Bone preserving Hip performed by first Indian surgeon in south India
A 33 year old South Indian house wife suffering from a condition called “Osteonecrosis” or avascular necrosis of both hips underwent a novel form of bone preserving hip replacements at a city hospital this week.
Dr.A.K.Venkatachalam, Consultant Orthopaedic Surgeon, performed the surgery. The prosthesis implanted was the Proxima Hip Replacement, which is a very small prosthesis. The technology has been introduced recently in India and Dr.A.K.Venkatachalam is the First Indian Surgeon to perform the operation in South India, as other surgeries had been performed by visiting foreign surgeons. "The size of the implant is smaller and provides maximum direct contact with bone, besides increasing the longevity of the surgical procedure and eliminating thigh pain," says the Doctor. "It preserves more bone than traditional hip implant surgeries, but lesser than what hip resurfacing does. Dr Francesco Saverio Santori an Italian Orthopaedic surgeon in association with a British Surgeon has designed this prosthesis and it has a ten year follow up. Talking about the operation Dr.Venkatachalam says that it is novel as the bone in the neck of the femur (Upper end of the thigh bone) is preserved. This type of hip replacement is a solution to selected group of patients who are not suitable for Surface hip replacement and in whom a total hip replacement is an option. This replacement surgery preserves bone stock, as the prosthesis is not implanted deep within the thighbone. It is a “stemless” stem. The bearing surfaces are made up of metal and this confirms enormous longevity to the prosthesis. It is also very stable as the diameter of the prosthesis is large and replicates the normal size of bone. At present, minimally invasive surgery is the main trend of orthopaedic surgery and involves almost all its fields, joint replacement included. A total hip arthroplasty should be considered minimally invasive not just because it can be done through a small incision but it should preserve bone and only if bone resection is limited to pathologic tissues (conservative replacement) and the procedure is performed without major sacrifice of soft tissues. This last statement suggests that the term “mini-incisions” be substituted with “mini-approaches”, meaning surgical approaches that respect the skin, but also fascia, tendons and muscles. Bone preservation may be obtained through proximal load, neck-retaining and resurfacing implants. Evaluating bone sacrifice both on the femoral side and on the acetabular side, neck-retaining arthroplasties seem to warrant the most balanced maintenance of bone tissue. Neck-preserving implants through a lateral or posterior mini-approach seem to be the most consolidated solution in minimally invasive total hip replacement. It could be used in selective cases of hip arthritis, such as for people with good bone stock for whom resurfacing would not be suitable and a total hip replacement would be too radical.