Stephen Richeley, a British citizen resident in Uganda shows his rapid recovery after a Birmingham hip resurfacing surgery in India. His surgery was performed at a super speciality hospital by Dr.A.K.Venkatachalam. Visit http://www.hipsurgery.in

Birmingham Hip Resurfacing India- British patient testimonial

Revision hip implant

Ugandan lady Esither Rubangura

A revision hip replacement was performed for a retired Ugandan midwife. A cemented hip replacement done in 2004 had loosened. She had severe bone loss in the femur and moderate bone loss in the acetabulum. Dr.Venkatachalam performed an uncemented revision hip replacement. He used the Wagner stem and Trilogy cup from Zimmer. Allograft bone was used to reconstitute acetabular and femoral bone loss.
The same patient had undergone a primary knee replacement last week.
Thousands of patients from Afrcian countries travel to India for joint replacements. Dr. Venkatachalam is a joint replacement orthopedic surgeon

Ceramic hip replacement

A Nigerian patient sought a hip replacement in India. He was suffering from a neglected posterior dislocation of hip with avascular necrosis. He was given an advanced Ceramic on Ceramic hip. Although the US FDA only recently accorded sanction for ceramic on metal hip replacement, this procedure had been done by us since the last two years.

 

Hip replacement in neglected acetabular fracture
Dr.A.K.Venkatachalam
Consultant Orthopedic surgeon, Chennai,
www.hipsurgery.in
Acetabular fractures are often sustained in four wheeler accidents. Most patients are young. The ideal treatment is internal fixation in displaced fractures. In neglected fractures or following improper fixation, avascular necrosis and secondary osteoarthritis result. In such cases total hip replacement is required. This case report shows a total hip replacement for a neglected acetabular fracture.
Case report- Mr. S A, a 30 year old Nigerian male presented with a neglected acetabular fracture of two years duration.

The head of the femur is lying posteriorly on the ischium.
He was taken up for a one stage acetabular reconstruction and a total hip replacement.
Technique
Acetabular reconstruction was achieved with a cortico cancellous bone graft from the femoral head. The posterior wall was recreated with bone graft fixed in place by a contoured reconstruction plate.
After achieving a contained acetabulum, it was prepared to receive an uncemented Pinnacle cup. This multi holed cup was fixed with four screws. A Corail stem was used on the femora side. The bearings were Ceramic on ceramic.  This case report can be seen here
E mail- drvenkat@kneeindia.com

Medical Tourism for Avascular Necrosis

It’s becoming more common by the day – as medical treatments procedures become costlier in some nations and simultaneously improve in quality in others, more and more people are choosing to travel out of their homelands in search of inexpensive alternatives to the medical procedures they require. Their preferred destinations are countries where healthcare is affordable to those who have money and where the quality of care provided depends on the amount you’re willing to spend.

Medical tourism is popular in and thrives in countries like India where costs are affordable and the care provided is of superior quality. If you suffer from avascular necrosis and need a hip replacement, a hip resurfacing procedure or stem cell treatment, here are a few tips that will come in handy:

• Research your options before you decide to travel abroad for surgery – choose your destination based on a variety of factors, the most important of which should be quality. Cost is a consideration too, but if you’re not careful, you could end up becoming the result of a medical error.
• Ask a friend or family member to accompany you on the trip – you will need their help to move around in the initial days of the surgery, to help you with your physiotherapy, and to ensure your safe travel back home once you’ve been discharged. Most hospitals in India allow a companion to stay with you in your private hospital room during and after the surgery.
• Be prepared to spend between ten days and two weeks for the procedure.
• Understand your legal rights and options in the country you choose to visit for your procedure – it is harder to sue medical practitioners in countries like India than it is in the USA. To avoid legal issues and unpleasantness, choose a doctor who is reputable and experienced in the surgery, or a hospital whose name is synonymous with quality.
• Be prepared to undergo physical therapy soon after your surgery – it is necessary to restore mobility and improve your range of motion.
• Learn a little about the country and city you’re going to be staying in for your procedure so you don’t get cheated or find yourself like a fish out of water when you get there. Use the Internet to find out the best ways to get to the hospital from the airport and read up on the culture of the country.
• If you want to do a few touristy things before/after the surgery, check with your surgeon if it’s going to be possible before fixing your itinerary.
• And finally, be prepared for any eventuality – ensure that you have access to enough funds to cover your stay, ascertain that you don’t break any local laws and rules, and most important of all, establish a good relationship with your preferred doctor/hospital before you get there for the procedure.

By-line:

This guest post is contributed by Rachel Davis, she writes on the topic of Radiology programs . She welcomes your comments at her email id: racheldavis65[@]gmail[.]com.

METHA hip A short stem hip with modularity

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

Birmingham Hip resurfacing prosthesis

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.

X ray of Birmingham Hip resurfacing surgery

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

American Grandon Benson, Hip resurfacing patient of Dr.Venkatachalam

Video testimonial of Grandon Benson from Seattle, Washington, USA. He underwent right Birmingham hip resurfacing by Dr.A.K.Venkatachalam of www.hipsurgery.in