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Abstract: The main character of this case is 68-year-old Auntie Zhao, who described herself as having knee pain with aggravation and limitation of movement without any obvious cause 10 years ago. 5 years ago, she was examined for osteoarthritis at a local hospital, and her symptoms were good and bad. 1 year ago, the pain in the left knee joint worsened, and there was an obvious inversion deformity. He visited our hospital and was diagnosed with osteoarthritis of the knee joint by knee X-ray and MRI. He was given a combination of surgery, medication and rehabilitation, and the joint function recovered significantly and the discomfort improved.
Basic information】Female, 68 years old
Disease Type】Knee osteoarthritis
Hospital】Hunan Provincial Brain Hospital
Date of Consultation】March, 20022
Treatment plan】Surgery (total knee arthroplasty) + medication (cefixime dispersible tablets, mazeline tablets, injectable parecoxib sodium) + rehabilitation (knee extension and straight leg raising training, ankle pump exercise) + other treatments (ice, pneumatic therapy, joint release training)
Treatment period】2 weeks of inpatient treatment, 1 and 3 months of outpatient follow-up
Treatment effect】Joint function is obviously restored and symptoms are significantly improved
I. Initial consultation
Auntie Zhao came to the outpatient clinic with a bit of difficulty in walking, and described herself as having knee pain with no obvious cause 10 years ago. She was unable to squat or go up and down stairs.
She could not squat and could not go downstairs. On examination, she had a positive patellar grinding test on her left knee, and her knee joint flexion and extension activities were significantly limited. She learned that there was a family history of old cold leg in her family. She then underwent relevant examinations, including positive and lateral x-ray and MRI of the knee joint, and found that there was indeed significant degenerative changes in the articular cartilage, with bilateral joint space narrowing and cartilage exfoliation, and the preliminary diagnosis was osteoarthritis of the knee joint.
II. Treatment
After the diagnosis was confirmed, Auntie Zhao was recommended to undergo surgery and total knee arthroplasty. After surgery, she was given routine antibiotics, such as cefixime dispersible tablets to prevent infection, Mizarin tablets to reduce swelling, parecoxib sodium for injection to relieve pain, and anti-osteoporosis treatment. At the same time, exercises for quadriceps muscle strength, such as knee extension and straight leg raising exercises, ankle pump exercises were performed. After the exercise, local ice was applied to reduce swelling, pneumatic therapy was performed to prevent deep vein thrombosis, and joint release training was performed to improve joint mobility and prevent joint adhesions.
III. Treatment results
Before the surgery, Auntie Zhao’s knee joint was inversion, flexion and deformity, and her flexion and extension activities were obviously limited. After the joint replacement surgery, Auntie Zhao’s knee inversion deformity was partially corrected, flexion and extension activities were significantly improved, and pain during activities improved. After a review 1 month after the surgery, Auntie Zhao could walk around at home with a walker. 3 months after the surgery, Auntie Zhao reported that the knee joint activity was significantly improved, and it was much easier to go up and down the stairs, the joint function was significantly restored, and the pain symptom when squatting was significantly improved.
IV. Notes
We are glad that Auntie Zhao’s pain symptoms have been reduced after the surgery. After the surgery, regular follow-up is very important. Auntie Zhao also needs to pay attention to local changes, such as the degree of joint swelling subsiding, the degree of pain reduction, and rehabilitation exercises on a daily basis. Daily exercises for quadriceps muscle strength, such as knee extension and straight leg raising exercises, ankle pump exercises, leg extension and flexion exercises, etc., but rehabilitation exercises cannot be done overnight and should be done gradually. The diet should be light and nutritious, avoiding spicy and stimulating foods. In addition, the lower limbs can be properly moved after surgery to avoid the formation of deep vein thrombosis in the lower limbs.
V. Personal insight
For middle-aged and elderly patients, if there are symptoms of pain in the knee joint without obvious causes, it should be differentiated from rheumatoid arthritis. Patients with rheumatoid arthritis are usually the first to have pain and morning stiffness changes in the small joints, and laboratory tests find positive rheumatoid factor, which can occur in the youth stage. For patients with osteoarthritis, early improvement in joint activity by doing less squatting and less walking up and down stairs can protect the joints appropriately. However, exercise such as swimming delays joint degeneration. In addition, you can take oral nutritional cartilage drugs, and symptoms can be oral anti-inflammatory and pain medication, which can play a very good treatment effect. In the case of severe osteoarthritis, total cartilage denudation of the joint surface, joint space narrowing deformity patients are recommended to follow medical advice for surgical treatment, post-operative rehabilitation is also very important.