A 22-year-old women with sickle diseases was bed ridden due to operation done at Niger, which was then treated successfully at Wockhardt hospital Mumbai Central 

by Suman Gupta

Mumbai: Idrissa Ordinaire, a 22-year-old young girl from Niger suffered from sickle cell disease. She presented at Wockhardt hospital with an inability to walk for several months. A detailed history revealed that she had undergone an attempt for a total hip replacement for Avascular Necrosis of her right hip joint in her home country which failed.

Unfortunately, in view of her altered anatomy with a dysplastic socket and an extremely narrow femoral canal with the operating surgeon was unable to complete the total hip arthroplasty successfully. Also, at the time of the index surgery, the patient sustained a long spiral fracture of the proximal femur complicating the existing scenario further, and the surgical procedure was abandoned, and an excisional arthroplasty was performed instead.

Dr Mudit Khanna, Senior Consultant, at the Joint Replacement Unit of Wockhardt Hospital, Mumbai Central, said, “The case presented to us with several challenges. The patient had reamed thin due to which her surgery was failed and also drs at Niger failed to put ball in surgery due to which patient was immobile and bed ridden.)

He added, “The femur has an altered anatomy with an extremely narrow canal. There was associated fracture of the proximal femur that was not aligned adequately causing mismatch of the already know femoral canal. With the existing abnormal anatomy and the fracture of the number of implant options are very limited. A longer stem that would be ideal is only available from a 9 mm diameter which the patient’s medullary canal and will not allow. Therefore, the patient required additional fixation of the femoral fracture with a long plate cable screw construct.”

The patient has been reasonably immobile since the index procedure for several months leading to diffuse and extensive disuse atrophy of the muscles and significant osteoporosis of the lower limb bones. This brings about a high risk of intraoperative fracture of both the acetabulum and femur.

“The patient is a known case of sickle cell anaemia too. There are specific implants available to address avascular necrosis of the hip arising from sickle cell disease. However, this case presented a revision scenario with a complicated and failed primary surgery. The implant options to deal with such a scenario is limited. She and her family needed to be fully aware of the existing risks and possible complications as there was a possibility that we may have to abandon the procedure at any stage of the surgery and accept the present condition.”

A team comprising of a clinical haematologist and critical care specialist optimized the patient for surgery.

“The patient underwent a successful complex total hip replacement surgery on June 20, 2019. A special 6mm narrow straight cylindrical-shaped femoral stem was used to achieve fixation in the femur. The fracture could not be bypassed due to the extremely narrow femoral canal as longer stems only come with diameters of 9mm or more. The fracture was however reduced and securely fixed with cable grip constructs. She was closely observed in the intensive care setting through the perioperative period and withstood the surgical procedure well. Physiotherapy was initiated the same day and the patient was progressively mobilized and could stand on her feet again,” said Dr Khanna.

“While I was in pain, I could still manage to do some activities prior to my first surgery in Niger. But after my first surgery, I was left crippled and bedridden and couldn’t do any of my daily activities. My mother would help me to get dressed, and eat.  I can’t tell you how it feels to be back on my feet again. I shall always remain grateful to Dr Mudit Khanna and the entire team of Wockhardt Hospital who gave me this precious gift of being able to walk again,” concluded Patient Idrissa Ordinaire.