CasePresentation

Greenunit-2

Dr. Md. Mizanur Rahman

D-ortho student
Department of Orthopedic
surgery
BSMMU
Patient Particulars
• Name: Mrs. KhodezaBegun
• Age: 70 years
• Sex: Female
• Maritial status: Married
• Religion: Islam
• Occupation: Housewife
• Adress: Sherpur
• Date Of Admission: 13/11/2022
• WARD/ Bed No: 7C / FP- 32
Complains of

• Pain in the both groin for 3 years.

• Difficulty in walking and movement of both hip for 2 years.
 History of Presenting illness
• She was in usual state of health about 03 years back.
• Then she developed gradual pain in the both groin,more in right.
• Initially pain was dull aching & intermittent in nature, localized & non
radiating, aggravated by walking for prolong duration & relived by talking
rest & analgesics.
• Symptoms are increasing in severity since last 1years making difficulty in
squatting, upstairs and downstairs movements which hampering her daily
activities.
• No history of fever/ cough/ weight loss or other constitutional symptoms.
• No definite H/O trauma.
 Past History
• She gives ooccasional history of taking Tab.Prednisolone for 3 years during
exacerbation of pain.
• No H/O bronchial asthma or any other joint pain.
• Normotensive, Non- diabetic & Non-asthmatic.
 General Examination
• Appearance- anxious
• Body built: Average
• Co-operative
• Non- Anemic, non-icteric, non-dehydrated
• Vitals -
• BP: 140 / 90 mm of Hg
• PR: 78 beats/min,
• RR: 18/ min,
• Temp: 98.4°F
• Systemic Examination reveals no any abnormality.
 Loco- Regional Examination
Look:
• Gait is antalgic
• Squatting is not possible.
• Pelvic tilting upwards on right side.
• No apparent muscle wasting of both thigh
and calf muscle.
• Apparent shortening of right lower limb
• Increased lumber lordosis.
• Skin over the groin: Normal.
 Loco- Regional Examination
Feel:
• No local rise of temperature.
• Mild tenderness present over the both groin.
• Muscle wasting : 1cm in right thigh & 1cm in right calf compared to leftt.
• Limb length discrepancy: right lower limb is 1.5 cm shorter compared to left&
shortening is supra- trochanteric measured by Bryant's triangle.
• Distal neurovascular status is intact.
 Loco- Regional Examination
• Range of movement of both hip joint :
Movement Right Left

Flexion 85 100°

Extension -15 -10

Abduction 20° 30°

Adduction 20° 30°

Internal rotation at extension 20° 30°

External rotation at extension 25° 30°

Internal rotation at 90 Hip flexion 15° 25°

External rotation at 90 hip flexion 20° 30°

 Loco- Regional Examination
Special test:
Faber test is positive – both side.

Thomas test - positive on bothside.

There is a 15° FFD & further ROM is 15 to 80° in right hip.
10*FFD & further ROM is 10 to 100* in left hip
Provisional Diagnosis:
A case of bilateral secondary oestoarthris of hip joint most probably
AVN of femoral head.
Radiological Evaluation
The Final Diagnosis

A case of Secondary Osteoarthritis of bilateral hip joint, more

symptomatic right due to AVN of Femoral head in a 70 years old
female.
(Ficat and Arlet stage– iv in rt,iii in left)
 Unit treatment plan

Cemented Total Hip replacment of right hip joint.

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