by The Welthi Bureau 15th April, 2019
Not many, especially the young adults and children, are aware that pain in thigh or knee may sometimes indicate hip problems and any delay in diagnosing and treating the problem will lead to irreversible damage and arthritis of the hip joint. If hip preservation surgery is performed in young patients, it will delay or arrest arthritis and also helps in avoiding or delaying total hip joint replacement surgery in future. Dr. Raghuveer Reddy K., Sr. Shoulder & Knee Surgeon, SISA, Hyderabad and Dr. Gourineni Prasad, renowned pediatric & young adult orthopaedic surgeon from Chicago, briefed media on the latest and much finetuned techniques to treat the hip problems in children and young adults.
To focus on these and other related issues, SISA Hospital (Sai Institute of Sports Injury and Arthroscopy) hosted the 12th SISA 2019 Advanced Hip Preservation Workshop, on Sunday. The Workshop familiarized Orthopaedic surgeons with the advanced techniques. Over 350 surgeons from different parts of the country participated in the workshop to learn these techniques focused on preservation of Hip joint.
The hip joint is a major ball and socket designed to give the ability to sit, squat, stand, run, and jump without popping out or wearing down during our life time. However, hip pain is becoming common even in young people. The pain is usually not severe in early stages and the diagnosis is not made readily without advanced training to doctors. Most hip arthritis is secondary to shape alterations of the bones. Several of these alterations start at a young age while a few conditions start in adulthood. We now have the knowledge and information to identify these alterations early, treat them, and prevent arthritis. The goal of this meeting was to disseminate this knowledge to more Orthopaedic surgeons so that more people can be helped.
Dr. Raghuveer Reddy K., said, there are several childhood diseases leading hip damage such as congenital dislocation where the child is born with a dislocated hip, infection of the joint (septic arthritis), problem with circulation of the ball (Perthes disease), ball slipping on the thigh bone (Slipped epiphysis) etc., the incidence of these is in the range of 1 in a lakh and normally seen when the child is between 10 to 14 years of age. There are newer problems especially in young adults like jamming of the hip bones known as femoroacetabular impingement, commonly seen in 25 to 30 years age group, with incidence being in the range of 1% of the population in that age group, leading to shape alterations. Appropriate early treatment can decrease the chance of these alterations.
Dr. Raghuveer Reddy said, these problems can be prevented by activity modification and going back to our older habits, of sitting on the floor and squatting or activities involving stretching of hip, doing yoga, seem to have a preventive role in the development of femoroacetabular impingement. These modifications can help especially when the child is between 5 to 10 years and the hipping is in a formative stage. Carrying the baby with their hips spread apart is well known to promote healthy hip development.
Once the alterations occur, correcting them in the hips that are at risk is now a well-established approach. With newer knowledge of the blood supply to the hip, we have the ability to safely deepen, rotate, or reduce the socket size, change the shape of the socket, make the ball smaller and rounder, lengthen the neck, and strengthen the muscles. We can also place new cushion on the ball and socket in selected patients.
The standard surgical procedures with larger incisions and longer recovery are safer now, but most of them can be accomplished with smaller incisions and day care surgery. Arthroscopy of the hip, a technically difficult procedure not so popular in India, but has tremendous potential to perform the treatment with tiny incisions, less pain, faster recovery and very good results.
Dr. Gourineni Prasad, born and raised in India, practicing in Chicago, and committed to spreading hip knowledge in India had the unique opportunity to learn modern hip preservation from its beginning from the original Swiss surgeons and accumulated unmatched experience with both open and arthroscopic techniques for 20 years. He simplified the approach greatly while maintaining its accuracy and his results are on a par with any international expert in the field.
Speaking on the occasion Dr. Gourineni Prasad, said, hip preservation means saving the hip which is at risk from arthritis or hip pain, necessitating hip replacement. This need identifying the hips at risk and treat them with appropriate surgical technique before the damage happens. This idea started in Bern, Switzeraland, but I was lucky to have learnt it when it was just getting popularized and then we expanded it in USA. Now I am trying to popularize these techniques in India by exposing it to many surgeons here. Off late Hip pain and arthritis is becoming more common than it was even a generation ago, especially in India. The reason being we became more Westernized, the earlier generations used to sit on the floor crossing our legs, squatting, people don’t do it anymore. The squatting which helped the hip to develop properly is not happening anymore, therefore the hip problem is becoming more common in India. Our culture of squatting was beneficial in hip development. It is preventable if children are educated to stretch their legs at a young age, squat, sit down, do yoga, especially between 5 and 10 years such activity modification helps. Early recognition of the problem allows to detect and treat. If the hip pain is not severe in children, they may not seek proper treatment. If the doctor they go to doesn’t diagnose the problem properly and treats it with some medicines for pain relief or if the child altogether avoids activities which cause pain, the problem will continue to exist and they live with it. But in due course it can lead to arthritis or damage, which is preventable and avoidable if recognized early. Today we have several new techniques which existed but have been modified, improved, finetuned to produce much better outcomes.
He collaborated with Dr. K. Raghuveer Reddy and dedicated himself to treat children and young adults with hip problems at SISA centre, Hyderabad and his soon to be launched world class center at Tirupati known as Amara Hospital.
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