Hip Replacement in Young Patients and Sickle Cell Disease

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.

International implant companies have withdrawn much of their complex hip replacement hardware because of government duties and policy changes, but two or three Indian companies have stepped in with cost-effective options. A hip replacement that used to cost $10,000 to $12,000 now costs between $7,000 and $8,000, and in cases of genuine financial difficulty, surgical fees can also be reduced to help the patient.

It depends on the pathology and the type of activity. A well-selected hip replacement lets most patients resume daily activities and many general activities, but for physically demanding sports like football or basketball a total hip replacement is not really compatible with returning to the same sport, and changing to a less demanding sport is usually the better path. Where the underlying problem is femoroacetabular impingement rather than true arthritis, hip arthroscopy to clean up the impingement and cartilage, combined with stem cell therapy, allows the hip to regenerate over about six months with good results on repeat MRI.

The X-ray tells the story: if the joint space and cartilage are still maintained, surgery is not the first answer even if pain has started. Arthroscopic cleanup of osteochondral bone formation or damaged cartilage combined with stem cell therapy is a good option at that stage. Hip replacement is reserved for once the cartilage is completely damaged and there is no blood flow left to the femoral head.

Hip arthroplasty is generally not recommended below the age of 17 to 18, because the skeleton has not yet fully matured. Younger patients are instead managed with arthroscopy and osteotomy techniques.

Surgery is planned in coordination with a haematologist, and is generally performed once the sickle cell level in the blood has been brought down to below 20%, after which standard primary hip arthroplasty can usually proceed.