Surgical Anatomy and Approach in Revision Hip Surgery

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International implant companies have withdrawn much of their complex hip replacement hardware because of government duties and policy changes, but two or three Indian companies have stepped in with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

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 sciatic nerve, which runs through the greater and lesser sciatic notches, must always be identified and protected before any instrumentation is placed near that area.

The posterior approach, either Kocher-Langenbeck or the Southern approach, defines the sciatic nerve early and gives wide visualisation of the acetabulum, making it considerably easier to reconstruct a deficient wall than an anterior approach would allow.