Dr.A.K.Venkatachalam performs a cementless hip replacement in India. visit http://www.hipsurgery.in

Dr.Venkatachalam of www.hipsurgery.in performs an uncemented hip replacement. Hip replacements in India are offered for young patients with arthritis.

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

A forty year old Nigerian lady crippled by pyogenic arthritis in infancy received a primary total hip replacement. This restored her mobility and gave her a new lease of life.

It was a technically difficult procedure as the native acetabulum was dysplastic, the femur was high riding and had a small medullary canal.

Primary hip replacement was done with an cementless modular femoral prosthesis and cementless acetabular shell.

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.

Avascular necrosis is the most common cause of hip pain in the young and middle aged population. The most common reason is idiopathic or unknown. Other causes include steroid intake, blood disorders, fractures of the neck of femur, alcoholism.
The disease is very common in the age group 20 to 50.
Treatment options are
1) Non surgical- This has a poor rate of cure.
2) Surgical- Surgical treatments can be further divided into joint replacement or non joint replacement. Non joint replacement measures are core decompression and regenerative therapy with bone forming stem cells. This modality of treatment is relatively new and is available in India at a modest cost.
Joint Replacement- This consists of hip resurfacing, BHR, Birmingham mid head resection (BMHR),Short stem hip replacements, Birmingham mid head resection and total hip replacement with an uncemented or cementless prosthesis.
The bearings used need to be long lasting and devoid of side effects. Metal on metal bearings are used in Hip resurfacing and BMHR.
Ceramic on ceramic or ceramic on metal or ceramic on poly bearings can be used with short stem and total hip replacements. Ceramic on ceramic bearings result in the least amount of wear. Metal bearings can produce some amount of wear particles.
Most procedures mentioned above are bone preserving operations with the exception of a total hip replacement.
We have been performing short stem hip replacements with the Proxima hip since the last 5 years.

Protrusio acetabuli is a medialisation of the medial wall of the acetabulum. The head of the femur lies medial to the Ilio-ischial or Kohler’s line.
• It is the result of remodelling of weak, medial acetabular bone after multiple, recurring stress fractures
• Migration occurs along the resultant joint-reaction force vector
• There are a number of causes, the common ones being secondary to inflammatory cause (inflammatory destruction) or metabolic cause (qualitative deficiency in the bone).
This case of protrusion acetabuli in a 25 year young male resulted from a long standing central fracture dislocation of the acetabulum. Stiffness and short limbed gait were the presenting symptoms. Other symptoms encountered commonly are progressive pain.
Radiological findings- The medial wall of the acetabulum lies medial to the Ilio Ischial line.
Medial wall (acetabular line) and it’s relation to ilioischial line (Kohler’s line)

Protrusio acetabuli Grade III

Treatment consists of a total hip replacement. Since many cases occur in young patients, a conventional total hip replacement is not ideal since it removes more host bone. Invariably a revision hip replacement will be required in a young patient undergoing a total hip replacement. A bone sparing option like Hip resurfacing or short-stem hip replacement is preferable. Hip resurfacing is possible in mild grades where bone grafting is not required. In the more severe grades, bone grafting is mandatory. An anti protrusio cage can also be used to reconstruct a severe medial wall deficiency.
In the present case, an innovative approach was adopted for hip reconstruction. Hip resurfacing was ruled out because of the necessity for bone grafting and severity of the condition (Grade III in this case)
A bone sparing Proxima hip replacement was planned. The cup was lateralized by bone grafting.
Hard on hard bearings were chosen in view of their established favorable long term outcomes. Hard on Cross linked poly was not chosen because of the lack of long term results. A Pinnacle cup with a metal liner and a Proxima stem with a Ceramic 36 mm head were used.
Figure 2 shows the Proxima stem with a 36 mm Delta Ceramic head.

Proxima stem with Ceramic head

The Final result is shown in this x ray

Proxima hip replacement
This is probably the first case of Proxima hip replacement done for a case of Protrusio acetabuli.
This operation was performed by consultant Orthopaedic surgeon
Dr.A.K.Venkatachalam.
Visit www.hipsurgery.in.