17 july 2012
Pune: A team of doctors from Pune recently carried out total hip replacement surgery on an 18–year–old girl from Yemen suffering from a rare birth defect, wherein her left hip bone had not developed and her hip had no cup (socket) since birth.
Congenital hip dysplasia or dislocation is seen in newborn infants wherein the hip is out of joint at birth. If this is detected at birth, the treatment is a special restraining splint for the legs which keeps the hip in joint.
If the condition is completely missed or if the initial treatment is not successful, the child grows up with a dislocated hip. This causes a shorter leg with limited movements and pain.
The treatment in adults with asymptomatic congenital dislocation of the hip is a total hip replacement and sometimes even a fusion of the hip joint (arthrodesis).
"A total hip replacement in this situation is potentially a very complicated operation because often there is severe shortening of the leg, the socket is flat and the bones are not well developed. Also, the muscles around the hip are not functioning normally because there is essentially no hip joint," said orthopaedic and joint replacement surgeon Murtaza Adeeb, who carried out the surgery on the girl at Inamdar Hospital on June 27. The girl was discharged after a complete recovery on July 4.
Surgery for this condition is carried out at very specialised hospitals around the world because of the required technical skills and the specialised instruments need, he added.
"The girl had undergone two resconstructive operations in the past without much success. Her affected leg was approximately 5–6 cm shorter and she walked with a very obvious limp," said Adeeb. "After the surgery, the girl has a brand new hip. Her leg is now the correct length and she can walk normally."
Asked why the girl had decided to come to Pune to fix the birth defect, Adeeb said, "There are lot of Yemeni students studying in Pune. The girl came to Pune through reference from them. Besides, Pune has emerged as a recognised centre for complicated surgery and people from foreign countries routinely come for treatment here."
The girl was admitted to the Inamdar Hospital on June 25. "Her X–rays revealed a very flat cup (acetabulum) and a very thin thigh bone (femur). Further investigations included a CT scan to get the exact measurements of the bony structure in order to get the appropriate instruments and implants," said Adeeb.
The surgery involved identifying the area where the hip socket should be. The doctors did this by careful dissection of soft tissues surrounding the hip joint. They also used intra–operative Xrays to identify margins of the missing hip socket.
"Once we identified the area for the socket, we started preparing the socket by gently reaming the bone and we created the socket using the reamers. After reconstructing the bone socket, which had never developed since childhood, we put a metal cup in the reconstructed socket," said Adeeb.
Then doctors addressed the femur bone. "Here we had to partially cut soft tissues around the femur to bring it down to the level of the newly–constructed socket. We then had to prepare the femur which involves preparing the passage to receive the femoral components which is composed of a stem and a ball that sits on the stem.
Since the girl had a congenital defect, the femur was very narrow and a special stem had to be ordered to fit her size. After preparing the femur, we fixed the femural stem and put the ball into the socket, thereby creating a new hip joint," said Adeeb, who was assisted in the surgery by orthopaedic surgeon Manoj Todkar.