: Total Hip Replacement (THR) and Total Knee Replacement (TKR) are the most performed orthopaedic surgeries across the world, so too in India. In India TKR is mostly performed for elderly women (75%), however THR is mostly performed for young men (60%). Young people expect more from life.
A young working person who needs a THR, is often the sole breadwinner of the family. Before disease strikes, these young patients are working, earning money, in the prime of their life, paying rents and debts and enjoying the happiness in life. Not only that, these young patients have triple responsibility of themselves, their elderly parents as well as their young children, all at the same time. Therefore, operating a young patient of THR thrusts upon the operating surgeon additional responsibility of not only curing the patient of his pain & disability but also putting them back on their feet as early as possible – so that they can start working and earning quickly.
A 34 years old, young pharma sales manager presented to Wockhardt Hospitals Nagpur: in October 2022, with complaints of both hip joints pain of 1 year duration. He had bilateral advanced arthritis of the hips due to osteonecrosis (avascular necrosis, AVN) of both femoral heads mostly secondary to COVID-19 infection in April 2021. He was severely disabled, barely able to walk few steps, and was carried to the OPD supported on the shoulders of younger brother and old father. He had history of cardiac arrest and myocardial infarction in 2016 for which he had undergone primary angioplasty in 2016. Serial reports of 2D Echo revealed – LV regional wall motion abnormality at rest with LV diastolic dysfunction and an ejection fraction of 25%.
He was discouraged to undergo surgery and was explained about death on table risk at few outside hospitals. One of his family friends referred him to Dr Alankar A Ramteke at Wockhardt who happily accepted the challenge. Preoperative thorough evaluation and medical preconditioning was done. Cardiac opinion was taken from Dr Nitin Tiwari who carefully managed cardiac health. Expert Physicians Dr Vaibhav Agrawal, Dr Swarup Verma and Intensivist Dr Chetan Sharma worked on his fitness for surgery. A staged bilateral THR one month apart was planned because of life threatening cardiac risk. Under expert Anaesthesiologist team comprising of Dr Melag, Dr Bawankule, Dr Awode & Dr Mrs Jaiswal, patient underwent right THR on 11 October 2022 followed by Left THR on 17 November 2022 under Spinal Anaesthesia. Minimally invasive small incision THR was performed with enhanced Recovery Protocols and stitch-less surgery.Despite two major surgeries one month apart that too in a patient with severely compromised cardiac function, this patient did not need any blood transfusion or ICU admission. He was shifted to wards immediately after surgery few hours post both THRs. He started walking within 2 hours after surgery both times. He was able to use commodes independently on Day 1 of surgery & was already climbing stairs on Day 2. Both times he was discharged on Day 3. Rest of his post op recovery was very fast and uneventful. This young man resumed his job within 1 month of second surgery.
Dr Ramteke believes that there is multidisciplinary care team approach at Wockhardt Hospital, Nagpur hence we can successfully manage complicated and high-risk cases. For this high-risk but young and active patient our team of Cardiologists, Physicians, expert Anaesthesiologists, skilled and experienced joint replacement Surgeon, and Intensive Care Team back-up, all acting in close coordination could help this young man get back to his feet withing couple of hours and back normal working life very rapidly despite life-threatening cardiac co-morbidity.