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Abstract: Ageing and overweight can lead to degenerative changes in the hip joint and osteoarthritis of the hip joint. In this case, the patient came to the clinic 2 years ago with self-reported hip pain and restricted movement, and gradually developed shortened deformity of the lower limbs and difficulty in walking. After radiographic examination, it was found that the hip joint space was severely narrowed and the femoral head had moved upward. In order to restore the function of the hip joint and the length of the lower limbs, total hip replacement surgery was performed, and the surgery went smoothly.
Basic information】Male, 68 years old
Disease Type】Hip osteoarthritis
Hospital】Harbin First Hospital
Date of consultation】May, 2021
Treatment plan】Surgery (total hip arthroplasty) + hip and lower limb rehabilitation + medication (rivaroxaban tablets)
Treatment period】7 days of inpatient treatment, 3 months of outpatient follow-up
Treatment effect】Hip pain relief, range of motion restored
I. Initial consultation
The patient was a 68-year-old male patient who had hip pain and limitation of movement for 2 years before the consultation, and gradually developed shortening deformity of the lower limbs and difficulty in walking. Because the patient was obese, excessive weight-bearing on the hip joint led to degenerative changes in the cartilage and other structures of the joint, which severely limited the walking range and eventually led to osteoarthritis. Radiological examination confirmed osteoarthritis and severe deformation of the joint. It is necessary to replace the artificial joint by means of total hip replacement surgery as soon as possible to restore the hip joint movement as well as the length of the lower limbs to avoid continued muscle atrophy of the lower limbs, which affects the patient’s daily walking. Because the early diagnosis and treatment time was missed, conservative treatment could not achieve the ideal treatment effect for this case. Patients should be fully aware of the risks of total hip replacement surgery before the surgery, such as deep vein thrombosis in the lower limbs and joint infection, and they should enhance nutrition and immunity to be fully prepared for the surgery.
II. Treatment process
During the surgery, it was found that the cartilage on the surface of the femoral head on the affected side had been completely destroyed, and the corresponding part of the acetabular cartilage had also been severely damaged, the joint surface was rough, the synovial membrane was inflamed and edematous, and there was severe hyperplasia. In addition, the femoral head on the affected side had collapsed significantly. After removing the femoral head, the acetabulum was treated at the same time, and considering that the bone strength of the patient was still satisfactory, a biologic artificial hip joint was selected for replacement. After the end of the artificial joint replacement, there was no significant dislocation of the mobile hip joint, and the results of measuring the length of both lower limbs reached complete symmetry. After the surgery, the rehabilitation training of the hip joint and lower limbs was carried out under the guidance of the rehabilitation doctor to restore the range of motion of the affected hip joint and the strength and power of the lower limb muscles.
III. Treatment effect
The patient experienced significant relief of pain symptoms about 5 days after surgery and could resume hip flexion and extension activities, but internal rotation activities were still severely restricted, preventing joint dislocation of the hip joint after surgery and restoring symmetry in the length of both lower limbs, but due to the long-term shortening deformity, there would be discomfort in the lower limbs, which required gradual adaptation. Through rehabilitation, the swelling in the surgical area was significantly relieved and there was no significant exudation from the surgical incision. The postoperative anemic state was significantly corrected by increasing nutritional intake. At 7 days of hospitalization, the patient was discharged from the hospital and was instructed to follow up at the door after 3 months.
IV. Notes
The operation went very well, which is one of the happier points for me. However, the patient still needs to increase nutrition after the operation and cooperate with the clinician for prophylactic anticoagulation therapy, such as strengthening the muscle contraction and diastolic training of the lower limbs, as well as taking oral rivaroxaban tablets and other drugs. Elevate the affected limb appropriately to accelerate venous and lymphatic reflux by using gravity to reduce swelling as soon as possible. After surgery, attention should be paid to avoid crossed lower limbs and internal rotation of the hip joint to prevent postoperative dislocation of the hip joint. The body temperature should be monitored daily and the blood count should be reviewed regularly to observe whether inflammatory infection occurs. Exercise of the muscles around the hip joint should be adhered to for a long time to gradually improve the stability of the hip joint and disperse the pressure on the hip joint, which can prolong the service life of the hip joint.
V. Personal insight
Osteoarthritis of the hip joint is characterized by degeneration of articular cartilage and joint dysfunction, which is related to various factors such as ageing, overweight and trauma to the hip joint. For example, in this case, overweight and excessive weight bearing on the hip joint led to osteoarthritis of the hip joint and limited mobility. In fact, the development of the disease is slow, and if it can be treated adequately at an early stage, it can slow down the development of the disease and protect the function of the joint, but the patient’s joint has been seriously deformed, and the effect of conservative treatment is not satisfactory, so surgery is performed. In daily life, patients should also strictly control their weight and strengthen the muscle strength of the lower limbs to protect the joints.