Luxury of Walking Regained

An international patient from Nigeria fi ghts all
odds to walk again

THE CASE

A 35-year old lady was referred to the Advanced Joint Replacement Centre at Nanavati Super Speciality Hospital, Mumbai from Kenya. She was unable to walk due to restricted hip mobility with a signifi cant disability to ambulate. She was suffering from Sickle Cell Disease (SCD) which entails sickle shape RBCs that are prone to cause blockage of capillaries during blood circulation. Her sickling index was 98% which meant her RBCs were abnormal, being sickle shaped. This condition can lead to sickling crisis causing acute abdomen pain due to vascular blockage of intestinal blood supply and bleeding tendency. Pre-operative meticulous planning is required to bring sickling index below 30% by Blood Transfusion using an ultra-modern exchange transfusion machine.

THE PROCEDURE

The surgery was conducted with proper pre-operative planning for a disease with confi rmed sickling index of less than 30% with normal bleeding and clotting profi le. The anticipated surgical diffi culties were Protrussio (intra pelvic migration of hip), large Supra-acetabular Bone Cyst 40mm X 20mm in size, poor bone quality, risk of bleeding and higher incidence of infection. Total hip joint was re-structured after reconstructing Protrussio and Supra-acetabular Bone Defect using Impaction Bone Graft, continuum trabecular metal coated titanium cementless cup (Zimmer) with 3 anchoring screws and 36 mm delta ceramic head.

THE RESULT

The Total Hip Replacement (THR) cementless construct was stable enough to allow the patient to be able to walk bearing full weight on the fi rst day of surgery itself. After a year of follow-up, the patient has near normal ambulatory activity with complete Osteo-integration of Hip Implants, Protrussio and Supra-acetabular Bone Defect.

Prof. Pradeep B. Bhosale
Director, Arthritis & Joint Replacement
Surgery
Nanavati Super Speciality
Hospital, Mumbai