Planning a Complex Hip Replacement: Examination and Imaging

Hip arthroplasty is not recommended below 17 to 18 years of age because the skeleton has not matured. For sickle cell disease specifically, bone marrow transplant, ideally done early in childhood, remains the standard curative treatment and gives the best results. In children who do need hip intervention before that age, arthroscopy and osteotomy techniques that reshape the weight-bearing surface of the hip are used instead of replacement, relieving pain while the child grows.

A well-fitted hip replacement lasts 30 to 35 years, and since most hip replacement candidates are older, most will not need it again in their lifetime. Longevity depends on the patient avoiding certain positions and activities that stress the implant, including sitting cross-legged or squatting on the floor, and avoiding high-energy sport activity.

Stem cells are osteoprogenitor cells capable of turning into bone, cartilage or other tissue types. For damaged islands of hip cartilage, the area is cleaned up arthroscopically and stem cells are injected. On follow-up MRI over about six months, the cartilage visibly starts regrowing, similar to grass regrowing, and the damaged area shrinks along with the patient's symptoms.

In orthopaedics, stem cells are harvested from the iliac crest using a Jamshidi needle, taking around 120 ml of bone marrow blood from either a posterior or anterior approach to the pelvis. This is then centrifuged for around 45 minutes to an hour to concentrate the stem cells before they are injected.

In one case, a cancer patient under care in India could not stay for months of ongoing treatment, so after a few treatment cycles the protocol was written up and shared with the patient's own doctor at home, who continued the therapy locally with periodic remote review of how the patient was responding. Not every case can be managed this way, since complex surgery still has to be done in India, but for many conditions this kind of doctor-to-doctor guidance lets patients continue much of their care and follow-up in their home country.

Up to about 2 cm of leg length can typically be regained through implant selection during surgery. Any remaining discrepancy beyond that is managed with a shoe raise rather than further surgical lengthening.

An AP pelvis view and Judet views assess the acetabular roof and walls first. Where there is doubt about the extent of bone loss, a CT scan with 3D reconstruction shows precisely how much bone stock is deficient and guides the reconstruction plan.