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Abstract: A 65-year-old patient with a past history of long-term hormone use and recent hip pain was confirmed to have femoral head necrosis, femoral head collapse, and hip joint space narrowing after examination. In order to improve the function of the hip joint and restore normal life, the patient was recommended to choose artificial total hip replacement surgery for treatment. After the operation, the patient’s hip pain was relieved and the range of motion of the lower limbs returned to normal.
Basic information】Male, 65 years old
Disease Type】Necrosis of the femoral head
Hospital】Harbin First Hospital
Date of consultation】November 2021
Treatment plan】Surgery (total hip arthroplasty)
Treatment Period】7 days of inpatient treatment, 3 months of outpatient follow-up
Effectiveness】Hip pain was relieved, and the range of motion of the lower limbs returned to normal.
I. Initial consultation
The patient was 65 years old and had hip pain and shortened limb deformity due to occlusion of the blood vessels supplying the femoral head caused by long-term heavy use of hormones. The patient was then advised to improve the CT examination of the lower limbs. The examination clearly showed that the patient had osteonecrosis of the femoral head and needed to be treated with artificial total hip replacement surgery to relieve clinical symptoms and restore normal life.
II. Treatment history
The patient had no serious medical diseases, such as diabetes, hypertension, coronary heart disease, etc. She met the indication for surgery and was able to withstand the artificial total hip replacement. During the operation, the femoral head was found to be significantly flattened and the joint surface was severely damaged. After removing the artificial femoral head, the acetabular joint surface was treated and the artificial joint was replaced to make sure the hip joint was perfectly matched. After the operation, the patient kept the hip joint abducted and carried out active activities of the hip joint under the guidance of the doctor to gradually restore the strength and stability of the hip joint. After the drainage tube was removed, the patient could walk with partial weight-bearing with the aid of double crutches and gradually resume normal life.
III. Treatment effect
After the hip replacement surgery, the patient’s hip pain, restricted activities and shortened deformity of lower limbs were all corrected, and both lower limbs could walk with normal weight bearing, and the limping symptoms disappeared. The patient resumed walking on the lower extremities after 7 days of hospitalization. Through rehabilitation exercises, the stability of the hip joint was significantly strengthened, the blood circulation of the whole body was accelerated, and the level of physical health was improved, and the patient was discharged. At the review 3 months after the operation, the patient was able to resume normal sitting rest and could participate in general exercises such as jogging and elliptical exercise.
IV. Precautions
We are glad that the patient’s condition gradually recovered, but we still need to advise the patient to pay attention to avoid hip flexion over 90° to facilitate the repair of the hip capsule and the muscles around the hip joint, and to complete the hip hyperflexion movement after the above structures are completely repaired. At the same time, attention should be paid to strengthen the strength training of the muscles around the hip joint, such as hip flexion and extension exercises with the assistance of elastic bands, and the daily exercise time should be 30-60 minutes. To further prolong the service life of the artificial total hip joint, patients should strictly control their body weight, and supplement calcium gluconate oral solution, vitamin D drops and other drugs, participate in low-intensity aerobic exercise appropriately, balance nutrition, strengthen bone density, and delay the loosening of the artificial joint and bone interface.
V. Personal insight
The patient’s long-term use of hormones led to serious impairment of blood circulation in the femoral head, causing insufficient blood supply and the occurrence of femoral head necrosis. After the surgery, although the function of the hip joint was restored, it is still necessary to pay attention to avoid long-term continuous use of hormone therapy to protect the contralateral hip joint. If hip pain occurs after surgery, you need to pay attention to it and follow up promptly to observe whether hip joint loosening occurs. You should pay attention to the protection of the hip joint in your daily life, avoid trauma to the hip joint, and try to extend the use cycle of the hip joint.
In addition, the service life of the joint after total hip replacement is usually 10-15 years. As the patient grows older, osteoporosis and weakening of the bone will lead to loosening of the artificial hip joint. Patients also need to undergo joint revision surgery again to replace the artificial hip joint.