Rare Hip Replacement in India for American citizen

Mr. Leonardo B a graphic designer from New York got a designer joint for his arthritic hip in Chennai, India. The innovative Proxima hip was implanted by Dr.A.K.Venkatachalam a British qualified orthopedic surgeon from the Madras Joint Replacement center.
Mr. Leonardo who turned 60 last December had come down with bilateral hip arthritis and was unable to enjoy life. Hailing from New York, he is settled in Spain now. He is one of several Americans expatriates who lacking medical insurance. Hospitals in New York shunned him when he sought treatment for knee and thigh pain. A diagnosis took a while to arrive as it didn’t cross the mind of the doctors that he met in a New York hospital to get hip x rays when he complained of thigh and knee pain. Often pain arising in the hip is first perceived in the knee on account of a common nerve supply.
He sought bilateral hip resurfacings in India in 2008 from Dr.Venkatachalam. This Joint replacement specialist performed a right hip resurfacing late last year. However the left hip had deteriorated to an extent to preclude a resurfacing. Mr. Leonardo was not keen to have a hip replacement as this would restrict his movements and had a risk of dislocation. His surgeon offered him a Proxima hip which has a unique design. It is not available in the United States. Moreover costs of a Hip replacement in the US are priced above $50,000.
Hip arthritis strikes middle aged and elderly Caucasians. Its treatment has been a total hip replacement in those over 70 as the prosthesis is expected to outlive its recipient. In a total hip replacement, surgeons cut the head and neck portion of the upper end of the thigh bone (femur) and implant a stemmed metal prosthesis into the bone. A cup is fixed into the socket of the pelvic bone.
However younger people afflicted by hip arthritis will outlive a conventional hip replacement and will need additional surgery later on. To skirt around these problems there are other alternatives to a total hip replacement which have better longevity.
Better materials, bone preservation, navigational aids are all used to increase the longevity of a joint replacement.
One such implant is the Proxima hip. This is a mini total hip. The stem portion of the total hip prosthesis is done away with and the prosthesis is impacted in the metaphysic of the femur. Bone in the neck of femur is not cut away as in a THR. Large diameter metal on metal (MOM) or Ceramic on metal bearings can be coupled to the stem to achieve a very durable joint. It is particularly useful when a resurfacing cant’ be done on account of advanced bone loss or presence of cavities in bone.
Designed by an Italian surgeon and launched in the international market in 2002, the hip has more than a decade’s follow up. It was introduced in South India by Dr.Venkatachalam in 2006.
This is the first time in India that this prosthesis has been used for an American patient.
Mr. B will spend a week in hospital and then recuperate in a lovely sea side resort.

Hemmed in by the recession, Americans like Mr. Leonardo are seeking treatment abroad.
The attractions of having a surgery abroad are many. No doubt will you be able to save 70 percent from your hospital bill; you will get an equivalent or better personalized service than in an American hospital. Indian surgeons like Dr. Venkatachalam of www.hipsurgery.in have been trained in the UK. The driving force in medical tourism is not only costs but availability of innovative procedures. Americans being consumerists are always looking out for best quality & value. Mr Leonardo can now boast to a friend back home that he has now got a Ferrari hip in India in comparison his Dodge hip.

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

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