A novel form of treatment is now available in India for patients with early stage avascular necrosis of the hip. This treatment is based on regenerative medicine.
Avascular necrosis of the hip is a condition of unknown origin affecting many young and middle aged patients. Steroid intake, alcoholism, Sickle cell diseas, hypertension, decompression sickness are some known causes. Moderate to severe disease is treated by hip resurfacing whereas core decompression is offered to the first stage of the disease. Grade II A disease is an intermediary stage between the two extremes and has no definite treatment options. There is controversy on the appropriate treatment. Hip replacement is perhaps too drastic an operation for this early stage of the disease. Core decompression has limited success rate. Left to progress it leads to deterioration and hip arthritis.
For this stage, a biolgoical option is now available. This is based on the potential of stem cells to heal the avascular bone. Stem cells are drawn from the patient and cultured in the lab. A few weeks later, they are injected back into the affected portion of the femoral head along with a core decompression. In a core decompression the surgeon will drill a tunnel in the hip bone leading into the affected area. The regenerative bone cells are injected into the affected area. The bone forming cells called Osteoblasts synthesize new bone in the dead area. This leads to healing and hence a biological cure. The technique is called Ossron.
For advanced stages of the disease resulting in hip arthritis, Hip resurfacing is offered at the same center by experienced Orthopedic surgeon India
This process is avaiable in India for a reasonable cost.
E mail- drvenkat@kneeindia.com
Watch story of American patient who had a Birmingham Hip resurfacing surgery in India.
E mail-drvenkat@kneeindia.com
A total knee replacement is generally performed for older people with arthritis. As people all over the old live longer, more joint replacements are being done.
However Orthopedic surgeons like me are seeing increasing number of young patients afflicted by knee arthritis. The causes of knee arthritis in the young are accidents, infection, rheumatoid arthritis, obesity, overuse. These patients are demanding knee replacements as a solution to relieve pain permanently.
I started researching for answers last year after a young Dutch patient approached me for a knee replacement a year and half ago.
How old should one be to have a knee replacement?
Many traditional pundits will say that in order to have a knee replacement you should be older than 65 years. The main reason behind this mind set is that younger people are likely to be more active. They are likely to place undue stresses on their knee joints that it might fail.
Until a few years ago, this was the case.
However with the advent of new materials, implants, techniques, this need not be cause of worry. The introduction of Knee & hip prostheses in ceramic and zirconium are promising. These materials are more durable than metal joints. They have the advantages of more scratch resistance, hardness and more tolerance. Another very important criterion is the design of these new implants.
The MJRC introduced Oxinium knee prosthesis and even performed a <em>live Twitter cast</em> of a Knee replacement with an Oxinium knee.
The latest innovation is the Journey knee.
This first of its kind implant combines the stability and natural movements( kinematics) of the normal human knee with low friction and scratch resistant Oxinium that may extend the life of the implant.
While the lifespan of a knee implant is heavily influenced by the materials used to make it, the natural feeling of the implant during physical activity is dependent upon the way the patient’s muscles, ligaments and tendons
are addressed during surgery and by the implant’s shape within the body after surgery.
The knee is a hinge joint, but it does not swing like a simple door hinge. It has a complex rotational motion that you don’t notice is there—but many patients who have undergone a TKR will tell you that it is not there. Traditional implants do not accurately recreate this subtle swing- and-rotate action.
As a result of these traditional designs, the muscles and ligaments around the new joint have to work harder because the implant’s slightly unnatural shape and resulting motion make these soft tissues move in unfamiliar, stressful ways. This leads to joint pain, muscle fatigue and the unnatural feeling patients experience while walking, descending down stairs, or bending in the post operative period.
after their procedure.
The JOURNEY knee, on the other hand, is the only knee implant designed to reproduce the original internal shapes and angled forces of the human knee through its full range of motion—accommodating the swing-and-rotate of the joint with the same engineering principles your real knee currently uses. Because of this, your soft tissues don’t have to readjust to new shapes and forces after surgery and your stride can return to its natural rhythm.
The JOURNEY knee also reproduces the stability provided by your anterior cruciate ligament (ACL) and your posterior cruciate ligament (PCL). Your ACL and PCL are key to the stability of your real joint and contribute to natural motion when your knee is fully extended and fully bent. No other knee implant reproduces both functions. It also is gender specific and provides high flexion upto 155 degrees.
I recently attended an Orthopedic conference in Australia where the theme was ‘Joint replacements in Young people‘.
The Journey knee was discussed in depth and surgeons from all around the world thought that it is an elegant high tech model.
The Journey knee has been introduced at my center. We propose to also launch in the near future Visionaire patient matched instruments to implant this knee specifically for your body.
Young patients need not dither from a knee replacement any more.
To get a quote for a Journey knee, e mail drvenkat@kneeindia.com.
To know more about the Journey knee, please visit the Smith & Nephew website.
Dr. Venkat demonstrating computer assisted knee replacement on a bone model
At Dr.Venkatachalam’s knee & Hip surgery center, Computer assisted surgery ( CAS) is performed for difficult cases. Patients with extra articular bone deformities, retained metal work and outliers are suitable for CAS as it gives better results and decreases the error margin.
Total Knee replacement for young patients
Unheard of until recently, this is now becoming a hot subject of deliberation amongst patients and orthopedic surgeons. Normally the typical patient for a knee replacement would be a patient in their golden years of life. Surprisingly now increasingly large number of young patients, plagued by end stage arthritis from various causes, are now seeking an end to their constant pain and stiffness by demanding a total knee replacement. To quote some figures, 27 percent of TKR recipients are between 18 and 64 years. This is setting a new trend in orthopedic surgery. Not surprisingly orthopedic surgeons are reluctant to offer these suffering patients, succor by means of a knee replacement. They tell their patients to put up with the pain and try to postpone a knee replacement for as long as possible.
Historically, total knee replacements are known to have poor outcomes in the young due to their higher activity levels compared to older patients. Normally a knee implant is expected to survive for 10 to 15 years and hence surgeons are reluctant to place them in younger patients as they are bound to outlive their implants.
Better materials
With the advent of newer materials and designs of knee prostheses, these perceptions are about to change. The biggest advance is the availability of newer materials like Ceramic for knee replacements. Pure ceramic or ceramic coatings on metal are the latest in technology.
Titanium carbide has been used for dental implants but its use as a bearing surface
in hip & knee prostheses is not widespread.
Knees made of ceramic are in restricted use. Implantation of pure ceramic knees requires specialized instrumentation.
Oxinium or Oxidised Zirconium is the wonder material that has been used successfully for knee & hip implants. It is a metal with a coating of ceramic. In the manufacturing process, prosthetic components made of Zirconium are heated and infused with oxygen to create a ceramic surface on metal. This ceramic surface is more durable than normal metals. This material received FDA approval in 1996. After rigorous testing, this material received approval for use in knees.
Advantages of Zirconium knees
The significant advantage of Zirconium knee implants is that it is considerably harder. On testing it lasts 85 times longer in tests that simulate the stresses inside the actual knee.
Additional advantages are scratch resistance. When it is wet, ceramic can glide smoothly along plastic, making for smoother motion than with metal-on-plastic. As a result, the Oxinium total knee replacement will not generate the quantity of plastic wear debris that cobalt chrome will, and the implants should last considerably longer.
Zirconium is one of the six most biocompatible elements know to man. So, your immune system will more easily tolerate your new implant.
Lastly, patients who are allergic to nickel, the metal most often used in the current implants, cannot currently receive total knee replacements. The ceramic implant, however, can be implanted safely in patients with nickel allergies, since it uses a zirconium alloy with no nickel. Implants made of Oxinium have been implanted in larger number of patients in the UK Australia and the US with great success.
Who would benefit most from an Oxinium total knee replacement?
Three types of patient have been identified as the “best” candidates for an Oxinium total knee replacement.
“Younger” patients: Because Oxinium knee implants offer significantly less wear compared to cobalt chrome implants, they are expected to last considerably longer. In the past, orthopedic surgeons have advised patients less than 65 years of age to wait to have knee replacement surgery because the life span of the cobalt chrome knee implants is only 10-15 years. Now, surgeons have a viable option for a younger patient who previously would not be a candidate for a total knee replacement because the Oxinium knee implants should last much longer. Therefore, a patient under the age of 65 who has advanced arthritis of the knee no longer has to suffer for years until he reaches an appropriate age for total knee replacement surgery.
“Active” patients: Patients, who desire to return to an active lifestyle, including sports, dancing, gardening, or other strenuous activities, may also benefit from an Oxinium knee replacement. As a result of their high activity level, this patient population will put more “wear and tear” on their knee replacement, which can cause the implants to wear more quickly. An Oxinium knee is better able to tolerate this high activity level and last longer that the traditional cobalt chrome knee.
Metal allergy patients: Because Oxinium is one of the most biocompatible materials known to man, it is the only choice for patients who exhibit metal allergies. Patients who have needed total knee replacement surgery, but could not tolerate the cobalt chrome implants due to their nickel content, can now have the surgery they need to return to an active lifestyle without the fear of an allergic reaction.
Three designs are available, the Genesis knee, Journey knee and the Deuce knee, according to the manufacturer, Smith & Nephew.
In India, the Genesis knee in Oxinium is to be introduced soon in South India.
The Chennai Knee surgery center offers knee replacements at affordable costs
Visit www.kneeindia.com
A Revision knee replacement is a second procedure done when a primary knee replacement has failed due to loosening, infection, loss of function and pain.
A British gentleman from Norfolk describes his revision knee replacement in this video
http://video.google.com/videoplay?docid=2698951676468034840&hl=en
