. the patient is very young;
2, the femoral head is not collapsed;
3, the necrosis is not too large.
Unfortunately, femoral head necrosis progresses rapidly and most patients miss the time for decompression surgery.
Is decompression always successful ? : The overall success rate is not high
The overall success rate worldwide is about 70%. Don’t think that 70% is high, the success rate of most surgical procedures is much higher than that. For example, the success rate of joint replacement is close to 99%.
What other treatments are needed after decompression? : Reduction of weight bearing
Medication to improve circulation, medication to promote osteogenesis, functional and strength exercises during decompression, and most importantly weight bearing reduction to ensure bone regeneration. The femur is similar in size to an egg and would take more than a year to fully grow back.
How long do I need to be weightless? At least 3 months
Bilateral patients are often wheelchair bound, bedridden, and have their films reviewed monthly, and will be weightless for at least 3 months. Unilateral patients can be on crutches for 2 weeks after surgery, using the good leg side for weight bearing and not the necrotic side for touching the ground.
Which patients have a high failure rate? : Hormones and alcohol consumption
Some patients have a high failure rate, such as those with a condition that requires the long-term application of hormones. Patients who have difficulty in getting rid of the temptation of alcohol after surgery and still drink alcohol have a high failure rate. The failure rate is also high in patients of advanced age, or in poor physical condition, such as combined kidney disease or blood disease.
Which patients have good results? Patients who are early and cooperative with treatment
Long-term clinical experience tells us that some patients have good treatment results. These are young patients, who are not very obese, who can stop drinking in time, who come to receive decompression at the early stage of necrosis, who can follow the doctor’s requirements for regular review, and who do not bear weight too early.
There are also some patients who have necrosis on both sides, and the severe side has undergone joint replacement surgery, so they are able to bear weight immediately, while the opposite side has less necrosis and can reduce the force with crutches, and the results are also good.
How long does it take to determine if decompression is effective: at least six months
The femoral head is very large and it takes time to completely regenerate and repair. Generally, if there is no collapse for about six months, you can be allowed to bear weight without crutches.
Should the patient have decompression? – If you want to treat conservatively, decompression is a must.
Decompression is the basis of all conservative treatment. From the patient’s point of view, many young patients with early stage of femoral head necrosis, without collapse and with a small area of necrosis, should still give their femoral head a chance.
But it is time to be psychologically prepared.
1.May need to do wheelchair for a long time.
2. It may be found that the femoral head collapses and decompression fails after several months or six months.
Long-term disconnection from work and society requires great psychological adjustment, and family support. Be optimistic, do your best and plan for the worst. Organize your work and life during recuperation.
Why not many doctors recommend decompression: doctors have many concerns
Femoral head necrosis is a worldwide problem. Although decompression surgery has a 70% success rate, the satisfaction rate is obviously too different compared to joint replacement, and there are too many factors that affect the outcome, some of which are beyond the doctor’s control.
Patients often come to us after decompression has failed and femoral head necrosis has progressed, “Why is my leg atrophied, it hit a nerve during the surgery, right?” , “Why is my collapse just so fast?” Even though I had told such patients before the surgery that the success rate would not exceed 70%, people still felt very aggrieved that they had been bedridden for so long and had not grown well. Some patients even developed depression. All doctors prefer to replace joints rather than preserve them.
A joint effort between doctors and patients
Over the years, we have saved many necrotic femoral bones through decompression surgery. My colleagues also suffer from many patients’ complaints, but most of them are understanding and cooperative, which is the motivation for us to persist in this work and hope to get everyone’s understanding and cooperation to give the necrotic femoral bones one last chance.