Implant Options for Severe Bone Loss in Hip Revision Surgery

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.

International implant companies have withdrawn much of their complex hip replacement hardware because of government duties and policy changes, but two or three Indian companies have stepped in with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.

A jumbo cup, up to about 65 mm, can be used when the anterior and posterior acetabular columns are still stable, since a hip cup's real support comes from those two columns rather than the superior wall.

It is used when the femoral canal is unusually narrow, under about 6 mm, or the patient's anatomy is highly atypical because of long-standing deformity, and standard off-the-shelf implants cannot be reliably fitted.