More & more young & active patients world wide are in need of hip replacement surgery. In such cases, it is imperative to pay special attention to the technique to ensure a successful outcome & longevity of the operation. Traditionally a total hip replacement was performed in the older age group. Young patients with hip pain either had to endure pain or subject themselves to a total hip replacement with its inherent disadvantages of dislocation and life span of 10 to 15 years.

Now, recent advances in bio- materials and techniques have made it possible for young patients to get a satisfactory & successful outcome after a hip arthroplasty. Definition of a young patient- The deciding factor is not necessarily the patient’s age, but their activity level. Even many older patients like to play Tennis, Golf or participate in physical activity. This applies also to anyone who can be expected to live for a long time, is biologically (not chronologically) young and has good bone quality. Today even septuagenarians meet these pre requisites. Surgeons have to re think their conventional strategy of putting in a total hip with a metal on poly bearing. Resurfacing also poses several un answered questions and cannot be considered as a panacea. Causes leading to hip pain in young patients-

Avascular necrosis is the leading cause leading to hip arthritis followed by developmental dysplasia of the hip. Perthes disease, slipped upper femoral epiphyses, sickle cell disease and post traumatic arthritis are other causes leading to the common outcome of secondary osteo-arthritis. In middle and older Caucasian patients, Primary osteoarthritis is the commonest cause of hip pain. Limitations of hip resurfacing Off late, hip resurfacing has been vigorously promoted on the internet as a possible & preferred treatment. However there are some inherent un answered problems with hip resurfacing. Elevated metal ion levels, metal allergy, metallosis are some of the side effects of metal on metal hip resurfacing. The long term impact of raised metal ion levels is unknown. Females in all age groups are high risk candidates because of the risk of fertility curbs in young & femoral neck fracture in the older. However the attraction of a hip resurfacing drives many females to ignore these risks and choose a hip resurfacing. Dr.Venkatchalam of www.hipsurgery.in discusses an alternate bone sparing safe approach in young & active patients. These approaches combine the advantages of a hip resurfacing and total hip replacement. Why do you prefer the short stem?

The various short stem prostheses like the Proxima hip & METHA combine the

Proxima hip, A short stem mini hip implant

advantages of resurfacing & THR. On the acetabular side a full range of options is available to the surgeon. The force transfer in the femur is more proximal and more biological. Lack of a distal stem component eliminates the incidence of thigh pain. In addition these implants open up the vast range of bio materials available. All biomaterial combinations like metal on metal, metal on poly, ceramic on poly, ceramic on ceramic are possible. These promise excellent longevity. If a revision becomes necessary, then one can switch to a standard stem. Some of these models like the METHA hip make it possible for the surgeon to tailor the implant to the individual’s anatomy. What other innovations can you use to ensure a proper implant positioning? Navigation allows the surgeon to place the implant in the optimal position.

What are the special considerations in Asian patients? Dysplasia, Ankylosing spondylitis and osteo necrosis constitute the most common indications for total hip replacement in India & Asia. Primary osteo-arthritis is rare. Moreover these patients are younger and more active. Their social and religious habits such as sitting with crossed legs dictate to the surgeon that he must use a prosthesis which provides a large range of movement. Risk of dislocation has to be reduced. Anatomic differences also exist. All these variables require a special implant concept and very wear resistant materials with a large diameter. To summarize, treatment of hip arthritis in the young poses a challenge to surgeons and scientists. Hip resurfacing while offering a possible solution has some draw backs. Short stem prostheses with newer bio materials promise to overcome these deficiencies and offer a long lasting surgical outcome.

Visit – www.hipsurgery.in

Email for a free consult- drvenkat@kneeindia.com

Are you a candidate for Birmingham Hip Resurfacing?
If you suffer from painful hip arthritis in young or middle age and need pain relief, you will benefit by a Birmingham hip Resurfacing.
This surgical procedure is designed to conserve more bone than a total hip replacement. Rather the head is reshaped & resurfaced with  a metal cap. On the socket side, the acetabulum is scraped and fitted with a metal socket.
The Birmingham Hip Resufacing prosthesis got FDA approval in 2006. It has been used in India much earlier and has relieved many young patients of hip arthritis.
What is Birmingham Hip resurfacing?
This implant has two components. On the femoral side, there is a metal cup made of cobalt chrome with a central peg. On the socket side there is a metal socket made of the same material and coated on the outside with Hydoxy apatite. Hydroxy apatite resembles bone tissue. Fixation occurs by natural bony ingrowth into this coating.
Hip resurfacing relieves pain and restores normal function. Young and middle aged patients upto 65 years can benefit from hip resurfacing.

Indications for Hip resurfacing- If you have the following conditions you may be considered for Hip resurfacing.

1. Primary osteoarthritis
2. Early Avascular necrosis
3. Post traumatic arthritis

Advantages of Hip Resurfacing
1. Less bone loss on the femoral side
2. Less risk of dislocation
3. Better range of movements

Some risks of this procedure are
1. Femoral neck fracture
2. Metal wear particles can damage bone & soft tissues.
3. Metal ion elevation in blood and urine

Best candidates for BHR
1. Suffer from Osteoarthritis
2. Young than 60 years
3. Bone shape is normal
4. Bone density is normal
5. No cavities or cysts in bone
6. Limb lengths are equal

Men younger than 65 years with good bone stock are the best candidates. Women with favorable criteria like a big frame may be considered.

While Hip resurfacing is an attractive option, it is not a panacea for everybody. Patients with the following criteria are not suitable candidates
1. Poor bone denisty
2. Large cysts in neck
3. Short or abnormal neck
4. Large cysts in head extending beyond 30% of the head
5. Infection
6. Impaired or anticipated deterioration of kidney function ( Renal failure, Sickle cell disease)
7. Bony fusion
8.Unequal limb lengths
Women in child bearing age are not good candidates. Post menopausal women with good bone density can be considered.

Hip Resurfacing Procedure
You can get an appointment for surgery at short notice. Just e mail us at drvenkat@kneeindia.com.
You will spend about 5 days in hospital. By six weeks you would have returned to normal walking and activities.
You can see the recovery of Mr.Chris Browne, one of our previous patients from Greece in this video. You will be amazed by the flexibility & mobility on the first anniversary of his right hip resurfacing.

Video shows recovery after Hip Resurfacing surgery at 1 year.

Dr.Venkatachalam is one of the few surgeons who perform Hip resurfacing. He received training in this procedure at the Zimmer institute. Please see our patient testimonials for Hip resurfacing here.
http://www.hipsurgery.in/patient-stories/
Visit our website, Hip Surgery India

Your health travel trip to India for a hip resurfacing will save you thousands and give you an opportunity to see the ancient culture and traditions of South India.

Ah, my favorite doctor ! Nice to hear from you. Summer is in full swing here, which means barbaque and boating. Thanks to your wonderful work I was able to try wake boarding this year. It was one of my goals to return to a more active lifestyle. Its really depressing to lose physical ability before your time. I was hoping to last till at least 99 before giving up skydiving and being shot out of a cannon ! Thanks again and good fortune.
signed Grandon Benson

Hip resurfacing surgery in India restores your mobility

People dread getting old. If you are Caucasian and approaching your forties, you may have already noticed that some of the things you did as a teenager aren’t that easy anymore. As a general rule, if you take care of yourself when you are young, getting old will be easier. Joint pains develop and progress to restrict your life style and stop you enjoying outdoor activities.
A lot of people will have to face as a part of the aging process one of those things is hip replacements for hip pain.

According to The National Institue of Arthritis and Musculoskeletal and Skin Diseases there are over 193000 hip replacements performed in the U.S. each year. In the UK, the numbers are about 5, 00000 per year.

Hip replacements have been the mainstay of treatment for hip arthritis. An alternative considered nowadays is a procedure called hip resurfacing. The main advantage that hip resurfacing has over a total hip replacement is the amount of bone removed. More bone is preserved in the top end of the thigh bone (femur) called the neck and head. During a resurfacing it is quite a bit less then the amount of bone that is removed during a total hip replacement. Is that a good thing or bad thing? It is a good thing because as a general rule a patient will recover quicker and go through less pain with a hip resurfacing then they would if they had a total hip replacement. Another advantage is that since the head size matches the natural size, there is little risk of dislocating your hip. This will give you a lot more freedom of activities.

When a young patient goes to an orthopedic surgeon because they are experiencing pain in their hip joints the doctor will more often than not try to put off surgery as long as possible. This is no longer necessary. Once the patient reports that the pain that they experience is beginning to limit their day to day activities surgery will be performed. However these young arthritic patients should understand that a hip replacement may have to be redone. This fact makes hip resurfacing a very viable option in younger patients.

The surgery itself can be performed in different ways. We use the approach from the side. Our incisions are quite small and measure about 7 inches. We prefer to keep the hip joint capsule in tact. Keeping the hip joint capsule intact is less damaging to the blood supply in the hip area and limits the risk of the patient dislocating their hip after surgery.

The surgery is performed by making a cut on the side of the hip.

The femoral bone is then dislocated from the hip. The head of the femoral bone is then shaped so that a new metal cap fits over the head snugly. This is then placed over the end of the bone and held in place by a pin & cement fixation. The hip socket itself may be left alone or a thin metal cup can be placed in the socket. To make room from that metal cup a reamer is used to remove the cartilage from the acetabulum and to shape the socket for the metal cup. The metal cup is pressed into the socket. Friction holds it in place until new bone grows and fills in the holes of the surface of the metal cup and attaches it to the bone.

The patient is generally released from the hospital 2-4 days after their surgery. Physical therapy starts almost immediately with a therapist helping the patient get out of bed on the very first day. Therapy progresses quickly with the patient walking around with crutches the second day after the surgery. The patient can expect to have physical therapy between 1-3 times a day while they are still in the hospital. Generally, the patient will be released when he or she is able to get out of bed, walk 75 feet with the aid of crutches or a walker, and is able to climb stairs.

If you are looking at having to have hip surgery, ask us at the Madras Joint Replacement center in India, whether or not you may be a candidate for hip resurfacing. If you are able to have your hip resurfaced over having to have it totally replaced, you will enjoy several advantages to a hip replacement.