In a rare surgery, a 33-yr-old patient of sickle cell disease from Nigeria with ulcer in both hips and dislocated hip joints was recently successfully operated on at Fortis Hospital after a year-long treatment. Not only had sickle cell disease destroyed the hip joints of the 33-year-old, there were ulcers as big as craters on both her hips measuring about 8” across and deep down to the pelvis. The hipbones were protruding out of the ulcers and oozing foul-smelling pus.
“As the ulcers complicated the patient’s condition of damaged hip joints, it was decided that treatment will be in two stages. The first stage involved cleaning up pus, dead bone and covering skin defect with skin flap which was achieved in December 2014 by a team of orthopaedic and plastic surgeons,” said Dr Sachin Bhonsle, Senior Consultant Orthopaedic Surgeon, who operated on the patient.
Doctors had to wait for the second stage i.e. hip replacement till the patient returned to India in August 2015 with her ulcers healed. Subsequently, the level of disease was brought down from 86 per cent to 40 per cent through exchange of sickle blood with normal blood.
“In this one-of-its-kind surgery, a chapatti-sized plump skin flap was sitting in the area of incision and three things further distorted the anatomy. The hip was destroyed and dislocated; the hipbone had migrated on top and healed up, with pelvis three inches above and the scarring in this distorted area was massive. It was difficult to locate the nerve and artery,” said Dr Bhonsle. He used CT scan and 3D reconstruction to plan hardware and decided to approach the hip from underneath the flap. Once the hip was approached, the bone was cut roughly where the CT scan indicated the hip would have been. Sickle bone, which is hard like concrete, was prepared carefully to implant a titanium alloy socket. The femur was also carefully prepared.
The CT scan provided indication of just 7mm cavity of bone, which doctors enlarged to 11mm, then cementing the famous Exeter Stem and carrying out repair with care. Dr Bhonsle said many aspects of the case were absolute “no nos” and impossibilities were obvious.
