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A Case of Avascular Necrosis of Femoral Head

Posted by Dr Prasad Arvind Rasal. on June 29, 2010 at 2:35pm in Cured-Cases-Database View Discussions

Case 1: Mr R.A.M., 40 yrs, staying at Mumbai, came on 7th Nov 2002, a diagnosed case of Avascular Necrosis of Femoral Head Left > Right with complaining of Severe Pain in Lt Hip Joint since 1 yrs <> Continued Slow Motion Pain in Lt Leg Calf > Stretching the limb Pain in Lt Leg Calf > Uncovering at night Lt Hip Swelling/ Inflammation/ Stiffness Lt Leg shorter than Rt Painful Varicose Veins both Lower Limbs Since 3-4 yrs Past H/O: Since Childhood Allergic Bronchitis & Leucoderma A lot of Steroids consumed in the past for the same. Family H/O: Paralysis PGM, MGF.

Personal H/O: Craving: Sweets++, Tobacco++ Aversion: Fatty Food+++ Sleep: Disturbs due to pain as well as due to frightful dreams Dreams: Cousin Brother who died in 1985+++; Frightful+++; Death of Relatives+++. Thermal: Ambi-thermal Mental State including Life Space Investigation: Patient from Poor Socio-economic Family; Childhood Average; Completed 10th & Went to Mumbai in 1985 for service; Working as a Machine Operator in a company; Married in 1986; Spouse House wife; Have 2 sons & 2 daughters; Happy go Lucky life was going on till last year except off and on episodes of Allergic Bronchitis; Vitiligo settled with Allopathic Treatment consisting of long term use of Corticosteroids; Very hasty in Nature; does everything very hurriedly; Since last year, started getting recurrent pain in Lt Hip Joint; Consumed Treatment from a GP quiet a long; As recurrence and spread to Rt Hip increased, shown to Orthopedician Dr K J Kamat who advised him MRI of Hip and diagnosed as a case of Avascular Necrosis of Lt Femoral Head. He advised him Total Hip Replacement Surgery which is not at all affordable for the patient. Since last 6 months, getting difficulty in concentrating at work due to pain; One interesting thing he told that when he doesnt concentrate on his work, he use to eat something which makes him comfortable; He becomes so restless that he avoids the work & wants to quit the job but he cant as whole family depends upon him; He is quiet anxious about Surgery and the consequences of it because it was told to him that after the surgery he cannot seat down forever & re-surgery requires every 5-10 yrs. Thats why he came for Homoeopathic Treatment to avoid the surgery. Physical General Examination: Wt: 77kg P: 80/min BP: 122/78 mm of Hg Male Pattern Baldness Tongue: Flabby Difficulty in Walking & even Riding on Examination Table Looks: Anxious, Sadness. Clinical Examination: Lt Leg shorter than Rt Stiffness Lt Hip; Cant bend it; Cant lift the Lt Leg Walks with limping Investigations: MRI OF HIP JOINTS (31/01/02) MRI of both Hip Joints reveals: Feature suggestive of Lt hip AVN with changes causing architectural distortion & subarticular irregularity seen in the left femoral head with mild joint effusion. The left acetabular margin is normal. The right hip joint & both sacro-iliac joints are normal.

RUBRICS FOR REPERTORISATION: 1. Concentration; Difficult 2. Concentration; Difficult, Eating, amel. from 3. Anxiety 4. Dreams; Dead, people, of, Weeping, with 5. Dreams; Death, of, Relatives 6. Dreams; Frightful 7. Fear; Poverty 8. Hurry, haste; Tendency 9.Generalities; Caries, necrosis, of, Bones 10.Generalities; Exostoses, Syphilitic 11.Generalities; Food & drinks, Fat & rich food, Aversion 12.Generalities; Food & drinks, Sweets, Desires 13.Generalities, Necrosis, Bones 14.Extremities, Pain; Lower limb, Hip, Motion, amel 15.Extremities, Pain; Lower limb, Leg, Calf, Stretching, amel. 16.Extremities, pain; Lower limb, Leg, Calf, Uncovering, amel. 17.Extremities, Swelling, Joints 18.Extremities, Shorter,one than other leg 19.Extremities, Varices,Leg,Painful 20.Extremities, Inflammations, Joints, Synovitis, Chronic RESULT OF REPERTORISATION: Calc fluor 33/20 Puls 27/13 Sulph 24/12 Lyco 24/11 Calc 22/12 Merc 22/11 Ars 22/10 Homoeopathic Management: 7 Nov 2002: Avoid Tobacco Weight Reduction Calc Fluor 6x tds 3wks 30 Nov 2002: Lt Hip Pains Persistent <> Continued Motion But feeling better at general level; Wt: 76Kg Can walk for 15-20 min freely Calc Fluor 6x bid 1mth 30 Dec 2002: Lt Hip Pains Much Better; Work freely; Looks Confident; Thought of leaving the job totally gone; Can walk freely without limping for 45min; Wt: 74.5Kg

Syph 1M 1 Dose Calc Fluor 6xOD 6mth 14 June 2003: No Pain in Hip; Working with full strength; Walking freely for 1hr; Normally climbing staircase; O/E: Easily lift the Lt leg & bend it; No Tenderness Wt: 74Kg Calc Fluor 6xOD 6mth 7 March 2004: No Pain in Hip; Working with full strength; Walking freely for 1hr; Normally climbing staircase; O/E: Easily lift the Lt leg & bend it; No Tenderness Wt: 74Kg Calc Fluor 6xOD 6mth 24 Dec 2004: MRI OF HIP JOINTS (21/12/04) MRI of Pelvic & both Hip joint for a follow up case left hip AVN reveals Changes in the superior weight bearing portion of the left femoral head noted with mild flattening of the head. In comparison with previous MRI there is mild increase in the flattening. However, the marrow changes appear to be localized to the weight bearing portion with reduction of the marrow edema in the neck that was seen in previous study. The hip effusion which was seen in previous MRI has also resolved. The left acetabulum margin is intact. No para articular soft tissue abnormality. The right hip & both S.I. joints are normal. No Pain in Hip; Working with full strength; Walking freely; O/E: Easily lift the Lt Leg & bend it; No Tenderness Wt: 74Kg Calc Fluor 6xOD 12mth 3 Nov 2005: No Pain in Hip; Working with full strength; Walking freely; O/E: Easily lift the Lt Leg & bend it; No Tenderness Wt: 74Kg Calc Fluor 6xOD 12mth

4 Sep 2006: MRI OF HIP JOINTS (1/6/2006) MRI of Pelvic & both Hip joint for a follow up case left hip AVN reveals Sequelae of Avascular necrosis seen with architectural distortion with flattening of left femoral head. The left acetabular margin is intact. As compared to previous MRI dt. Dec 2004, no significant interval change noted. No further progression of the disease seen. The right hip & both S.I. joints are normal. No Pain in Hip; Working with full strength; Walking freely; O/E: Easily lift the Lt Leg & bend it; No Tenderness Wt: 74Kg Treatment stopped. Follow Up after 2 years. Like 1 member likes this Share Twitter

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