CHENNAI: A hip replacement procedure using metal-on-metal prosthesis is catching on as an alternative to conventional total hip replacement for younger patients.

Though total hip replacement yielded satisfactory results for elderly patients, the results were generally poor in the case of younger patients. "The Articular Surface Replacement (ASR) using metal-on-metal prosthesis is a minimal bone removal procedure that holds promise for young patients," Vijay C. Bose, orthopaedics consultant, Apollo Speciality Hospital, said. Some benefits of the procedure are faster recovery of patients, lower risk of dislocation, greater mobility and improved quality of life.

According to Dr. Bose, the primary affliction of arthritis was common in the knee in the Asian population whereas it was usually secondary in origin as regards the hip. As a consequence, the average age of patients suffering from hip arthritis was much lower in India than those with knee arthritis.

Common pre-existing conditions that lead to secondary arthritis in the young are avascular necrosis (blood supply deficit), perthes disease (unexplained softening of the head of the femur) and hip dysplasia (lack of complete development of hip).

Some problems that are eliminated with the all-metal prosthesis are the limited life span of the replacement, advocacy of gentle movements and avoidance of postures such as sitting down on the floor or crossing legs.

"The preservation of bone stock is one of the chief benefits of the articular surface procedure," said A.K. Venkatachalam, consultant orthopaedician, Malar Hospitals, who has performed surface replacement of knee joints.

In the resurfacing procedure, only the diseased lining of the joint surfaces — the articular cartilage — is replaced with a metallic cup on either side. This preserves the normal bone that is usually sacrificed in a conventional hip replacement.

Cost factor

A typical articular surface replacement procedure in India costs around Rs. 1.7 lakhs.

The cost factor could find appeal among foreign patients requiring hip replacements. In fact, as many as 14 patients from the U.S. are scheduled to undergo hip replacement surgery at Apollo Speciality Hospital in June alone.

Though the metal-on-metal combination has been approved by the Food and Drug Administration of the United States, the knowledge gap on the full biological response to metal particles or ions has been an area of concern.

Fears over metal toxicity and carcinogenesis are among the issues being addressed by ongoing research in the West.

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