Wockhardt Hospital, Mira Road performs successful constrained revision total hip replacement surgery with complete hip instability first time in North Mumbai  

After 12 Surgeries Over 25 Years, 57-Year-Old Woman Walks Freely Again

by Suman Gupta

Mrs. Linda R. Kotak, a 57-year-old lady, came to consult with Dr. Girish L. Bhalerao at Wockhardt Hospital, Mira Road about one month ago, for Recurrent Dislocation in her Left Hip joint that was operated elsewhere about 25 years ago. The patient is able to move freely after 12 failed surgeries Over 25 years.

After thorough history taking it was understood that the patient had symptoms of Avascular Necrosis(AVN) of Left Hip for which she was operated with a surgical procedure called Core Decompression in 1995 at her young age of 30 years. However, it did not succeed in reestablishment of the blood flow to the Femoral Head and had to undergo Left Total Hip Replacement in 1996. The Hip Prosthesis, in accordance to availability to those times, was all-cemented First Generation Charnley’s Implant of Metal on Poly type (metal head with polyethylene cup) – monoblock design. In comparison to today, this was a very initial design without any modularity. However, the same disease pathology of AVN affected in progressive manner to Right Hip as well and patient had to undergo Right Total Hip Replacement, elsewhere with a different doctor – this time with an uncemented method in 2005. However, her gait was not symmetrical and due to inadequate posture training, she occasionally required stick/ walker support to balance her gait using upper limbs. This caused further injuries to her in form of Right ankle fracture (required Surgery – 2017) and Rotator Cuff Injury of Left Shoulder (required Surgery – 2018). Furthermore, this unbalanced gait and abnormal posture put a lot of stress on her spine and her knees. She was operated on Lumbosacral spine in 2018 & Dorso-Lumbar Spine in 2019. She underwent Bilateral Knee Replacement in 2019.

After such extensive treatment journey, her troubles did not end and she got recurrent dislocation of her Left Replaced Hip from February, 2020 onwards. After having 5 episodes of such dislocation, which required hospitalization each time, the patient decided to consult with Dr. Girish L. Bhalerao – Super Specialty Consultant Orthopaedic and Spine Surgery at Wockhardt Hospitals, Mumbai. After detailed examination he advised her a Revision/ Redo of the Total Hip Replacement, in July after the lockdown would be lifted due the ongoing Corona Pandemic.

 However, on !6th June, 2020 she again dislocated her Hip while in bathroom and suffered from unbearable pain. She immediately shifted to Wockhardt Hospital, Mira Road and her joint was reduced/ relocated in Emergency Department, however with slight movement it again used to dislocate. Due to recurrent dislocations, the adjoining stabilizers (joint capsule, muscle tendons, ligaments) of her Left hip had taken injuries and she got a completely unstable Hip.

“Any Joint Replacement procedure revolves around the principle of stability and mobility with perfection in tissue balancing to restore the normal bio-mechanical axis of the joint. A complete unstable Hip, post THR, is a very rare complication which requires a high precision and skill set to operate with appropriate logistic support in terms of high modular dual mobility/ constrained implant availability”, said Dr. Girish Bhalerao.

While enquiring about the challenges faced during surgery, Dr. Bhalerao said, “The cementing technique applied by the previous surgeon was impeccable and he did a very nice job, considering the availability of instruments and logistic support at that time. However, this created lot of difficulties for me during implant removal and complete excision of remnant cement with such delicate weak bone tissue of hip joint. With lot of patience, precision techniques like Extended Trochanteric Osteotomy and help of the latest instrumentation the job was completed. Following this, the next challenge was tissue balancing as the trial implants were also unstable owing to complete laxity of tissues. I had to use the latest Design of Constrained Total Hip Replacement respecting the anatomical dimensions to replicate the physiological bio-mechanical axis and decided to perform total cement-less method for better future outcome in terms of acceptability of implants.”

The patient was mobilized full weight bearing immediately the next day and was discharged within 5 days. Post-operative physiotherapy and Rehabilitation is tolerated well and is showing steady progress in term of full weight bearing functional gait with minimal support and ability to perform all her activities of daily living independently. Being an avid traveller, soon the patient is willing to plan her favourite tourist destinations.

A joyous patient Linda Kotak said, “After 12 failed surgeries, I had lost hope. I never believed that I will be able to stand on my feet. But, Wockhardt Hospital turned my dream into reality. I can live my life the way I want to without depending on anyone.”