Background
Prof. Chen Xiaodong, Chief Physician, Doctoral Supervisor, Director of Orthopaedic Department of Xinhua Hospital of Shanghai Jiaotong University, Member of Shanghai Orthopaedic Specialty Committee of Chinese Medical Association, Member of Shanghai Orthopaedic Quality Control Center, Member of Shanghai Medical Accident Identification Center. He specializes in artificial hip and knee joint replacement surgery, artificial joint revision surgery, especially in the treatment of adolescent and adult acetabular dysplasia.
Acetabular dysplasia, also known as acetabular subluxation, is a hip deformity formed when the acetabulum fails to develop well. Generally, most patients develop symptoms around the age of 20 to 40. If the disease is not taken seriously and the best time for treatment is missed, the patient may not even be able to take care of himself or herself and must have the artificial joint replaced. Early detection and treatment of this disease is the key to ensuring the healing outcome.
Ms. Jiang is a senior white-collar worker in a foreign company, in the eyes of outsiders, she is not lacking in anything, but in fact, only she knows that she has a secret that is not known to others. In order to protect their secret, Ms. Jiang chose an office job, but over time, a new trouble came. Because of the inability to squat, Ms. Jiang did not dare to go to the toilet, from the office to the toilet this short distance of 50 meters, for Ms. Jiang seems longer than 500 meters. And Ms. Jiang has the same pain is Ms. Chen, Ms. Chen is also because of leg inconvenience, so choose to sit all day accounting work, as long as the need to walk, the trouble came. As for going to the toilet that situation and Ms. Jiang is simply the same. Others just a few minutes to go to the toilet, but Ms. Chen needs to struggle for ten minutes, in her eyes, comfortable going to the toilet has become a luxury. What disease do they have, and why this disease will make them unable to squat freely.
Q: We have just seen that both women are your patients. Both of them have a characteristic of this disease, they are unable to squat.
A: There are many reasons why a person may not be able to squat, including trauma, such as a fracture, infection, such as septic or tuberculosis infection, and of course, neuromuscular problems, such as a stroke in the brain, etc. Ultimately, of course, there may be a problem with the joint itself, such as a problem with the hip or knee joint.
Q: They both seem to have the same kind of disease, right?
A: For them, this is a kind of problem, which is what we usually call hip dislocation, the problem is the same.
The beautiful Ms. Jiang, like all the girls who love beauty, especially like shopping, but because of the difficulty in walking, she has not had a good shopping for so many years. For many years, Ms. Jiang has had a strong desire to do so. The physical inconvenience has brought a lot of trouble to her life, but I never thought that because of this inconvenience, Ms. Jiang would accidentally harvest a legendary love. It was ten years ago, one summer afternoon, Ms. Jiang, who was in her prime, was walking back to school after sending a letter to the post office. In the rain, Ms. Jiang wanted to run, but her heart was not strong enough, when a warm umbrella was propped up on her head, and the person who propped up the umbrella later became Ms. Jiang’s husband. Due to leg problems, and contributed to a strange relationship in the rain, such luck is not everyone has. Ms. Chen precisely because of the leg and foot problems ended a heartfelt love. Just the beginning of the relationship, Miss Chen did not feel that her legs have any problems, from time to time, the knee pain always let her think it was caused by the cold. Over time, the pain became more and more obvious, from the beginning of the knee pain, slowly shifted to the hip joint. The most painful time, even in winter, Miss Chen can break out in a cold sweat. The frequency of pain is increasing, and the duration of pain is getting longer and longer, to the point where Miss Chen’s life is almost impossible to take care of. Thinking that the disease will bring great inconvenience to their own lives and the lives of others, Miss Chen decided to say goodbye to her beloved boyfriend in pain. In front of the disease, love has become a luxury.
Q: I am very emotional after watching this film, almost the same type of disease, can make the two of them have such a deep connection with love, before Professor Chen also said, they have this disease is called acetabular dislocation, so what kind of disease is this?
A: Hip dislocation is actually a relatively common problem, first of all, we know which part of the hip joint in the human body, I have a film, the hip joint in the human pelvis and lower limb connection, the hip joint is a very important joint in the human body, then the hip dislocation is such that there is a total dislocation and subluxation, we just saw Ms. Chen and Ms. Jiang, they are not the same, this is Jiang This is Ms. Jiang’s film. Generally speaking, you can’t see anything wrong with this film at first, but when you look at a normal person’s film, you can see that her joint has dislocated outward, while Ms. Chen, half of her left femoral head is outside, which means that the acetabulum is not well developed, so the acetabulum can’t cover the femoral head well, so this is a subluxation.
Q: I would like to ask you, is a subluxation less severe than a total subluxation?
A: Yes, we can also use this model to see what is meant by total dislocation. Total dislocation means that the head of the femur is completely dislocated to the outside of the acetabulum, so the leg becomes shorter after dislocation, while subluxation is only one side of the head of the femur inside and one side outside, so the acetabulum is not able to accommodate the head of the femur well, so one of its characteristics is that there is no difference in the length of the leg.
Q: For example, if the acetabular joint is dislocated, will it be semi-dislocated first and then fully dislocated when it becomes serious?
A: There are cases like this, but it varies from person to person. Generally speaking, there are more cases of total dislocation, but if the subluxation is not treated in time when it is small, it can evolve into total dislocation.
Q: Whether it is a subluxation or a total dislocation, one common feature is that it is very painful.
A: The pain of hip dislocation has one characteristic, the first one is related to the activity, that is to say, the pain often occurs after more activities or longer walking. The pain occurs at the root of the thigh.
Q: Does this pain get better after rest, or what are the consequences if it continues to develop?
A: In the early stage, it can be relieved after rest, but slowly, because the final destruction is the cartilage of the joint, after this destruction, the whole joint will be completely destroyed, and this time will become more and more powerful, and it can not be improved after rest.
Q: What will happen if the condition progresses?
A: If the disease is fully dislocated or semi-dislocated, the result of development is the formation of an osteoarthritis, which will make you very painful, no way to work, and in serious cases, you can not take care of yourself, because you can not walk, it is very difficult to go to the toilet, which is not the general public can experience. If you don’t get treatment, you may spend the rest of your life in a wheelchair.
Q: What kind of people are prone to this disease?
A: Unfortunately, this disease is particularly fond of women, that is to say, women are most likely to get this disease, among my patients, and this kind of disease is often very young, very beautiful, very smart girls, very many, of course, not all girls are necessarily like this, another is that many girls have it at birth, female patients will be higher than male 4-6 times. There are also some girls who are born well, but from the age of zero to 18, because of the poor development of the hip joint, they can also produce dislocation, of course, at this time is often seen as semi-dislocation.
More than 30 years ago, when Ms. Jiang was a little baby, her parents noticed that the child was very weepy and felt that she was very difficult to raise. When she grew up a little, they finally realized that the child was not crying for no reason, she did seem to have some problems. The anxious parents took the child around to seek medical help, but the medical conditions at that time could not solve the problem of hip subluxation, and the doctor’s answer was so desperate. The reluctant family did not give up on this, and for many years, they have been looking around for an effective treatment, while Ms. Jiang’s condition was also in search, getting more serious day by day. While waiting, Ms. Jiang spent her student days, and then became a wife and mother. One day in 2006, Ms. Jiang heard that Shanghai Xinhua Hospital could effectively treat hip subluxation, so she came to Shanghai with hope, but the doctor’s conclusion was unacceptable to Ms. Jiang. But the doctor’s conclusion was too much for Ms. Jiang to accept. After so many years of searching for a solution that would allow her not to replace the joint, why did she end up with such an ending?
Q: It turns out that she had the disease at such a young age, why couldn’t it be cured at an early age?
A: This problem should be very common in our country, especially pediatric orthopedics is a very strong professional discipline, then 30 years ago, the medical conditions and equipment at that time is limited, a doctor’s treatment technology is also limited, so this is one of the main reasons for her delayed treatment.
Q: For a disease like acetabular dislocation, I believe that the earlier it is detected, the better the treatment.
A: Yes, the earlier the treatment the better, if you can diagnose and treat early, many problems can be solved, but what is the problem is that some total hip dislocation you are relatively easy to find early, for the semi-dislocation, it is more difficult to find, often until later there are symptoms, then you can find the problem, so how to do early detection of total dislocation.
How to detect hip dislocation early
1.Shortening of one limb
2, abnormal gait
3.Hip and knee pain after activity
4.The pain is wandering
Q: Why did Ms. Jiang show symptoms as soon as she was born, while Ms. Chen showed symptoms only after she grew up?
A: Because Ms. Jiang is a complete dislocation, complete dislocation has many characteristics, she walks very late, and swaying when walking, the degree of her dislocation, Ms. Jiang should be very heavy, but Miss Chen, she is a semi-dislocation, so the degree of her dislocation is light, the other is that Ms. Jiang because of the childhood, so the onset of the time is very long, has lasted for more than 30 years, but she knows her But after she knew her problem, she did not participate in activities, and she seldom ran and jumped, so her symptoms appeared later, then Miss Chen, because she did not know she had this problem, so she was more active, so her symptoms appeared earlier, and the course of the disease was shorter, so this is the difference between them.
Q; in the treatment, the two of them should also be different methods, right?
A: Different, Miss Chen is relatively light, can be treated by osteotomy, osteotomy is to break the acetabulum of the bone, after breaking a rotation, is to rotate laterally, so that the whole femoral head is well wrapped up, that is, so that its subluxation is corrected.
On March 12, 2007, Ms. Chen underwent osteotomy, the surgery went very well, more than a month after the operation, Ms. Chen began to receive rehabilitation exercises in the hospital bed. More than two months after surgery, Miss Chen can walk on crutches on her stomach, and in September 2008, we saw Miss Chen walking freely, if she did not say, no one could not see that her hip had been operated on. Now Miss Chen has long said goodbye to the pain of the past, not only can you go shopping as you like, the original can not do the housework also do not speak. She has even started to plan her own travel itinerary, as she has regained her cheerful personality.
Q: Ms. Chen has changed a lot after this surgery?
A: Yes, her subluxation was very well corrected.
Q: What are the advantages of osteotomy surgery?
A: First, it can be very effective in relieving pain, so that arthritis will not develop further, the second is to preserve her own joints, and even a bad own joint is better than a better prosthetic joint, people think so, in addition, such an operation, it does not have any impact on your future marriage and childbirth, if the operation is very successful, you can do this operation once in a lifetime, you will not need another operation. There is no need for another surgery.
Q: As we usually say, it takes a hundred days to break a bone, how long is the recovery period for a surgery like this?
A: Because we are to break a good bone to do a rotation and then fixed up, the bone grows well about three months, then in the early stage, not that you are lying in bed for three months, you can early crutches down, can do some muscle exercise, can do some joint function rehabilitation, after your bone grows well, you can quickly walk, this rehabilitation training, for the effect of surgery. The effect of this rehabilitation is very good.
Q: Who are the people who are suitable for osteotomy surgery?
A: Not all patients are suitable for osteotomy, the first basic form is good, not to say that it has been deformed, if the femoral head has become flat, this can not be done, the second hip pain, then is not the surgery as soon as there is a subluxation, you can wait until it has symptoms, this time should be done, if not done because your subluxation cartilage will be damaged, in addition is your If you can’t bend or extend your joint before the surgery, you can’t have the surgery.
Who is suitable to receive osteotomy surgery
1.The shape of the hip joint is basically normal
2.Hip joint has soreness or pain
3.Limited mobility is not obvious
Q: Can we do osteotomy surgery in Ms. Jiang’s case?
A: We can take a look at Ms. Jiang’s X-ray film, we can see that her whole femoral head is completely outside, what is her main problem, we say that a normal joint should have a gap, this gap means something, her cartilage is good, but Ms. Jiang’s cartilage is gone, it has been destroyed, then this time you can not do osteotomy surgery, but to do Other surgery.
Who is not suitable to receive osteotomy surgery
1.Significant deformation of the joint
2.Significant impairment of joint movement
3.Severe osteoarthritis
Q: Ms. Jiang has a very long course of disease and has been living in pain, and she does not want to replace the artificial joints?
A: Yes, artificial joints have their advantages and disadvantages, of course, for her, Ms. Jiang can not do osteotomy, but there are two options, one is to do the joint to death, that is, the future of the hip joint to fix it, the joint can not move, but this time can not be pain, but Ms. Jiang is certainly not happy to accept, so she is left with only one other option, that is to do artificial joint replacement The only other option left for her is to have an artificial joint replacement.
Q: What are the consequences if I don’t have an artificial joint replacement?
A: Ms. Jiang can hardly even go to the toilet of 50 meters, which means that her development is getting more and more powerful. If she does not have any surgery, fixation, osteotomy and joint replacement, she may only be able to live with a wheelchair for the rest of her life, and she will have to give up her beloved job, and she will not be able to go shopping and travel like women of her age, and eventually she may not be able to take care of herself.
After a fierce struggle, Ms. Jiang finally decided to undergo artificial joint replacement surgery, and according to her condition, the doctor decided to replace her right hip first. After the surgery, the pain in her hip joint was relieved, but a problem that she had not expected was in front of her again. One leg was long and the other short, which was simply unacceptable to the beauty-loving Ms. Jiang. In order to make up for the gap between the two legs, she came up with a solution. The custom-made shoes covered Ms. Jiang’s slightly limp walking posture for a while, but the road of life is so long in the future, is Ms. Jiang going to live like this for the rest of her life.
Q: Two legs, one long, one short, what’s going on?
A: Yes, this is a film of Ms. Jiang before, and this is a film after the surgery, so what is the difference between the two, Ms. Jiang has done joint replacement is basically restored her normal joint structure, the height of the two legs before the surgery is the same, and after the surgery, we can see that the side without the surgery is still higher, or in dislocation, this problem It doesn’t matter, it’s just for a period of time, if we say that after the surgery on the other side is also done, her two legs will also become the same length, in addition to her a wider hip will also become slimmer.
Q: Why did Ms. Jiang have to have the surgery on one side at a time? Because it is painful to undergo one surgery.
A: Technically speaking, it’s not a problem to have both sides operated at the same time, it’s perfectly possible to replace both joints together, but when both sides are done at the same time, it’s very traumatic and some people may not be able to bear it. If both sides are done at the same time, especially those who are very afraid of pain will not be able to cooperate with the doctor for rehabilitation training, and the effect of the surgery will be greatly reduced later.
Q: How long is the interval between the two surgeries?
A: There is no specific limit, generally speaking, we hope that this side has recovered better, and then we can do the other side, because the side that has recovered well should have support to help the other side recover, and this period is generally about three to six months.
Q: If it is an osteotomy, is it also done on one side first and then on the other side?
A: Yes, it is the same, because it takes two to three months for the bone to grow after the osteotomy.
A year after the surgery on her right leg, Ms. Jiang underwent hip replacement surgery on her left leg. As soon as the surgery was over, Ms. Jiang found that both of her legs became the same length again, which was a great comfort to her heart. After a period of recovery, Ms. Jiang recovered completely. As an executive in a foreign company, Ms. Jiang has many opportunities to travel, and she was never afraid to go out, but now she even took the opportunity of her annual vacation to make a few trips abroad with her family. Before the surgery, Ms. Jiang’s hip was very prominent, and after the surgery, her figure became very mannish. A surgery ended Ms. Jiang’s decades of pain and also gave her back her beauty and self-confidence. Ms. Jiang’s life has opened up a new page since then, and a bright smile finally bloomed on Ms. Jiang’s face, but behind Ms. Jiang’s smile, there is still a matter of the heart that she did not reveal to people. Every time I didn’t expect to face this problem, a trace of imperceptible melancholy would sweep across Ms. Jiang’s face.
Q: Ms. Jiang is now 30 years old, this artificial joint must be replaced regularly, right?
A: Yes, because after the installation of artificial joints, with the extension of time, but also with the increase in activity, like Ms. Jiang, the body now happens to be a peak period of her work, so a lot of work to do, the joint also had to go around with her, this time, after a large amount of activity, what is the problem, the first problem is wear and tear, after the wear and tear of this layer of plastic, there will be some powder-like particles, which will produce some powder particles. This particle will cause a chemical reaction that will lead to the dissolution of the bones around the joint, that is, the cavity, this is a problem, the second problem because you have to constantly bend constantly active, if not used properly will be between the joint and the joint to produce a bump, this bump will also bring a disaster, that is, the joint is loose inside, in addition to time, there This infection may be caused by the extraction of a tooth or a boil on your body that is not treated in time, and this bacteria can run high on your joint through the blood circulation. There are nerves, so after repeatedly hitting the inside will produce pain, infection will also be pain, you can not let it, so they all need to be revised, so no revision is not a solution to the problem, then for the loose, if not timely revision, the hole will be bigger and bigger in the future, until the time to do the revision, found that the revision is very difficult, even to the inability to carry out appropriate surgery, this time the patient’s The patient’s pain will still make him unable to take care of himself, so he must have a revision surgery.
Q: Is there any way to extend the life of the artificial joint?
The first is the product, that is, if the joint is very wear-resistant, there is no doubt that the life span will be extended. For example, if we talk about the impact problem, you have to install it in the right position to minimize the impact, which can also prolong the life, of course, the main thing is that the patient has a maintenance, so how to maintain such a joint, you can do less long-distance walking or weight-bearing, but it does not mean that after the surgery, you can hold your leg in your arms all day long, you can do swimming, you can ride a bike, like this You can do swimming, you can ride a bicycle, such as this kind of activity can make the wear and tear to a minimum.