Patient: Description of condition (onset, main symptoms, hospital visited, etc.): Patient female, 50 years old, previously in good health. This time the condition.
1, walking legs hard, legs straight, squatting can not get up, get up squatting, symptoms for 3 years, at first it was leg pain, back pain, then the whole leg has been pain, sleep at night is very painful. At first, the left leg was more serious, but now both legs are about the same symptom.
2, in Lanzhou Army General Hospital, Gansu Provincial People’s Hospital, Henan Luoyang Orthopaedic Hospital, Gansu Provincial Hospital of Traditional Chinese Medicine to take pictures and understand the situation. No systematic treatment, only to find a doctor to see, eat some painkillers, bone-building drugs. The effect is not good. Hope to take conservative treatment, there is really no way to take replacement surgery. Most hospitals recommend joint replacement surgery, and experts at the Hospital of Gansu Province College of Traditional Chinese Medicine recommend joint preservation surgery.
Qin Jian, Department of Bone and Joint, Guangzhou First People’s Hospital.
First of all, we must clarify whether it is ischemic necrosis of the femoral head, you said there are bilateral hip dislocation, I think it is very small possibility of femoral head necrosis, probably acetabular dysplasia secondary to osteoarthritis, but many hospitals in China mistook this disease for femoral head necrosis, especially the Chinese medicine system, almost no such concept. Can you send a film up to see? If it is acetabular dysplasia secondary to osteoarthritis, the surgery to preserve the joint does not make much sense.
Patient: Thank you very much, Dr. Jian Qin. I will ask my family to send the film as soon as possible. My mother is very reluctant to have an amputation. We don’t know much about this disease either and are very confused as to what to do.
Even though the current science and technology is not perfect, the satisfaction rate of joint replacement surgery for the elderly is already over 95%, the key is still lack of understanding. So it is better to wait for you to upload the film before giving further opinion!
Patient: Have new information to upload
Patient: Dr. Qin, I’ve uploaded the photos, please take a look.
Qin Jian, Department of Bone and Joint, Guangzhou First People’s Hospital.
Your mother is not suffering from ischemic necrosis of the femoral head, but from bilateral acetabular dysplasia secondary to osteoarthritis, which is usually misdiagnosed as ischemic necrosis of the femoral head.
From the film, your mother’s bilateral femoral heads have not collapsed and the bone quality is still quite good, only the acetabular development is shallow, resulting in insufficient coverage of the femoral head. Currently, the bilateral femoral heads have been subluxated and the joint space has almost disappeared, which means that the articular cartilage has completely worn away, which is the real cause of the current pain. The above appeal is also the reason for judging the acetabular dysplasia as secondary to osteoarthritis.
Therefore, conservative treatment is no longer meaningful and is merely delayed, costing a lot of money but having no real effect. Arthroplasty is the only viable treatment option.
I can understand the psychology of the elderly, who are afraid of spending too much money to burden their children, and who do not know much about the surgery and feel very scared and unsure. I can responsibly say that joint replacement is a mature surgical technique that works very well and can be described as a “new lease on life”, and that patients who have had the surgery feel that their recovery is progressing faster than the average person can imagine.
In rural areas where economic conditions are limited, you may consider the use of clinically tested artificial joint prostheses. Our hospital has been conducting experiments with artificial hip and knee joints from several companies for the past two years. We have a complete ethical review process and are under the supervision of the State Drug Administration and the Ministry of Health, and patients are fully protected by law to participate in the experiments. We have performed nearly 30 surgeries without adverse events.
I would recommend that you consider this option.
Patient: Thank you very much Dr. Qin for your detailed answer. After telling my mom, she felt a lot more secure. My mom also wants to ask if she can be reimbursed for cooperative medical care, and she wants to have the surgery next fall after she finishes packing her crops.
Qin Jian, Department of Bone and Joint, Guangzhou First People’s Hospital.
Rural cooperative medical care can be reimbursed in the field, but the reimbursement ratio is lower than that of local hospitals, probably between 30% and 50% of the total cost, depending on the local policy.
Usually joint replacement is not an emergency surgery, but it is not recommended to postpone it for too long. If the patient is already almost unable to walk, then the surgery should be done as soon as possible, because the bone density decreases by about 7% for one week of bed rest and by more than 50% for two months of bed rest, which means severe osteoporosis, which not only causes adverse effects on the surgery, but also brings about spontaneous fractures of the lumbar spine and hip, which is very unfortunate .
Therefore, as long as the quality of life is seriously affected, we recommend to operate as soon as possible. Of course, this is only a consideration from a purely medical point of view, and the problems of society often leave people helpless.
Patient: En, indeed, I will ask my mother, thank you very much for your reply, I feel that you are a very responsible doctor, you gave my mother a lot of confidence in the group surgery, thank you again!