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Abstract: The patient was an alcoholic on a regular basis. In the last six months, he developed pain in his right hip without any obvious cause, which was aggravated after walking and relieved after resting, and after detailed examination, he was diagnosed with femoral head necrosis and decided to be admitted for surgery. The patient underwent artificial total hip replacement surgery, and the walking function basically returned to normal after the surgery, with no obvious discomfort in the hip.
Basic information】Male, 47 years old
Disease Type】Necrosis of the femoral head
Hospital】The First Hospital of Harbin Medical University
Date of consultation】March 2022
Treatment plan】Total hip arthroplasty
[Treatment Period] 14 days in hospital, 1 month postoperative review
Results】Walking function basically returned to normal, no obvious discomfort in the hip
I. Initial consultation
The patient was always addicted to alcohol and drank about ten bottles of beer every day for more than ten years. In the last six months, he gradually developed pain in his right hip without any obvious cause, which was aggravated after walking and relieved after resting, and in the last month, he also experienced pain when resting, so he came to the clinic. Detailed examination revealed that the patient had obvious pressure pain at the femoral head at the inguinal midpoint of the right hip, limited hip flexion, extension and rotation activities, and the presence of claudication when walking. The patient’s right femoral head was found to be collapsed, cystic and sclerotic, and the joint space was obviously narrowed through X-ray.
II. Treatment process
After the patient was admitted to the hospital, the CT examination of the femoral head was completed, and the patient was found to be in stage III of femoral head necrosis, and conservative treatment was not effective. Preoperative measurements were performed by high-resolution CT of the hip to assess the possible joint prosthesis type, and preoperative tests such as routine blood, liver and kidney function, and coagulation were completed. Artificial total hip arthroplasty was performed on the 3rd day after admission to the hospital. The drainage tube was removed on the third day after surgery, and orthopantomogram of the pelvis and front and lateral radiographs of the femur were taken. The incision was changed every other day, and the stitches were removed and the patient was discharged 14 days after surgery.
III. Treatment effect
On the second day after surgery, the patient’s hip pain was relieved and the incision was painful, accompanied by mild swelling of the hip, and the joint could be flexed and extended in the abducted state. On the 5th day after surgery, the swelling of the hip was significantly relieved and the joint could be flexed up to 45°. The skin of the lower limb felt no obvious abnormality and the temperature was normal. There was no necrosis, infection and other abnormal manifestations in the incision after surgery, and the incision healed smoothly 2 weeks after surgery. One week after surgery, the patient could stand at the bedside, and at the time of discharge, the patient could hold the railing and walk. Three months after surgery, the patient’s walking function basically returned to normal, and there was no obvious discomfort in the hip.
IV. Notes
We are glad that the patient’s hip pain was relieved after the treatment, but it should be noted that although the artificial total hip arthroplasty can restore joint activities and weight bearing more quickly, there are still many precautions after discharge. First of all, we should always pay attention to the incision condition and follow up promptly if there is redness, swelling, pain and abnormal exudate from the incision. Secondly, in case of gingivitis, pharyngitis or other infected lesions in other parts of the body, you should seek medical attention and choose appropriate antibiotics according to medical advice to avoid spreading infection to the joint prosthesis. In addition, pay attention to control the range of joint activities, avoid deep squatting, stilts, cross-legged and other extensive joint activities, and do not sit too soft, too low sofa, try to use squatting stool to avoid falls. Patients should adhere to anti-osteoporosis treatment, review bone density regularly, and be sure to quit drinking.
V. Personal insight
This patient suffered from femoral head necrosis caused by long-term heavy alcohol consumption. In the early stage, it only showed pain in the hip, but as the degree of necrosis increased, the femoral head collapsed, resulting in restricted joint movement and difficulty in walking. The patient must abstain from alcohol after the surgery, otherwise the other femoral head may also develop necrosis.