Fortis Hospitals Puts 27 Year Old Nigerian Back on her Feet After Multiple Joint Replacement Surgery

MUMBAI, India, May 13, 2010 - Fortis Hospitals Mulund, Mumbai, performed a multiple joint
replacement surgery on a 27 year old young Nigerian patient. Rebacca
underwent a hip and a shoulder replacement surgery by Dr. Sachin Bhonsle,
Consultant Orthopedic Surgeon, after years of suffering in pain and
immobility.

Rebecca was suffering from a sickle cell disease since birth;
an inherited (genetic) disorder where the RBC (red blood corpuscles) assumes
an abnormal shape of a sickle under certain conditions. Any stress, injury,
or operation can lead to change in shape of the RBCs. But they are extremely
sensitive to drop in oxygen saturation of blood. This causes immediate
'sickling'.

Sickle cells contain abnormal haemoglobin, known as
'haemoglobin S', which causes the cells to have a sickle shape. Sickle-shaped
cells don't move easily through blood vessels. The clumps of sickle cells
block blood flow in the blood vessels that lead to the limbs and organs.
Blocked blood vessels can cause pain, serious infections, and organ damage.
It can be at times life threatening.

    Commonest problems encountered are:

    1. Sickle crises - painful abdominal emergencies because of
       blockage of blood vessels to abdominal viscera.

    2. Anaemia - red blood cells are easily destroyed and their
       life span is reduced causing anaemia.

    3. Avascular necrosis (AVN) of bones - certain bones with
       peculiar blood supply undergo AVN because of blockage of the artery.
       Once the blood circulation is lost the bone crumbles and the adjoining
       joints undergo arthritis. Commonest are hip and shoulder joints.
       Remodelling of entire skeleton is affected sometimes.

In Rebecca's case the disease was severe to the degree that
93% of her haemoglobin was abnormal. This resulted in extreme abdomen pain
and loss of blood supply to bones. Due to the lack of blood flow in her bones
she developed avascular necrosis in her hip joint and right shoulder. "She
came to us in a complete immobile state with a painful right hip and shoulder
which were completely damaged. The sickle disease had affected her knees as
well" said her surgeon Dr. Sachin Bhonsle, Consultant Orthopedic Surgeon.

"We had three major challenges before we decided to go ahead
with the surgery. Firstly, control of her Sickle cell disease - Rebecca had
93% 'haemoglobin S' (HbS). Subjecting her to trauma of a major surgery like
joint replacement, associated blood loss and stress would have precipitated a
life threatening sickle crisis. To reduce her HbS to about 30% we had to
perform an exchange transfusion. Exchange transfusions involved removing
blood with HbS and replacing it with fresh blood of compatible donors. It
took about five days to restore the HbS to a safe level, after which she was
ready for surgery.

Secondly, there was the challenge of doing a shoulder and hip
replacement at same time. Thirdly, when doing a joint replacement on very
young patient it is important to perform a joint replacement surgery which
would give her a long lasting and better quality of life."

After proper examination we decided to go ahead with the
replacement of right hip and shoulder. A decision was taken to use an
'uncemented hip replacement' of a robust construction, which has a potential
to last a lifetime. A ceramic bearing was chosen for this hip which again
will never wear out.

Dr. Bhonsle used a minimally invasive approach to replace
Rebecca's right hip whereby the hip joint was reached by minimal disruption
with just a 4 inch cut. Because of avascular necrosis the bone quality was
very hard and difficult to prepare, but it was achieved using careful and
specialized instrumentation. Uncemented prosthesis was securely implanted and
a ceramic bearing was fitted. Rebecca's hip was ready to use. Similar minimal
invasive approach was taken to the shoulder joint. Cemented shoulder
prosthesis was selected and secured.

Rebacca was able to walk on the 2nd day of her surgery.
Following the surgery her pain has gone completely. She had a speedy recovery
and was able to get back to her normal course of life within few weeks of the
surgery.

    For More Information Please Contact:

    Priyam Bortamuli
    PR & Communication
    Email - priyam.bortamuli@fortishospitals.in
    Mobile - +91-9845558559

    Or enquiries@fortishospitals.in

For More Information Please Contact: Priyam Bortamuli, PR & Communication, Email - priyam.bortamuli at fortishospitals.in, Mobile - +91-9845558559, Or enquiries at fortishospitals.in