Archive for April, 2009

Hip arthritis – Types & solutions

Hip arthritis is of two types. Young and middle aged persons suffer from secondary osteoarthritis. Primary osteoarthritis can affect middle aged and elderly. Surgery in this group of relatively younger patients requires newer techniques like hip resurfacing.

Hip Resurfacing is the preferred option in young & middle aged males with primary

Types of Hip arthritis

Hip arthritis is classified as Primary and secondary Osteoarthritis.

Primary osteoarthritis is age related wear and tear arthritis. It is rare in India.

Secondary osteoarthritis occurs at a younger age and is more common. Rheumatoid arthritis, avascular necrosis, traumatic arthritis and other connective tissue disorders like SLE, Psoriasis etc. all lead to secondary osteoarthritis.

Rheumatoid arthritis is an auto immune disorder, affects all joints particularly the small joints but also does not spare the hip and knees.

Avascular necrosis is a condition that reduces the blood supply to the end of the bone. It affects patients with excess alcohol intake, consuming steroids, connective tissue disorders like SLE. Systemic lupus erythematosus (SLE) is a connective tissue disorder affecting mainly young women A photo sensitive rash on the cheeks, renal involvement and arthritis are some notable features. Avascular necrosis affects a proportion of the patients with SLE.

Gaucher’s disease is a rare genetic storage disorder.

Post traumatic arthritis occurs after a severe injury to the hip. Fractures of the ball (top of the femur) or socket (acetabulum) can lead to arthritis after inadequate treatment.

Hip arthritis is very disabling as it is a small ball and socket joint. In advanced disease a total hip replacement was recommended by Orthopaedic surgeons until recently. The ideal age for a hip replacement is 74 years.

Surgical solutions

are the mainstay of treatment as conservative measures fail to relieve pain. Total Hip replacement (THR) is a time tested operation and has a success rate of 93 % survivor ship at 10 years.

Who needs a hip resurfacing?

In India, many young patients with ankylosing spondylitis, avascular necrosis, post septic arthritis, post injury suffer from hip arthritis and are advised a hip replacement for disabling pain. Thus many hip replacement operations are performed in younger patients. The surgery should cater to the enhanced demands on an artificial joint by younger and more active patients. Naturally an operation designed for Western elderly patients is not suitable for younger patients.

Hip resurfacing vs replacement

Hip Resurfacing vs Hip Replacement

In this operation the ball shaped upper end of the thigh bone (femur) and the socket (acetabulum) are replaced. The ball is replaced with a long metal stem that is fixed into the upper end if the thigh bone. Its upper spherical end articulates with a cup shaped polyethylene socket that is cemented into the pelvis.

Conventional hip replacements sacrifice a great deal of normal bone as the head, neck, and upper part of the thigh bone is removed for implantation of the prosthesis. Moreover wear debris from the poly-etheylene liner lead to osteolysis and bone loss. When this first hip is to be changed or revised after its lifespan more bone loss occurs. Conventional hips have a small ball to reduce friction and wear, but the ill effect of this is an increased risk of dislocation. An average dislocation rate of 3- 4 % has been reported. These implants do not last very longer than 20 years and revision rates of 50% at 20 years have been reported. Survival rates are less satisfactory for the relatively younger active patients. Thus a total hip replacement is not an ideal implant for younger patients less than fifty years old who need a new hip.

Problems with conventional total hip replacement:

  • Excessive bone sacrifice and loss
  • Increased risk of dislocation
  • Patients cannot squat or sit cross legged on the floor with out the risk of dislocation.
  • Range of movement is less
  • Patients cannot involve in sports
  • Poor survival in young and active patients they require earlier revision.
  • Revision surgery is difficult
  • The hip feels less like a normal hip
  • The cup wears with time and plastic from it harms bone
  • Change in length of the leg after surgery leading to leg length discrepancy.

Why remove normal bone when only the surface of the ball is bad?

This is the logic behind hip resurfacings. This bone preserving hip resurfacing involves replacing only the diseased bony surfaces of the head of femur and acetabulum. This involves sculpting the head of the femur and covering it with a metal cap and fixing an uncemented socket into the acetabulum to receive the head.

Hip Resurfacing- A bone preserving hip replacement!

Preservation of bone and less stress shielding makes it easy to revise this hip if needed. The large head size provides a very stable joint and recreates the sensation of a normal hip joint. Patients have gone back to playing Judo and Squash after this operation. Advances metallurgy makes the metal on metal articulation likely to survive longer in the young and active patient. With less metal inside the bone and less invasion of the medullary cavity of the femur, the risk of infection is reduced. Rehabilitation is faster and better.

Advantages of hip resurfacing:

  • Allows the patient to squat and sit cross legged on the floor safely
  • Allows a normal range of movement
  • Sacrifices only the surface diseased bone and preserves normal bone
  • Imparts a more normal sensation
  • The joint is likely to last longer even in younger and active patients.
  • Earlier and faster rehabilitation
  • Less risk of dislocation
  • Easier to revise if needed.
  • No leg length discrepancy.

In summary a Hip Resurfacing offers several advantages in young patients in young patients.

Avascular necrosis treatment India

Young patients are affected. Some of the causes leading to osteonecrosis are steroid intake, alcoholism, connective tissue disorders like SLE, Sickle cell disease, hypertension, decompression sickness, thrombosis, In a large number of individuals the cause is unknown or Idiopathic. Young and middle aged patients are affected. Involvement of both hips is fairly common.

Hip AVN

Avascular necrosis treatment India

Hip showing advanced changes of avascular necrosis

Diagnosis- It takes a long time for the bony changes to be visible on plain x rays.

MRI scans and nuclear bone scans reveal the diagnosis early on when the condition is suspected. Both hips need to be imaged simultaneously. CT scans help to identify the extent of the bony involvement.

Treatment

The treatment depends on the stage of the disease. Most often conservative or non operative measures fail. Surgical treatment ranges from core drilling to total hip replacements. In the early stages core drilling can lead to a positive result in a good proportion of cases.

When this has failed, or the stage is more advanced, hip resurfacing is advised. However the surgeon should do so after a diligent assessment of the extent of disease. Hip resurfacing can be done when the extent of the femoral head involvement is less than 30 percent.  Presence of cysts,  small size of the head are not the right indication for a hip resurfacing. A short stem hip replacement is a better choice. It is most suited for young patients as it sacrifices very little bone from the top of the femur.

Hip resurfacing operation

Hip resurfacing operation

The presence of cysts makes hip resurfacing more difficult to perform with confidence. In these cases there are two options. The Short stem hip replacement is one option.

Avascular necrosis treatment India

Short stem hip replacement

where the bone is amputated at the base of the head.  Then a short stem is impacted into the top portion or Proximal part of the neck and metaphysis of the femur. This has a large ball made of Delta ceramic of nearly the same diameter as the natural femoral head. The socket is  lined with a ceramic cup.

The other option is the Mid head resection Birmingham hip or BMHR.

Birmingham Mid head resection prosthesis

Birmingham Mid head resection prosthesis

This operation involves amputating almost the entire head of the femur containing the cysts, impacting a conical stem into the neck portion of the femur and attaching a Birmingham hip like prosthesis. The cup also gets a metal liner

Ceramic hip replacement

To get a stem cell treatment or short stem hip replacement visit http://www.hipsurgery.in for more information. If you suffer from this disease and want these procedures, e mail drvenkat@kneeindia.com

Hospital


Video shows Chettinad health city hospital. Joint replacements are performed by Dr.Venkatachalam at this super specialty hospital.

Hip resurfacing surgery- who needs it?

Are you suffering from hip arthritis? Has your surgeon advised you a hip replacement?Hang on! If you need a hip replacement, please read the following information on facts about the operation and a more advanced bone preserving option called hip resurfacing.

What is the hip joint? Watch video on hip joint anatomy and hip replacement operation

The hip joint is a ball and socket joint which connects the torso to your legs. It is formed by the upper end of the thigh bone ( femur) and the socket of your pelvic bone ( acetabulum). A natural shock absorber tissue called “articular cartilage” lines the ends of the bones and allows painless smooth movements.

What are the symptoms of hip arthritis?

The patient complains of pain and restriction of movement. Pain may often be felt in the knee alone with no hip symptoms. Occasionally the pain may be felt more in the buttock area rather than in front of the groin. Gradually you will loose your ability to retain a active life style through exercise and sports.

Diagnosis

Your doctor may advise x rays on which hip arthrosis is seen as a loss of joint space or narrowing of the gap. Loss of this lining shock absorber articular cartilage results in pain while you walk.

Treatment options

Initially your doctor may prescribe you pain killers and suggest you to perform exercises to retain flexibility of your joints.

When you have run out of non operative options like pain killers, physical therapy your orthopedic surgeon might advise you to seek a hip replacement.

The hip joint may need to be replaced with an artificial joint when it is irreversibly damaged and cannot be salvaged by alternate surgery. The patient complains of pain and restriction of movement.

Who needs a hip replacement?
In India, many young patients with rheumatoid arthritis, ankylosing spondylitis, avascular necrosis, post septic arthritis, post traumatic arthritis, are advised a hip replacement for disabling pain.

Thus many hip replacement operations are performed in younger patients. The surgery should cater to the enhanced demands on an artificial joint by younger and more active patients. Hip replacement is a successful operation for patients above 60 years

What is a total hip replacement?

In this operation the ball shaped upper end of the thigh bone (femur) and the socket (acetabulum) are replaced. The ball is replaced with a long metal stem that is fixed into the upper end if the thigh bone. Its upper spherical end articulates with a cup shaped polyethylene socket that is cemented into the pelvis.
Conventional hip replacements sacrifice a great deal of normal bone as the head, neck, and upper part of the thigh bone is removed for implantation of the prosthesis. Moreover wear debris from the polythetheylene liner lead to osteolysis and bone loss. When this first hip is to be changed or revised after its lifespan more bone loss occurs. Conventional hips have a small ball to reduce friction and wear, but the ill effect of this is an increased risk of dislocation. An average dislocation rate of 3- 4 % has been reported. These implants do not last very longer than 20 years and revision rates of 50% at 20 years have been reported. Survival rates are less satisfactory for the relatively younger active patients. Thus a total hip replacement is not an ideal implant for younger patients less than fifty years old who need a new hip. It is however the best option in elderly people.
Problems with conventional total hip replacement:
A total hip replacement is an excellent & time tested operation in the elderly. However in the young problems may arise. These are
(1) Excessive bone sacrifice and loss
(2) Increased risk of dislocation
(3) Patients cannot squat or sit cross legged on the floor with out the risk of dislocation.
(4) Range of movement is less
(5) Patients cannot involve in sports
(6) Poor survival in young and active patients they require earlier revision.
(7) Revision surgery is difficult
(8) The hip feels less like a normal hip
(9) The cup wears with time and plastic from it harms bone
(10) Change in length of the leg after surgery leading to leg length discrepancy.

Why remove normal bone when only the surface of the ball is bad?

Video shows comparison of Hip replacement and hip resurfacing

This is the logic behind hip resurfacing. This bone preserving hip resurfacing involves replacing only the diseased bony surfaces of the head of femur and acetabulum. This involves sculpting the head of the femur and covering it with a metal cap and fixing an uncemented socket into the acetabulum to receive the head.
What is Hip Resurfacing?
It is a bone preserving hip operation. In this operation only the worn out surface at the top of the femur bone is scraped and shaped into a cylindrical form from a spherical form. A metal spherical cap is glued or cemented over the cylindrical stump like a tooth crown over an old stump.
This restores the normal shape & size to the upper end of the thigh bone. Next the socket in the hip bone is scraped into a hemisphere. A metal cup is impacted after complete cartilage removal. This cup will integrate with the body’s bone on the back side as it has a layer of the same material as bone. The hip shape is thus restored to normal. Bone is preserved in the head of the thigh bone. If a hip resurfacing were to fail for some reason, it would be still possible to change this to a conventional hip replacement later on.
Preservation of bone and less stress shielding makes it easy to revise this hip if needed. The large head size provides a very stable joint and recreates the sensation of a normal hip joint. Patients have gone back to playing Judo and Squash after this operation. Advances metallurgy makes the metal on metal articulation likely to survive longer in the young and active patient. With less metal inside the bone and less invasion of the medullary cavity of the femur, the risk of infection is reduced. Rehabilitation is faster and better.
Advantages of hip resurfacing:
(1) Allows the patient to squat and sit cross legged on the floor safely
(2) Allows a normal range of movement.
(3) Sacrifices only the surface diseased bone and preserves normal bone
(4) Imparts a more normal sensation
(5) The joint is likely to last longer even in younger and active patients.
(6) Earlier and faster rehabilitation
(7) Less risk of dislocation
(8) Easier to revise if needed

So in conclusion although total hip replacements remain an excellent option in a specific elderly age group, Hip replacement alternatives like Hip surfacing should be strongly considered in young and middle aged patients ( less than 60 years) requiring a hip replacement in India.

Dr.A.K.Venkatachalam is a consultant Orthopaedic surgeon in Chennai.View Patient stories here-

Visit http://www.hipsurgery.in

American’s Hip Resurfacing

battipaglia

American patient relaxing at a seaside resort after hip resurfacing at MJRC.

American’s Hip resurfacing with Dr.A.K.Venkatachalam in Chennai
An American citizen from New York Mr.Leonard Battipaglia underwent a hipresurfacing in Chennai with Dr. A.K.Venkatachalam. The affordable treatment provided saved him a lot of money.
In a vote of confidence for Indian surgeon Dr. Venkatachalam, an American citizen
joined a long line of foreigners to undergo a Joint replacement. New Yorker, Mr. Leonard
Battipaglia recently underwent a hip resurfacing for an arthritic hip. He will soon return
to have his second hip also treated by the same surgeon. He is scheduled to undergo a
Proxima hip replacement on that side.
Mr. Battipaglia had faced frustrating times with American doctors. Nearly for two years
ago, he had been approaching the prestigious Lennon Hill hospital in New York with
thigh and knee pain. Every time he was shooed away by a junior doctor without
undergoing an x ray even. Finally an X ray revealed that he had advanced hip arthritis in
both hips. He was refused a total hip replacement. Unable to bear the pain, Leonard then
searched for other options.
He zeroed in Indian Orthopaedic surgeon, Dr. A.K.Venkatachalam for his expertise in hip
resurfacing.
He arrived in Chennai with his wife and was accorded a warm welcome at Chennai
airport on the night of the Mumbai blasts.
Within a day of arrival, he went under the knife of Dr. Venakatachalam. The surgeon
performed a hip resurfacing on his right hip.
The left hip was destroyed beyond a hip resurfacing and will have a Proxima hip
replacement shortly.
After enjoying another week’s holiday at a seaside resort, the couple has returned to
Spain for recuperation.
Surgery performed at DR.Venkatachalam’s Hip & Knee surgery centre, Chennai, India
Tel 91 9176640002
119_19122
British Hip Resurfacing patient

A British gentleman underwent a hip resurfacing with Dr.A.K. Venkatachalam. He chose this surgeon for his expertise and affordability.

A 56 year old British gentleman Mr.Chris Browne, settled in Greece underwent a hip resurfacing in a Chennai private hospital. The operation was performed by Orthopaedic surgeon Dr.A.K.Venkatachalam. Mr.Browne learnt about Dr.A.K.Venkatachalam after his name was recommended by former patients in England and Greece. He chose India for his surgery rather than Britain for the reasons of high quality service and competitive cost. The surgery was performed in a state of the art operation theatre in a private hospital. Two days later the patient is thrilled by the surgery is totally pain free and has already started walking.

Hip resurfacing is the preferred operation for Hip arthritis in young and middle aged patients. It conserves bone and conversion to a total hip replacement is possible at a later date when this prosthesis wears out. A full range of movement is possible without any risk of dislocation.

Mr. Browne reckons that he wore out his hip through sports. Chris is eager to return to jogging, Yoga and Bungee jumping.

Medical treatment in India continues to attract patients even in the face of the world wide recession. Some Indian surgeons like Dr.A.K.Venkatachalam, offer high quality recent advances in surgery. Indian hospitals are also geared up to treat the discerning overseas patients with fantastic infra structure, top class service. Costs of treatment in India are the cheapest amongst world wide medical tourism destinations. Some Indian surgeons possess qualifications and skills acquired abroad in the UK and USA. Doctors and staff speak excellent English. Any Western patient can expect to get 60- 80 percent savings on a most advanced hip resurfacing. A Hip resurfacing procedure that costs about 50000 USD in the US costs only 8000 USD for a one week stay. A Total knee replacement is also available for 8000- 10,000 US dollars. Some of the latest advances like the Oxinium knee are available.

http://www.hipsurgery.in

Twin Orthopaedic surgery for Nigerian patient

118_1891

Nigerian patient underwent multiple Orthopaedic surgery by Dr. Venkatachalam. These included a Total hip replacement, ankle arthrodesis, femoral supra condylar ostetomy

Hip resurfacing procedure video

Hip resurfacing videp has graphic content for patient education purpose.

Visit http://www.hipsurgery.in

Hip replacement video – Proxima hip operation


Video shows a Proxima hip replacement operation done by Dr. A.K.Venkatachalam
This is an uncemented hip replacement with a micro stem. It is useful in young & older patients to replace a diseased hip. It allows a full range of movement and is long lasting.

Hip resurfacing India- British patient story E mail akvenkat@gmail.com for an appointment for hip resurfacing.
visit www.hipsurgery.in

Hip resurfacing in females is restricted to a narrow demographic age group window of 40 – 50 years. It is not advised in young child bearing females.