Patient: Checked out at the beginning of February this year, symptoms usually manifested as slight pain in the right leg abduction and right knee joint, walking is normal. He has not been treated and is on bed rest and crutches. Please help Dr. Tang to confirm the diagnosis and how to treat it. I want to choose conservative treatment, is it possible?
The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Department of Orthopedics, Tang Liming: Thank you for your trust. From the introduction of your case and the MRI and X-ray data, the preliminary diagnosis is: bilateral ischemic necrosis of the femoral head (stage 3B on the right side, stage 2B on the left side) with a necrosis area of about 30%, no obvious joint collapse, normal joint space, mild bilateral acetabular dysplasia, no subluxation, and a small amount of fluid in the right hip on MRI, and no obvious collapse. (Unfortunately, there is no frog x-ray.) The cause is unclear, but hormonal femoral head necrosis cannot be ruled out.
I suggest: 1: Take additional x-ray frog films to find out whether the femoral head is collapsed or not. 2: Walk with the help of crutches. 3: Take medication for the treatment of osteonecrosis of the femoral head. 4: Observe the changes in your condition and check the x-ray films regularly. 5: Keep in touch. 6: Of course, there are other treatment methods including interventional and minimally invasive surgical treatment. However, I suggest that conservative treatment is better first.
Patient: Thank you, Dr. Tang. Does conservative treatment mean bed rest, crutches, and medication? If I take medicine, is it Chinese medicine or pure Chinese medicine? Can I swim and ride a bike as an aid?
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: It is a non-surgical treatment, and our medications are three kinds of proprietary Chinese medicines – Shengvei Chengbao Tablets, Chuanxiongzin Tablets and Xianlingbao Capsules. You have to walk with double crutches, it is better not to ride a bike, you can swim.
Patient: Do I need to use all three kinds of medicine together, namely, Shengwai Chengbei Tablets, Chuanxiong Xiongzin Tablets and Xianling BonePro Capsules? How long do I have to take them and how much do they cost?
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Yes, a course of treatment for 3 months. The course of treatment depends on the condition, and usually takes more than a year. If the condition gets worse during treatment, you can change the treatment method.
Patient: I’ll contact you after taking additional X-ray frog films.
Patient: I took a frog film today, please ask Dr. Tang to take a look again, thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: I saw the frog X-ray of both hips that you took today. The anterolateral aspect of the right femoral head can be seen to be slightly collapsed, about 1-2 mm. In this case, you should pay special attention to protect the right hip joint, because collapse is an important indicator of prognosis. At this stage we recommend medullary decompression peroneal column bracing, but of course, you can also start with conservative treatment and strictly observe the changes in your condition to decide the treatment plan.
Patient: Hello Dr. Tang, thank you for your patience in answering my question. My disease since the discovery of the diagnosis, the mental pressure on me is very large, I also many consultations about the medical (Zhengzhou People’s Hospital, College of Traditional Chinese Medicine, Luoyang Orthopedic Hospital), patient personnel, Chinese medicine and Western medicine have their own treatment, judgment is not the same, there are recommendations medullary decompression, implantation of tantalum rod support, interventional therapy (decompression, injection of drugs), Chinese medicine, Chinese medicine plus physical therapy (fumigation, acupuncture, massage), Zhengzhou Wangguozheng Specialized plaster, etc., to understand the surrounding patients also through various places, various methods to get rid of the double abduction. So far I have not treated, mainly because the treatment plan has not been determined. I want to determine a program, single and comprehensive treatment can be, adhere to the treatment, of course, depending on the development of the disease, any program is not necessarily absolute. Recently, through understanding, I have adjusted my mentality, and I still have confidence in the treatment and am prepared for the final result. With my current condition, I would like to ask Dr. Tang to help me analyze what kind of conservative treatment plan is suitable for me? Thanks again. My email: [email protected]
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Okay. Because there is a lot of content, I will organize it and send it to you.
Patient: Dr. Tang, I know you are busy, I don’t know if you have sent it and I didn’t get it, please send it again. Thank you. My email: [email protected]
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Okay
Patient: Dr. Tang, I’m really sorry, I don’t know why I still haven’t received it, if it’s convenient, directly back in the page or telephone contact can? Thank you again and anxiously waiting.
The First Affiliated Hospital of Guangzhou University of Chinese Medicine, orthopedic department Tang Liming: Sorry, I’m very busy these days, I’ll give you a call tomorrow, okay?
Patient: Dr. Tang, I am very touched by your serious and responsible attitude, and it also makes me feel very solid, thank you. I will definitely visit you in Guangzhou if I have the chance. I wish you good health and happiness.
The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine Tang Liming: Thank you, I will send you the mail order phone number tomorrow
Patient: Hello, Dr. Tang: After a period of recuperation at home, taking medication on time, doing some traction and auxiliary functional exercises, I feel that the right leg abduction is better than before, except for a slight discomfort, the amplitude is the same as the left leg. However, I can hear the sound of the joint during exercise, and occasionally there is a very slight pinching pain in the hip joint, but no other discomfort. I went to have a film taken a few days ago, so I would like to ask you to see if the condition is controlled or reduced. Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: From the imaging data, we can understand that the condition is stable and no collapse has occurred. We can continue to follow the treatment plan.
Patient: Thank you, Dr. Tang. Should I continue to take Chuanxiongzin tablets? And should I still not put any weight on it? Do I need to take calcium supplements?
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Do not put any weight on it now, and continue to use Chuanxiongzin tablets. If your diet is normal, do not take calcium supplements.
Patient: Thank you, Dr. Tang. We will be in touch later.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine: Okay
Patient: Hello, Dr. Tang: After another six months of recuperation at home, taking medication on time, doing some traction and auxiliary functional exercises, I feel that both legs are functioning normally, but I can still hear the rattling of the joints when exercising. I went to take a film a few days ago, please see if the condition is under control or has progressed. Thank you. Happy New Year!
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.
The condition is stable, the femoral head is not significantly deformed, and the joint space is normal.
MRI examination is needed to understand the recovery of bad water.
Patient: Hello, Dr. Tang, I had an MRI examination today, please help me again; according to my current condition, can I walk short distances under weight (off crutches)? Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: The edema of the femoral head is in the round ligament area, which is small in scope, so you can move around without crutches, but you should pay attention to the feeling and not too much activity at first.
Patient: Dr. Tang, I’m really excited to see the news that I can move around without crutches. I would like to say thank you for your selfless help over the past year, and thank you for your tireless response. Dr. Tang, should I continue to take Yuan’s Bone Boosting Tablets, Xan Ling Bone Depot Capsules and Chuan Xiong Zin as my next treatment? If so, how many more months should I take them for review? Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine.
We should continue to take the above three drugs for treatment and review them in three months.
I wish you a speedy recovery.
Patient: Thank you, Dr. Tang. We will be in touch later. Have a happy Lantern Festival!
Patient: Hello, Dr. Tang. I have been walking off the crutches for the past two months with no significant discomfort. But in the past two weeks, the right metacarpophalangeal joint (index and middle finger) is swollen with morning stiffness, and the outer side of the big toe and little toe is painful on pressure but not red and swollen, the blood test is normal, the sedimentation is 5mm/60 minutes, but the ASO value is 204IU/ml, (normal value 0-160), RF59U/ml, (normal value 0–30), I suspect it is rheumatoid, and the ccp value was tested again 237RU/ml, (normal value less than 25), thus confirming the diagnosis. But I think every painful joint will be relieved in one to two weeks without any medication, and also, the inflammation of the throat in the past two days of the test, is it related to this? Do I need to do further tests? Could I have a strong spine? Because I sometimes have pain near my tailbone on the left side. Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: It should not be ankylosing spondylitis, if it can be relieved in a week or two, no medication is needed.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: Thank you for your trust. From your information and MRI and X-ray data, the preliminary diagnosis is: bilateral ischemic necrosis of the femoral head (stage 3B on the right and stage 2B on the left) with a necrotic area of about 30%, no obvious joint collapse, normal joint space, mild bilateral acetabular dysplasia and no subluxation. （The cause is unclear, but hormonal osteonecrosis cannot be ruled out. I suggest: 1: Take additional x-ray frog films to find out whether the femoral head is collapsed or not. 2: Walk with the help of crutches. 3: Take medication for the treatment of osteonecrosis of the femoral head. 4: Observe the changes in your condition and check the x-ray films regularly. 5: Keep in touch. 6: Of course, there are other treatments including interventional and minimally invasive surgical treatments. However, I suggest that conservative treatment is better first.
Patient: Hi Dr. Tang, I just had an MRI today, please help me out. With my current condition, can I walk short distances under weight (off crutches)? Thank you.
Tang Liming, Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine: If the condition is stable, if you can walk 5 km or 2 hours without significant discomfort, you can continue without medication.