We started hearing this pretty frightening word after the second wave of covid. It is a name given to a well-known condition called 'Avascular necrosis of the hip'. Consultant Orthopedic Surgeon in Mumbai, Dr. Shreedhar Archik explains more a about it.
Our normal hip joint looks something like this and if the blood supply to the ball of the joint gets disrupted then that part of the bone dies. Hence the name 'bone death syndrome'.
Once the bone dies it is replaced automatically by a new bone tissue. However, this bone is not very strong and as a result the bone crumbles when it taken on the body weight. This causes irregularity of the smooth part of the ball. This rough irregular bone rubs against the good sockets and eventually destroys it completely
Once the bone dies it is replaced automatically by a new bone tissue. However, this bone is not very strong and as a result the bone crumbles when it taken on the body weight. This causes irregularity of the smooth part of the ball. This rough irregular bone rubs against the good sockets and eventually destroys it completely
Once the joint is destroyed the patient is in immense pain and cannot perform simple daily activities. At this stage they need a total hip replacement.
Unfortunately, all these patients are in a very young age group i.e., 28 to 48. At this age its better if one can avoid a hip replacement surgery for obvious reasons. The main reason is that even the bets of the best artificial joint wont last for more than 15 years. So, one is looking at another surgery, for example if you get a hip replace at age 30 you are certainly going to need another surgery at the age of 45!
Let’s understand why COVID pandemic highlighted this issue. Avascular necrosis is mainly cause by alcohol abuse and a drug called steroid. In India however half of the patients no cause is found.
During Covid a lot of patients were given steroids as a life saving drug. This and COIVD infection n together cause avascular necrosis in a lot of patients.
My first 8 patients were all young doctors working in the COVID wards.
Unfortunately, there are a very few symptoms in the early stages of the disease and hence the disease gets ignored by the patient. A minor limp while walking or finding it a bit difficult to wear the socks are the only warning signs. Also, the disease is more common in males than females.
Traditionally a group of drugs called bisphosphonates are used to slow down the disease progression. However, these do not prevent thew ultimate collapse of the ball (femoral head). A minor surgery called core decompression is also popular wherein we drill a small hole in the thigh bone and start a fresh blood flow to the dead bone.
As you can see, we insert a needle under local anesthesia near patient’s hip bone and draw his bone marrow. This is an outpatient procedure.
The bone marrow is sent to a lab which grows crores on new stem cells from this sample. This usually takes 6 weeks. After 6 weeks we insert these stem cells after drilling the hole.
This procedure can reverse the process of bone death and can potentially can preserve one’s natural hip. The take home message is that do not ignore mild pain in the hip area or a limp while walking especially if you have suffered from COVID. Technological advances have made treatment easy and, in many cases, the natural hip can be preserved.
Read more from Consultant Orthopedic Surgeon in Mumbai, Dr. Shreedhar Archik,
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