Having hip arthritis in young age?

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Hip replacement in India - UK trained orthopedic surgeon, 1-1 care

Improper indications lead to early failure of hip resurfacing

A 49 year old man with secondary hip arthritis approached us for a hip replacement/ Hip resurfacing. He was suffering from Perthes disease. After seeing his x ray, I told him that he was not a suitable candidate for hip resurfacing. However he went to another surgeon who offered a hip resurfacing.
Interestingly within a span of one and half years, this poor man has developed pain in his hip. His latest x rays show thinning of the inferior portion of the neck and acetabular edge loading. This has probably lead to increased wear and metallosis leading to bony resorption.
This as leading hip surgeons should know is a disastrous complication. It leads to gross bony and soft tissue destruction.
No doubt he will need a revision to a total hip replacement soon.

Hip resurfacing recovery video - British patient

Watch Mr.Chris Browne demonstrate his full flexibility and mobility in outdoor activities one year after a hip resurfacing done by Dr.A.K.Venkatachalam of the Madras Joint Replacement Center in November 2008.
Video recorded in Nov 2009.
Visit http://www.hipsurgery.in
E mail -drvenkat@kneeindia.com

Hip resurfacing - American patient story

Testimonial of American patient who underwent a Birmingham hip resurfacing by Dr.A.K.Venkatachalam of www.hipsurgery.in

Madras Joint replacement center offers hip resurfacing in super specialty hospital in Chennai, India
To get an appointment for a hip resurfacing or replacement e mail - drvenkat@kneeindia.com

THR in Young & Active 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 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

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 Hip resurfacing with Dr. Venkatachalam

American’s Hip resurfacing with Dr.A.K.Venkatachalam in Chennai

www.hipsurgery.in

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.

Mr. Leonard Battipaglia.

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

http://www.hipsurgery.in/

E mail – drvenkat@kneeindia.com

Tel 91 9176640002

First Proxima hip for Renal transplant patient

In what could be a landmark operation in Hip replacements world wide, surgeons implanted a Proxima hip, a large diameter uncemented total hip in a young and active patient. TK, an advocate in his thirties was afflicted by renal disease since a young age. He had undergone two renal transplants to ameliorate suffering. Compulsory intake of steroid medication had led to Avascular necrosis or osteonecrosis of both hips. When Hip pain crippled him, he was referred to Dr.A.K.Venkatachalam, a senior orthopedic surgeon in Tamilnadu, India. He was advised the Proxima Hip, a latest implant for total hip replacement. Minimal invasive surgery was done through a posterior approach to the hip.
The patient has been discharged after only a seven day stay in hospital.
To seek an appointment for Hip resurfacing, Proxima hip, THR, articular surface resurfacing e mail akvenkat@gmail.com & akvenkat15@hotmail.com
Call 00 91 44 28345301 Bharathi raja hospital.
Visit http://www.hipsurgery.in