What is Limping?
First, we should start by answering the steps and walking questions. A degree is a name given to the time elapsed between a foot coming off and back on the ground. The whole of the movements that the steps are made in harmony and that the body makes without losing its balance is also called walking. Limping is the deterioration of walking.
What are the most common causes of limping?
Problems in the joints, tibia and thigh bone disorders, foot disorders and pain are the leading causes of limping. There are different reasons for children and adults.
What Hip Disorders Lead to Limping in Children?
Limbing occurs in children more often in the Developmental hip dysplasia disease, formerly known as congenital hip dislocation. The diagnosis of this disease has started to be made early by performing hip ultrasonography in newborns worldwide in the first month. For this reason, treatment has also begun to be provided before. In our country, we see this disease relatively less as a result of the fact that this examination is included in the routine child examination. In addition, as other causes of lameness in childhood, Perthes Disease, which develops due to disruption of the vessels of the femoral head, and lameness due to fracture of the femoral head, may develop.
What Hip Disorders Lead to Limping in Adults?
The most important of the hip problems that are the cause of limping in adults is hip calcification, which is called hip arthrosis. Hip calcification can occur for many reasons, as well as for genetic reasons, the cause of which has not been fully explained in some people; it has been reported that it may also occur. Suppose cases with hip calcification are caught at an early stage. In that case, they can provide solutions to their problems with various bone correction surgeries, at least for a while, because we will have preserved our hip joints and delayed the operation, which we call prosthetic surgery.
Why Should Prosthetic Surgeries Be Delayed?
Is Prosthesis the Absolute End in Cases of Calcification?
Prosthetic surgery is the operation of cutting the bones in the damaged joints of patients with calcification of the hip and replacing them with metal joints. Two fundamental problems of prostheses that this bone replaces seriously trouble patients and orthopedists. The first of these is infection. To avoid this complication, we must prove that there is no infection in their bodies from the dentist, skin, urology and obstetricians before surgery. After the prosthesis is made, the patient should keep the disease away from his body. The second complication is the loosening of the prosthesis. Prostheses have a certain period of endurance. In young patients, this period will pass more quickly due to excess activity, while in older cases, it will pass more slowly. For this reason, it will be necessary to revise the prostheses in young patients throughout their lives. Due to this risk of having too much surgery, we recommend prosthetic surgery to our patients as a last resort.
So Shouldn’t Hip Replacement Surgeries Be Performed on Young Patients?
On the contrary, it should be done in the necessary cases because there is no point in spending the teenage period in restlessness with pain and limping. With prosthesis applications, a life in which the patient can walk painlessly and without limping can be provided. But again, it should not be forgotten that it is necessary to perform prosthetic operations after the conditions I mentioned a little earlier have been met. The procedures that can be performed before have been completed.
Could the Cause of the Limp Be Due to the Knee?
It is one of the causes of limping caused by walking with pain in the knee at least as much as the hip.
What Problems in the Knee Lead to Limping?
The most crucial cause of limping in the knee, as in the hip, is the calcification of the joint called arthrosis. Knee calcification can generally be a continuation of problems that started from childhood. Limping occurs as a result of damage to the cartilage of the knee joint and deterioration of the articular surface later.
What Problems in Childhood Lead to Arthritis in the Knee and Limping in Adulthood?
Due to various vitamin deficiencies (especially vitamin D), the fact that the legs are in the shape of O leads to problems in people’s knees at an advanced age. For this purpose, we can prevent calcification in the knee in adult life with simple vitamin supplements in those leg cases that are noticed during routine check-ups in childhood.
Is It Possible to Prevent Wear on the Knee Joint Cartilage?
Of course, today, there are several cartilage protective and regenerative treatment methods. These are very helpful to us orthopaedics and traumatology specialists to prevent knee calcification. Nevertheless, since we cannot replace cartilage with natural human cartilage, knee replacement surgeries are sometimes the inevitable end.
What are Cartilage Protective and Regenerating Methods?
We can prevent knee calcifications with bone correction (osteotomy) surgeries in cases where the arrangement of the bones, that is, the shape, deteriorates. We can contribute to the repair and regeneration of cartilage at specific rates with artificial joint fluids, and PRP supplied from the outside. Patients who do not benefit from these have no choice but to have a knee replacement.
Are Any Reservations and Risks in Knee Replacement Also Present in Hip Replacement?
All the risks I just mentioned are valid in a knee prosthesis.
What Problems in the Tibia and Thigh Bone Lead to Limping?
The length differences and deformities of these bones with each other are the most important causes of limping. The most important cause of these length differences and deformities are the fractures that have been undergone. Fractures in childhood usually do not leave significant sequelae in the future due to the excellent growth potential of the child. The exceptional cases of these are fractures involving the joint. In fractures involving the joint, shortness and limping due to deformity will be observed. When these fractures occur, their treatment must be carried out in full.
Can the Length Differences and Deformities in the Bones Be Corrected Later?
Thanks to today’s knowledge and technology, these are possible. Many devices are applied from the inside and outside of the body to extend the length of the bones and correct their shape. With these, these problems have become solvable.
How Many CM Should Be Short For Extension?
It is unnecessary to perform surgery for length differences below 2.5 cm. Any length difference above this can be closed with various surgeries.
Is Height Extension A Process That Is Completed Immediately?
There are various devices related to height extension surgeries. These devices can be applied from inside and outside the body. After the bone cut is made, we wait a week and start the extension process, 1 mm per day. For example, in the patient where we will make a 5 cm extension, a total of about four months passes, including a 50-day extension and a 50-day waiting period. These periods will take place if there are no complications and problems.
What Other Problems Can We Mention as the Cause of Limping?
As a result of tilting the spine forward (kyphosis) and sideways (scoliosis), limping can develop in both legs without a difference in length. Both scoliosis and kyphosis have become correctable diseases due to increased surgical accumulations.
In the Light of These Stories, Is Lameness a Bad Fate?
If we know the cause of lameness, it is a situation where we have a lot of possibilities to relieve the patient with various methods.
Prof. Dr.
Ahmet Murat Bülbül, MD
Orthopaedics and Traumatology Specialist
