Hip replacement patient at three years post op

This patient underwent a hip resurfacing three years ago in Chennai. He enjoys good function for daily activities. Hip replacement/ resurfacing restores  mobility to young and middle aged people and allows them to lead normal lives.

Hip replacement result

Hip replacement result


Please visit www.hipsurgery.in for more information.

To get this procedure for yourself, e mail- drvenkat@kneeindia.com

Hip Resurfacing India American success story Dr.Venkatachalam

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

American Grandon Benson, Hip resurfacing patient of Dr.Venkatachalam

Hip Resurfacing India-testimonial of American patient

Hello Leonardo– I was going to write and tell you of my adventures,
but time just seems to fly. Anyway, the following is what happened.
Oct. 14 flew to Chennai at night. Dr. V had forgotten there was a major Indian Holiday on Sat the 17th and there would be few in the Hospital working. Hurray up and do tests! Ooops–Andy has high
blood pressure. Worked hard and got it down for the Proxima operation on Friday.
They talked me into having a “spinal” for anasthesia (I’ve had a prejudice against spinals since 1963!) and I was very happy I had it.
NO PAIN–at all. Turned out during the operation they could do the Birmingham Method–so I went out with the second biggest Birmingham head they make(It’s the best for me).
Got rid of all pain pills in about 3 days.
After 6 days went to Mahabs Resort(Dr. V’s friend).
The BEST place, for sure. The people were so friendly and tried to be helpful all the time–including the man that cleaned the pool everyday, the maids who cleaned the room, and the waiters from the restaurant. In 10 days we only had one meal in the restaurant.
They came to our room 3-4 times a day for food orders and the owner of Mahabs even had a table specially made so I could use my laptop and my wife and I could eat all meals on the deck.
I felt quite special.
Left India on Nov. 2 feeling a little weak, but with no pain.
Stopped using the hand crutches Dec. 4, swam on two different days, and am driving my truck just fine, now!!
I tell everyone that I’ve had many worse experiences and pain from going to the Dentist!!! But wait, Dr. V, just remember I’m going to be looking for rewards from you, for the 100 or so patients I’ll be sending you!!!
Thank you, Leonardo, for your imput and support.
Everything turned out to be much easier than I ever expected.
I miss having fun with Dr. V, too. I don’t miss the Indian food–
very happy to be back in Thailand!!

Hip Resurfacing – Patient testimonial one year later

Hello Dr Venkat, greetings to you and your family. It was 11 months ago yesterday that I had my resurfacing operation and I just wanted you to know how successfull it has proved! This past season here I have again been able to guide tourists on walking tours of the island and in September I led the 21km “marathon” walk here, with no negative after effects. I have completely forgotten what it was like before the operation. As it is coming up to my 1 year anniversary I wondered if you would like any progress photos/video/story from me.
With very best wishes,
Chris Browne

Sufferin from hip pain? Hip resurfacing a solution

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 resurfacing operation

Hip resurfacing operation

Hip Resurfacing – viable alternative to Hip replacement

Hip resurfacing operation

Hip resurfacing operation

Hip Resurfacing is Viable Alternative to Hip Replacement
Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery.

Patients who had hip resurfacing surgery, such as the Birmingham Hip Resurfacing technique, reported a better quality of life, less pain and greater satisfaction a year after surgery than those who had a total hip replacement, according to a study presented at the American Academy of Orthopedic Surgeons (AAOS) 2009 Annual Meeting.

The study was based on data on the outcomes of 214 total hip replacement patients and 132 hip resurfacing patients that was recorded in a joint registry maintained at a single surgeon’s practice from 2003-2006. Orthopedic surgeon Dr. Elizabeth Anne Lingard of Freeman Hospital in Newcastle Upon Tyne, England, was the study’s lead researcher.

Each patient enrolled in the study completed a questionnaire preoperatively and one year after surgery. The questionnaire included the Western Ontario and MacMaster Universities Osteoarthritis Index (referred to as WOMAC, it is a 24-item questionnaire that is completed by the patient and focuses on joint pain, stiffness and loss of function related to osteoarthritis of the knee and hip) and the SF-36, a self-report questionnaire completed by the patient that measures health-related quality of life (and generates 8 subscales: physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role-limitations due to emotional problems, and mental health; and 2 summary scores: physical component and mental component). The patients also completed a questionnaire regarding satisfaction with their procedures and outcomes one year after surgery.

The study showed that one year after surgery both groups of patients experienced significant improvements in WOMAC and SF-36. Hip-resurfacing patients, however, posted significantly higher WOMAC scores for decreased pain symptoms. When asked about patient satisfaction with the surgery, a greater number of hip-resurfacing patients said they were satisfied with their ability to perform functional activities after surgery.

For more information:
Keywords: hip resurfacing, hip replacement, joint replacement, orthopedic surgery, minimally invasive surgery
Dr.A.K.Venkatachalam, Consultant Orthopedic surgeon at the Madras Joint Replacement center opines that hip resurfacing allows excellent range of movements with least incidence of dislocation in males younger than 60 years. While choosing female patients who demand hip resurfacing, one has to be more selective says the surgeon. Females with small femoral head circumference less than 44 mm had a higher risk of complications like femoral neck fracture. Therefore female patients with large bone size in the appropriate age group with good bone density are also suitable candidates for Hip resurfacing.

Dr.A.K.Venkatachalam, consultant Orthopedic suregeon
Madras Joint Replacement center
Chennai, India
E mail- drvenkat@kneeindia.com

Indications for the BMHR

BMHR prosthesis

BMHR prosthesis

The Birmingham mid head resection prosthesis is a new implant invented over a year ago by Dr. Derek McMinn. It is useful in those patients who are sold on the idea of a hip resurfacing but unfortunately don’t have enough bone stock in the femoral head.

After x rays, the surgeon can predict pre- operatively which patients are going to require a mid head resection resurfacing prosthesis rather than a Birmingham hip resurfacing.
These are patients with

1) Osteoarthritis with large cysts
2) Avascular necrosis > 40 %.
3) Perthes disease
4) Slipped capital femoral epiphysis.
In these cases the surgeon can go in for a BMHR rather than a BHR.

Particularly in AVN with large bony involvement, hip resurfacing is not possible. In these cases, BMHR is ideal as it behaves like Hip resurfacing but all diseased bone is removed. Yet more bone conserved during BMHR is more than a total hip replacement.

The prosthesis uses the same cup as  a BHR. On the femoral side, a modular head component fits onto a short conical stem confined to the neck of the femur.

BMHR surgery is very exacting. Dr.Venkatachalam got exposure in Australia for this surgery.

Hip Resurfacing with Dr.Venkatachalam- American patient story

American double hip surgery with Dr.Venkatachalam

An American afflicted by bilateral hip arthritis sought advanced hip surgery in India with Dr.A.K.Venkatachalam. He underwent a hip resurfacing procedure and the advanced short stem Proxima hip replacement at the MJRC. He narrates his experience of double hip surgery in this video.

Total hip Replacement in Young patients

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

Proxima hip prosthesis

Proxima hip prosthesis

the 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 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.

Contact us- drvenkat@kneeindia.com


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.