Tian Hongtao, Department of Orthopedics, Wuhan Union Medical College Hospital
Femoral head necrosis: The most well-known group of patients is the “SARS survivors” who escaped the SARS disaster but suffered from femoral head necrosis due to the use of high doses of glucocorticoids (GC).
High-risk groups: people aged 20-40, alcohol abuse, glucocorticoid use, hip trauma, hematologic diseases (e.g., coagulation dysfunction), gout, certain liver, kidney, and skin diseases (e.g., systemic lupus erythematosus, chronic hepatitis).
Clinical manifestations.
There is no sensation in the early stage of ischemic necrosis of the femoral head. As the disease progresses, the patient begins to feel joint pain: initially pain during weight-bearing and later pain at rest, accompanied by limited hip movement. If the femoral head collapses, the pain is extremely increased and immobilized, followed by osteoarthritis and more severe pain. The pain lasts for several months to a year between the onset of pain and the loss of most of the joint function. In some patients, there are also no obvious symptoms.
Proper treatment can halt the progression of the disease. Without effective treatment, patients can experience severe pain and eventual loss of most of the joint’s movement.
Prevention.
Abstinence from alcohol and avoidance of glucocorticoids are the primary forms of prevention; smoking cessation, statin lipid-lowering drugs, anticoagulant therapy, and Fosamax also have preventive effects.
Preventive treatment.
1. medications to improve blood supply to the femoral head and anti-inflammatory medications to control pain.
2. weight reduction, restriction of weight-bearing activities, and use of crutches. Reducing joint load can reduce joint damage and strengthen the self-healing effect of the femoral head.
3. joint mobility exercises to maintain joint range of motion through exercise
4. decompression osteocage osteogenesis of the femoral head.
5. bone grafting with a vascularized tip.
5. osteotomy to reduce the pressure in the necrotic area by changing the bone structure, but the patient has a long recovery period after surgery, with restricted activity for 3-12 months.
6. Hip arthroplasty is the most effective treatment for advanced ischemic necrosis of the femoral head. It can completely solve the patient’s pain and joint movement disorder.
Physical therapy.
Strict weight restriction and the use of canes, and crutches can significantly improve the condition, although it cannot slow down the progress of the disease.
Exercise: appropriate exercise can increase blood supply to the joints, especially stretching exercises (Tai Chi, yoga, etc.); weight-bearing exercises (squatting and jumping, long jump, deep squatting) are contraindicated.
Dietary management: abstain from alcohol, smoking, reduce salt and coffee intake; supplement with sufficient protein, calcium and vitamin D; try to avoid calcium-absorbing food groups (coffee, tea).
Post-operative hip arthroplasty.
Postoperative – day 2: bed rest, cold compresses and thong shoes.
Postoperative day-2nd week: bed exercise: contraction of thigh muscles, passive leg lifting with the assistance of family members at first, then gradually active leg lifting; hip flexion and knee flexion (0-90 degrees of hip flexion), get up and stand using a walker to bear weight.
Postoperative week 2~4: contraction of thigh muscles, active leg lifting exercise, calf lifting exercise, ball clenching exercise, hip abduction exercise, hip posterior extension exercise, hip flexion angle between 0-100 degrees, start walking with a walker.
Postoperative week 4~8 Active leg raising, calf raising exercise, hip abduction exercise, hip posterior extension exercise, gait training, balance and proprioceptive training, etc., hip flexion angle between 0~120 degrees, gradually get rid of the walker.
More than 8 weeks after surgery The overall muscle strength of the affected limb strives to reach the normal level, and the walking posture is close to normal; it can complete the function of fast walking and jogging, and can do sports such as cycling, bowling, table tennis, swimming and dancing, but still avoid weight-bearing sports (deep squatting, horse stance, etc.).
Daily matters.
1. Sitting and riding in a car: sit with your hips positioned forward, lean your body backward, and extend your legs as far forward as possible. Do not sit for too long during the first month after surgery, choose a high stool, do not cross your legs and ankles, and do not bend your body more than 90 degrees in front.
2. Toilet access: use a raised homemade toilet seat to access the toilet, or lean back with the body assisted with the affected leg extended forward to access the toilet, paying attention to keep the knee joint higher than the hip.
3. fetching things: do not bend down to pick up things on the floor for 2 weeks after surgery, do not turn around suddenly or reach for objects behind you, and it is advisable to put the rice bowl in front of you when eating.
4. Shower: After the wound has healed, it is feasible to take a shower. It is recommended to take a shower in a sitting position with a removable hand-held nozzle and prepare a shower sponge with a long handle so that you can reach your lower limbs and feet.
5. Put on and take off shoes and socks: Ask someone to help you or use a shoe puller, choose elastic shoes without laces and loose pants.
(Image from the Internet)
Author: Hongtao Tian, Wuhan Union Orthopaedic Hospital
Title: Associate Professor, Associate Chief Physician
Specialties: artificial joint replacement Joint diseases: femoral head necrosis, knee osteoarthritis, rheumatoid rheumatoid arthritis, ankylosing spondylitis, joint infections, bone and joint deformities.
Clinic hours: all day every week on 1, 3 and 6.
Contact: Tel: 13908622515
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