Expert bets on hip replacement as safe option

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Chennai, Mar 2: Conventional hip replacement surgery is a limousine now, not a bullock cart as widely perceived as it is safer and effective than hip resurfacing technique, according to an expert.

Talking to to the sources here, Dr Prithvi Mohandas, Consultant Hip Surgeon at the MIOT Hospitals, who had peformed more than 1,500 primary hip replacement procedures in India and abroad, said both the procedures had developed very well due to rapid strides in medical science and technology.''However, the perception of people that total hip replacement is a difficult and painful procedure dates back to the 60s. There is a misconceived notion that hip resurfacing is better than replacement which is totally untrue,'' he said.

However, there are pitfalls in resurfacing technique as the doctor has to be very selective before deciding on conducting it. He should study the prognosis of the bone.

''The recovery process is longer in resurfacing and cannot be done without incision smaller than 12 cm. The surgery can be performed only if femur head is rock solid,'' Dr Mohandas, who is also the Director of Hip Arthroplasty at MIOT Hospitals, observed.

Besides cracking the reason for the previous hip replacement failures, the medical fraternity does not use cement, metal or plastic for the procedure and the titanium implants used now showed no evidence of anything going wrong. A scientific comparison of this with the results of the worldwide figures for resurfacing proved the superiority of the modern total hip replacement in the long term, Dr Mohandas said.

Resurfacing involves shaving the ball or head of the femur, cementing a metal head onto it and making this articulate with an uncemented, hemispherical, metal socket. ''There are concerns about fracture as the metal head has to be impacted onto the ball of the femur to ensure a close fit. Also, with time, there is loss of bone mass within the femural head,'' Dr Mohandas said.

''According to the FDA, resurfacing cannot be done on patients suffering from severe osteopenia, family history of severe osteoporosis, severe osteopenia, osteonecrosis or avascular necrosis with more than 50 per cent involvement of the femural head, multiple cysts of the femural head, pregnancy, breast-feeding, skeletal immaturity, vascular insufficiency, muscular atrophy, or neuromuscular disease, moderate to severe renal insufficiency, severely overweight, metal sensitivity, immunosuppressed or receiving high doses of corticosteroids,'' he said.


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