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Abstract: A 60-year-old male who loves alcohol has had right hip pain for more than 2 years, which is progressively aggravated and has limited joint movement. In the past 3 months, the left hip has also been painful and has gradually developed a limp, which is getting heavier and heavier, and now walking is difficult. After treatment with oral medication and surgery, the patient’s right hip pain disappeared, the right hip joint moved freely, and the left hip pain was relieved.
Basic information】Male, 60 years old
Disease Type】Necrosis of femoral head
Hospital】Liaocheng Hospital of Traditional Chinese Medicine
Date of consultation】May 2021
Treatment plan】Surgery (total hip arthroplasty) + hip abductor exercise
Treatment Period】Inpatient treatment for 10 days, outpatient follow-up for 1, 3, 6, 9 and 12 months after surgery
Treatment effect] The right hip pain disappeared, the right hip joint moved freely, and the left hip pain was relieved.
I. Initial consultation
The patient is a 60-year-old male with right hip pain for more than 2 years, which is progressively aggravated, accompanied by limited movement of the right hip joint, and in the past 3 months, the left hip pain also appeared, which is aggravated when walking. On examination, he saw that the right lower limb was about 1 cm shorter than the left lower limb, with bilateral inguinal midpoint pressure pain. The right hip flexion, posterior extension, abduction, adduction, and internal and external rotation mobility were significantly reduced compared with the left side. The patient had a history of drinking alcohol for more than 30 years, and in recent years, he drank about 1 kg of liquor almost every day. X-ray examination showed that the right femoral head was collapsed and flattened, and the bone density in the left femoral head was uneven and cystic changes were visible. Combining the medical history, clinical manifestations and imaging examination, the patient was diagnosed with bilateral femoral head necrosis, with the right side being advanced and the left side being early to mid-stage.
II. Treatment process
The patient’s right hip had severe pain and poor mobility, which had significantly affected his life, while the left hip had less pain and near normal mobility. After completing the preoperative examination and excluding the contraindications, the patient underwent total hip replacement on the right side under lumbar anesthesia. The drainage tube was removed on the second postoperative day, and the review X-ray showed that the prosthesis was in good position. At the same time, strength training of the muscles around the hip joint was carried out, especially the exercise of the hip abductor muscle.
III. Treatment effect
The postoperative radiographs showed the postoperative performance of the right total hip arthroplasty, with good prosthesis size and position and equal length of both lower limbs. The patient was discharged from the hospital 1 week later, and the stitches were removed 2 weeks after the operation. The stitches were removed 2 weeks after surgery. The patient came to the hospital for review at the 1st, 3rd, 6th, 9th and 12th months after surgery, and every 3-6 months thereafter. When the patient came to the hospital for review six months after surgery, the right hip joint moved freely without pain, indicating that the surgical treatment was effective.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still need to inform the patient that he should strictly quit smoking and alcohol after discharge, and at the same time use hormone drugs cautiously, mainly adjust the dietary structure, avoid eating fatty food, and at the same time control weight and reduce the weight-bearing of the hip joint. It is necessary to strengthen the training of the muscle strength of both lower limbs, especially the exercise of hip abductors, and to perform straight leg raising, ankle flexion and extension, and double lower limb abduction exercises. In addition, patients need to pay attention to controlling the mobility of the right hip joint, avoiding internal retraction and internal rotation of the hip joint, avoiding cross-legged sitting, and controlling the squatting angle to prevent hip dislocation. And control the weight and reduce the weight-bearing of the hip joint. If there is redness, swelling and pain in the right hip, you need to come to the hospital in time to exclude hip infection, and if there are infections in other parts of the body, such as pneumonia, urinary tract infection, tinea pedis, etc., you need to treat them in time to prevent inflammation from transferring to the hip joint and causing intra-articular infection.
V. Personal insight
Femoral head necrosis often occurs in young and middle-aged men and is usually associated with the presence of long-term heavy alcohol consumption, high doses of hormonal drugs, femoral neck fractures, and hip dislocation, etc. Patients like the one in this case, who have a drinking habit, have a greater than normal risk of suffering from femoral head necrosis. In conclusion, patients with osteonecrosis of the femoral head should not only abstain from smoking and alcohol, but also use hormonal drugs with caution. Femoral head necrosis is divided into early, middle and late stages. For early and middle stage femoral head necrosis, hip preservation treatment should be actively carried out, including conservative treatment such as oral medication, physiotherapy, and hip preservation surgery such as interventional and minimally invasive decompression treatment. For those with advanced femoral head necrosis, severe femoral head collapse and obvious hip joint dysfunction, total hip arthroplasty can be performed. Since total hip arthroplasty can play a very good clinical effect, fully relieving hip joint pain and dysfunction, and the prosthesis is very durable, so femoral head necrosis is now less fearful, and the majority of patients only need to accept the physician’s advice and actively cooperate with the treatment, usually can obtain better treatment results.