Dr.A.K.Venkatachalam performs an uncemented hip replacement. The patient has a neglected fracture dislocation of the hip.

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

 

 

 

 

 

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

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

Ankylosing spondylitis affects young men pre dominantly. The earliest manifestations are low back pain and gradually the disease results in hip pain stiffness and involvement of other joints. The spine is most commonly affected and can result in fixed deformities.
The diagnostic tests for ankylosing spondylitis consist of blood tests, x rays of the lumbar spine and other involved joints.
Hip involvement starts early. The permanent solution is Hip replacement.
Hip resufacing is possible in the early stages of the disease. However with totally fused joints, Hip replacement is the only option.
Since most patients are young, cementless hip replacements are preferred. Long lasting bearings like metal on metal, ceramic on ceramic, ceramic on cross linked poly are preferred.

A few years ago, it was the common perception that joint problems were a problem of old age and young were spared. This is far from the truth today and in years to come. Orthopedic surgeons are seeing increasing numbers of young patients with end stage arthritis proceeding to Joint replacement.

Take the case of thirty eight year old Radhika from Bangalore. Both her knees are worn out from osteoarthritis. Osteoarthritis usually affects older people but young patients with certain risk factors, injury or a genetic pre disposition can get it much earlier.  She is going to require knee replacements soon.  Another example is Safia from Mangalore who at the age of forty five has already had bilateral Oxinium knee replacements done.  Her main contributory risk factor was obesity. The photo is a young African patient who underwent hip resurfacing three years ago. His video testimonial is provided here. http://www.youtube.com/watch?v=-k9F9NpF8UI

It is contextual to deliver this message today on the occasion of World Arthritis day says Dr.Venkatachalam an orthopedic surgeon from Chennai, India. Arthritis refers to any affection of a joint leading to swelling, pain, noise, and restriction of movements.  World arthritis day is commemorated each year on October 12^th to raise awareness of joint problems. This year’s theme is “Let us work together”.

Conditions leading to end stage arthritis in the young are rheumatoid arthritis, post traumatic arthritis, ankylosing spondylitis, post infective arthritis, hemophilic arthritis and osteoarthritis in the genetically prone young patient. The end result is a breakdown of articular cartilage, the natural shock absorber.

Increasing incidence of joint problems amongst the young has led to a commiserate increase in demand for intervention as the young are not content with resting at home or taking medicines. This population of so called “baby boomers” wants to enjoy life to the hilt & be able to earn their living.

Early diagnostic radiologic methods like MRI can pick up disease in its earlier phase. Laboratory diagnosis of ‘Rheumatoid arthritis a debilitating disease is also possible with blood tests.

Early diagnosis enables surgeons to offer newer methods of treatment and perhaps even nip the disease in its bud. Disease modifying drugs, stem cell therapy, advances in joint replacement are examples of advances.

Cartilage surgery is a method of biological treatment. Damaged articular cartilage is repaired or regenerated. Autologous chondrocyte implantation an established technique has been introduced in India in its latest technological advance. This fourth generation cartilage regeneration technique is invaluable for treating lesions in high demand patients like athletes.

Joint replacements also have got a boost in the last two years. Earlier Joint replacement had a survivorship of ten to fifteen years. A young patient in need of a Joint replacement was certain to need a revision surgery later on. This requirement is now mitigated with the availability of implants made of durable materials like Oxinium. Oxinium is a metal substrate with a ceramic coating. Oxinium knees & hip implants offer longevity, low friction and non allergenicity.

Madras Joint Replacement center is dedicated to restoring mobility & flexibility.

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

Metal on metal hip replacement problems
A recent study from Belgium found that metal on metal hip replacements that included resurfacing resulted in pseudo tumors in 8% of cases. This required a revision due to loosening of the implant. This paper was presented at the American Academy of Orthopedic surgeons conference in March 2010.
The failure rate of metal on metal rates was about 8 % or more according to this study.
Ceramics, cross linked polyethylene, metal on metal are different types of bearings used in total hip arthroplasty. Ceramics and metal are hard bearings thought to reduce wear. However metal on metal implants resulted in a high early failure rate. It is thought that this complication could result from metal hypersensitivity.