Total hip replacement for Avascular Nercrosis of the Hip

Avascular necrosis of the hip, also known as asceptic necrosis of the hip is a devestating condition usually affecting young individuals resulting from loss of blood supply to the ball of the hip joint. The condition tends to progress and results in early degenerative changes in the hip joint causing pain, stiffness, limp and loss of function. Treatment usually involves hip replacement surgery to restore function and treat pain. You can watch a video of one of my patients who suffered from this condition at : http://www.youtube.com/watch?v=XMz-T68D58E

Orthopedic boys like newer toys!!.

Having worked in the UK for a few years and believing in the old school of thought that newer technology/implants should only replace the time tested ones only after rigrous evidence of their advantage over older techniques is documented in the orthopedic literature, I have realised that in Delhi NCR area, a significant chunk of Orthopedic Surgeons are eager to jump on the the bandwagon of a newer, more advanced, fashionable  and of course, more expensive implants as soon as they are launched in the market. Many a times these so called newer more expensive  implants are used even if they are not clinically indicated. The whole idea behind this is to prove (to oneself and your colleagues) that one is producing the better results using the latest technology and in many instances coercing/impressing patients by demonstrating that his clinical acumen and skills are better than the doctor next door who recomended "old obsolete implants" or "1st Generation implants" . I have found that in majority of these patients either these newer implants are not indicated or there is not enough data in the literature to prover the superiority of these newer implants. I have observed this most common especially in the treatment of fractures where locking plates are used in simple transverse fractres even in perfectly healthy young individuals with goood quality bones. These plates were found to be better for fixation of fractures in patients with osteoporosis and sometimes in patients with comminuted(shattred fractures in multiple pieces) fractures near the joints. However these plates have also been used exensively to treat simpler forearm fractures in healthy individuals who were being treated perfectly well for many decades with DCPs and LCDCPs, which cost 50-75% less as compared to these locking plates.

Bigger the hospital, more expensive the implants that is likely to be used in the patients. Although I an saying this purely based on my experience of seeing patients in my OPD for last 3 years, but I am sure this can be substiantiated by the data from the insurance companies(if it has not already been done by them!!). 

It is the patient who ends up footing the bill for bragging rights and boosting the ego of the operating surgeon either at the time of discharge directly or at the time of paying the insurance premiums indirectly. 

Fw: Total Hip Replacement for Mahendra Kumar

 

----- Forwarded Message ----
From: Nilesh Kumar <nkumar@builtform.com.au>
To: rashmi.hingorani@columbiaasia.com
Cc: jayant.arora@gmail.com; arorajayant@yahoo.com
Sent: Fri, June 3, 2011 3:44:04 AM
Subject: Total Hip Replacement for Mahendra Kumar

Dear Dr. Jayant / Rashmi,

 

On behalf of the Kumar family we'd like to send warm thanks for an excellent outcome of your services.

 

We appreciate your originality, the fact the pre-care, surgery and post-surgery activities were unique in nature and showed an "excellent skills presentation" of consciences.

 

It's not always easy to get this organised with such a short notice but you managed to do a great job of it.

 

Again, thank you, and we'd be pleased to recommend your services to anyone that may require your services.

 

 

Thanks and regards,

Nilesh Kumar

Senior Contracts Administrator

 

Builtform Constructions Pty Ltd

West Ryde Village Construction Site

15 Chatham Road NSW 2114

Tel: 02 9858 2514| Fax: 02 9858 2572 | Mob: 0450 929 499

 

Fw: Mr. Rasheed Oyeniya, M39- Ortho case

 

Dear Rashmi

 

This patient has significant malunion of the femoral shaft fracture with an angulation of approximately 30 deg. I need to get orthognal views/CT of the femur to ascertain the plane and extent of deformity. He  will need removal of the bent implants, corrective osteotomy at the site of deformity and fixation with another plate/IM nail +/-bone grafting at the osteotomy site.

The shortening  will improve substiantially however he still may have some residual shortening of the leg needing a heel raise.

Other potential complications would be possibility of the nonunion at the osteotomy site and implant faliure.

 

Regards

 

Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK

Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon

 

 

 

Web: http//www.arthrocure.com

---

Fw: Mr. R O, M39- Ortho case

 

Hi
Please get opinion from Dr Jayant Arora on this case Regards PT


i had road traffic accident 27 july 2009 where i sustaind fracture of the
left femur, had (ORIF),done on 28 july 2009 ,then ihad pulmunary embolism,
unconscius for four days.on the 5th day i fell in the hospital and the plate
bent, POP was used to stabilize the limb and the fracture healed,with
angulation on my femur and shortening of the limb(R).

Now i wont it repair. attarched is the x ray report.

Re: FW: Pt. Mazin Kasim / Columbia Asia

Dear Rashmi

This patient is walking with a hyperextension at the knee and equinus at the ankle.

There is sill minimal shortening of the tibia however video also shows that patient has possibly some problem in the hip joint as well.

Correction of the equnius deformity and compensating the resudual shortening with heel raise is likely to tackle the hyperextension/valgus at the knee (provided there is no muscle weakness). It appears that he will benifit from TA lenghthening as mentioned in my previous mail, but he may also need some procedure at the hip.

 

  I need to see an Xray of the hip and examine him thoroughly before any additional treatment can be finalised. This need to be comminunicated to the patient that providing a detailed treatment plan based only of few pictures of his leg taken from different angles without any previous medical record is not feasible.

 

Expected duration of stay after TA lenghthening will be 5 days  and that he will be in a plaster cast for 6-8 weeks postoperatively and walking with help of crutches.Wheather he needs any additional procedeue will only be decided after clinical examination.

 

He should also be informed that he has a long standing(possibly by birth) shortenning of the leg, therefore he should not expect any treatment will  miraclously give him a normal limb. At best he can expect an improvement as compared to the current clinical situation. 

Thanks
 

Dr Jayant Arora

Fw: FW: Pt. Mazin Kasim / Columbia Asia

,

Please find attached some pictures & a video of the patient. The previous surgery was done in Turkey, so the discharge summary is in Turkish. I dont think it would be of much use.

 

Fw: Pt. Mazin Kasim / Columbia Asia

 

 

 

History provided for this patient is minimal and inadequate. My guess is that this patient has developed Equinus deformity post limb lenghthening procedure and is likely to benifit from Z-plasty and lenghthening of TA.

However this is only a tentative plan and I will need to examine the patient before surgical treatment is finalised.

 

We should also request the patient/HCA to send us more information /discharge summary from previous surgery/clinical pictures the patient.

 

Kind regards

Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK

Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon

 

 

 

Web: http//www.arthrocure.com

---

Fw: Pt. Mazin Kasim

 

 

 

32 years old male pt. complaining from shortening of the lt. leg since 30 years, he did a surgery in 2000 to lengthen the leg & put an apparatus for 6 month, but the surgery was failed & his leg split laterally during walking.

The pt. went to turkey 2 months ago, but the surgery was expensive & he is asking about the success rate & the duration of treatment.

Arthroscopic Bankart repair for recurrent dislocation of shoulder by Dr Jayant Arora
http://www.youtube.com/user/drjayantarora#p/u/6/o8YttPsM1Ew

Hip Replacement Surgery -

 

 

Dear Mr Rahman

 

The attached Xrays are of poor quality and do not give me any useful information apart from the fact that there is a cemented bipolar hemiarthroplasty (half hip replacement) on the right side. I cannot make out if there is any arthritis of the left hip or if the implant on the right side has loosened.

 

I presume that patient's symptoms from left hip are due to arthritic changes. It is possible that the right hip dicsomfort could be due to either loosening of the implant or due to erosions of the acetabular cavity on right side.

 

Treatment will depend on the severity of symptoms and Xray findings. Since patient is 75 year old it do not think that it will be wise to adress both hip surgeryies together. In such a situation we should treat more symptomatic side first. Onleft side it will involve a cemented TOTAL hip replacement surgery and on right side it will involve Revision Total hip replacement(or conversion of hemiarthroplasty to a Total hip replacement). If pain on the right side is mild at present then we should only do left side first and wait till symptoms on right side worsen.

I would like to know which is the more symptomatic side and it would be also helpful if patient could send us another good quality photograph of the Xrays of both hips.

 

Thanks.

Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK

Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon

 

 

 Tel-00-91-9873830947 

Web: http//www.arthrocure.com

 

Hip Replacement Surgery

 

 

 

"My father Md Foyzur Rahman ( 75) needs to hip replacement on his left leg. He did hip replacement on his right leg in July, 2006. But still he is getting pain his right leg. I want to send my father for his hip replacement (could be one or both). But depending on his condition of right leg. Bangladeshi Doctor said he needs to hip replacement only left leg."

 

I am also attaching the patient's x-rays and the medical questionnaire herewith for your consideration.

 

Fw: Treatment Assistance Patient Ms Chidinma from Nigeria

 Dear Ms Chidinma

 

Patients with sickle cell disease(SS) usually develop avascular necrosis of the ball of hip causing arthritis, pain and shortening of the leg. This complication usually occur in the younger age group as in your case.

Treatment options include using painkillers and physiotherapy till the pain and functional limitation is mild to moderate. Once pain appears even on rest and on minimal movements then Hip replacement surgery can be considered.

 

Hip replacement surgery works wonderfully well in relieving pain and restoring function in patients with arthritis and has excellent results. However in patients with sickle cell disease hip replacement has an increased risk of complications as compared to normal population. The complications will include increased possibility of infection and early loosening of the hip implants. These complications can also happen in normal population after total hip replacement but its chances are increased in patients with Sickle cell disease. Having said that we have sucessfully carried out Total hip replacement in patients with sickle cell disease from Nigeria at out hospital previously. Chances of complications after total hip replacement in normal population is 5% and in patients with sickle cell disease it is 15%.

 

Looking at your xrays it appears that you have badly damaged the hip joint.You should delay the surgery as long as possible but if you have significant pain and discomfort in the hip that is not responding to nonoperative treatment then hip replacement surgery will relieve your symptoms and can be carried at out hospital, provided you are aware of and accept the increased risks of complications associated with such a procedure.

 

Hospital stay after such a procedure is 1 week approximately and would involve an expenditure of(-----Dr Kousar/Rashmi  please mention the figure). 

Feel free to contact us if  you have any further queries

 

 

Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK

Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon

 

 

 

Web: http//www.arthrocure.com

---

From: Kousar Ali Shah <kousarali.shah@columbiaasia.com>
To: 'Jayant Arora' <arorajayant@yahoo.com>
Sent: Tue, February 15, 2011 10:26:00 AM
Subject: FW: Treatment Assistance Patient Ms Chidinma from Nigeria

Dear Dr Jayant

Please suggest.

 

Thanks & Regards

Dr Kousar A Shah

Chief of Medical Services                            

Columbia Asia Hospital – Palam Vihar

Block-F, Near Gol Chakkar,

Palam Vihar, Gurgaon – 122017,

Haryana.

Telephone:  +91 - 124 - 39898969

Facsimile:     +91 – 124 - 3022022

Website:   www.columbiaasia.com

 

 

Please find below the query from the patient.

 

My name is chidinma and am 25 years old.my genotype is ss,i've sickle cell anemia.since 2008 a developed a hip problem here is a copy of my X-ray.The doctors said that i've Avascular Neurosis(AVN)of Formal Head,limp shortening of 3cm i want to know if i can get  hip replacement. Though the doctors in Nigeria said that there are so many implications based on my genotype that Replacement is not the best option.Please doctor i want to know the best option, implication of the surgery based on my genotype, and also the cost of the surgery.Please will be expecting a response from you .

 

---

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Fw: Treatment Assistance Patient Ms Chidinma from Nigeria

 

Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK

Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon

 

 

 

Web: http//www.arthrocure.com

----- Forwarded Message ----
From: Kousar Ali Shah <kousarali.shah@columbiaasia.com>
To: 'Jayant Arora' <arorajayant@yahoo.com>
Sent: Tue, February 15, 2011 10:26:00 AM
Subject: FW: Treatment Assistance Patient Ms Chidinma from Nigeria

Dear Dr Jayant

Please suggest.

 

Thanks & Regards

Dr Kousar A Shah

Chief of Medical Services                            

Columbia Asia Hospital – Palam Vihar

Block-F, Near Gol Chakkar,

Palam Vihar, Gurgaon – 122017,

Haryana.

Telephone:  +91 - 124 - 39898969

Facsimile:     +91 – 124 - 3022022

Website:   www.columbiaasia.com

 

 

Please find below the query from the patient.

 

My name is chidinma and am 25 years old.my genotype is ss,i've sickle cell anemia.since 2008 a developed a hip problem here is a copy of my X-ray.The doctors said that i've Avascular Neurosis(AVN)of Formal Head,limp shortening of 3cm i want to know if i can get  hip replacement. Though the doctors in Nigeria said that there are so many implications based on my genotype that Replacement is not the best option.Please doctor i want to know the best option, implication of the surgery based on my genotype, and also the cost of the surgery.Please will be expecting a response from you .

 

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