Doctors at Apollo Spectra perform hip replacement surgery on 40-year-old patient suffering from TB arthritis
Delhi: A team headed by Dr Pankaj Walecha, Specialist Hip And Knee Surgeon, Apollo Spectra, Delhi successfully performed a hip replacement surgery on a 40-year-old teacher from Uttar Pradesh battling TB arthritis for the last 20 years.
The patient, who experienced unbearable hip pain, was unable to maintain balance or take even 10 steps can walk without any difficulty now. She has resumed her daily routine with ease and leads a normal life after surgery.
Neelu, Mishra, a teacher by profession from Jaunpur, UP. She had to struggle through her youth owing to tuberculosis arthritis at around 20 years ago. She had hip pain, was limping, and couldn’t walk properly. She took opinions of many doctors in UP but she was advised to take pain medications & manage her life like that.
She kept on looking for solutions so that she can take care of her family & especially her two daughters. In her pursuit to live a pain-free life, she came across Dr Pankaj Walecha at Apollo Spectra Hospital, New Delhi where after a successful hip surgery, she could walk freely again.
Dr Pankaj Walecha, Specialist Hip, And Knee Surgeon, Apollo Spectra, Delhi said, “On arrival, She could not walk even few steps. The patient had immense hip pain, used a walker while walking, and has great difficulty in getting up from bed or a chair. She couldn’t even lift her right leg without supporting it with her hand. There was pain as she tried to turn on her left side, was unable to get a good night sleep also.
Her hip joint was jammed, and no rotational movement hence the pain on moving. With a clear history of tuberculosis (TB) of hip joint in a young age, & X-rays showing a damaged hip joint, she was a clear case of Tubercular hip arthritis. Tuberculosis (TB) is seen in a large number of patients in India. People generally think that TB affects only the lungs but It has the potential to impact any joint of our body & it can cause severe damage to the joint leading to secondary arthritis. According to a study published in 2014, Tubercular arthritis accounts for approximately 1-3% of all cases of tuberculosis & it primarily involves large weight bearing joints of the body like Hips, knees & ankles.
Dr Walecha, counselled the whole family before the surgery about the outcome of the surgery & the need of starting Anti tubercular treatment (ATT) again, at least for a period of 3 months after the surgery. Its very important to prevent the reactivation go the disease. After a complete check up, finally the day arrived & Neelu was taken up for surgery. She was successfully operated on 4th April, 2022 at Apollo Spectra Hospital, Karol Bagh, New Delhi.”*
Dr Pankaj Walecha added, “In Total Hip replacement (THR) surgery, damaged ball & socket of the hip joint are replaced with artificial ball & socket (fig ). Although hip replacement surgery can be cemented (special kind of bone cement is used to fix the parts in the body) or Uncemented (uncemented implants have a special kind fo surface finish so they snugly fit into the bone & within few weeks get integrated to the bone). Uncemented THR is performed more commonly.
First of all the damaged hip joint is approached using smallest incision possible for that patient (Minimally Invasive Surgery or MIS). Minimum muscles are damaged in this process & this muscle preserving approach helps the patients in recovering faster. Then the damaged femoral head is removed to expose the acetabulum. THR has four components- Acetabula cup or socket, which is made up of titanium & is fixed to the acetabula after clearing the dead bone.
This socket can be fixed to the bone with special screws if needed. Second part is Highly Cross Linked Polyethylene Liner, which is a special type of plastic which is fitted on to this socket. After this attention is shifted to the thigh bone or femur. Uncemented Femoral stem preparation is done & a well-fitting stem is implanted. Fourth part is the Ceramic ball head, which is mounted on the femoral stem. This completes the implantation part. When this surgery is performed using muscle preserving techniques or MIS then most of the patients do not complain of much pain after the surgery. In this surgery, its ensured that leg length of the both sides is equal after the surgery.
In case of Neelu also, both her legs were equal after the surgery & she was delighted to see that after the surgery. The uncemented cup got a very good hold in the bone & did not require any screws for fixation, Uncemented stem was implanted in good position, using ceramic head on highly cross-linked polyethylene liner. Surgery lasted for almost one hour & she was, Ade to stand & walk with in 24 hours of surgery. She could do stair climbing after 36 hours of surgery & was happily discharged from the hospital after 72 hours of operation. At 4 weeks after surgery she could walk long distances & at 6 weeks she could do light jogging also. Imagine how her life changed in matter of 4-6 weeks, from severe pain even in getting up from bed to jogging. Isn’t it amazing !!
Here is our message to patients who have been living with arthritis due to any reason- A pain-free active life is possible for all of you irrespective of your age or disease. Even if you are young, after hip replacement surgery with the modern implants & modern surgical techniques patients can have normal life without any major lifestyle restrictions. These modern implants are designed to last for 20-25 years after the surgery & after that a revision hip replacement surgery can be performed with good success rates.
“I had a sharp pain in my hips and couldn’t even take 10 steps. As I grew, my health deteriorated. There was a time I felt hopeless as I couldn’t walk, sit or stand on my own. I required a walker and my family’s support. I am a teacher and couldn’t even climb the stairs of the school. My life had become miserable. I had never heard about TB arthritis before.
I didn’t have any idea regarding how to go about it. But, I thank Dr Pankaj Walecha & the team of doctors for their prompt treatment. It is because of them that I could walk again. The hip pain has vanished after the surgery and I can walk, run, drive, and sit without any difficulty. I am happy as I can live an independent life now,” concluded the patient Neelu, Mishra.
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