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Apollo Hospitals, Chennai successfully performed a rare Quadruple Joint Replacement surgery on a Bangladeshi patient, which enabled him to walk after more than four years.

27 Jul 2018

A new lease of life was given to 23-year-old Bangladeshi man who underwent a successful rare quadruple joint replacement surgery that enabled him to stand and walk after more than four years. The Quadruple Joint Replacement Surgery is the replacement of four joints (both Hips and both Knees). This procedure requires multidisciplinary care, meticulous surgery, safe anesthesia, ICU back up and dedicated rehabilitation for a proper recovery.

Mr. Amit Kar, was leading a normal life, until he was 16 years-old when he developed sudden joint pain in his neck, hips, knees and back. His condition rapidly worsened in few months, whereby his hips and knees became stiff, inflexible and extremely painful, making him completely immobilized.

Mr. Amit Kar was diagnosed with Ankylosing Spondylitis, a condition which generally affects and destroys the spine and hips and sometimes other joints like knees and shoulders. This condition usually occurs at the age group of 20-30 years during prime of a person's life. In general, men are more affected by this condition than women. Patients diagnosed from Ankylosing Spondylitis suffer from worse low back pain during the night time and stiffness of lower back early in the morning. As the day progresses or with some activity, the pain and stiffness becomes better. But despite undergoing several medical therapies in Bangladesh, Mr. Amit's condition only continued to worsen and within a few days, he became completely dependent on others for his day-to-day activities, deformed and confined to the wheelchair.

After being wheelchair bound for more than 4 years and trying several therapeutic modalities in Bangladesh, Amit Kar was brought to Apollo Hospitals in a state with completely destroyed and fused hip joints and severely damaged and deformed knee joints. His knee joints were bent at 90 degrees, further making it impossible for him to walk. In such a complicated case, surgeons generally prefer to have a gap of at least a year between the two joint replacement surgeries. However, Dr. Arun Kannan, Orthopaedic Surgeon, Apollo Hospitals, Chennai along with the team of doctors decided to perform Rare Quadruple Joint Replacement Surgery.

While addressing the conference Dr. Arun Kannan, Orthopedic Surgeon, Apollo Hospitals, Chennai said, "This surgery was performed in two stages in two weeks' time. In the first stage, the right hip and right knee were replaced and in the second stage the left hip and left knee were replaced. Both stages required Awake Fibreoptic Intubation- a specialized anesthetic technique where the airway tube is placed while the patient is awake. Hip replacements were of the complex variety and required a technique called Digastric Trochanteric Osteotomy for safe completion. We used Oxinium components for his hips in view of his age, as they tend to last longer. His knees which were bent about 90 degrees were straightened during his knee replacement surgery with meticulous soft tissue balancing."

The patient recovered well from the surgery and underwent rehabilitation therapy. Since the patient did not walk for several years, his hip and knee muscles became weak and could not support him. Hence, a specialized rehabilitation technique was used to help him regain muscle-tone and strength. Initially, he walked with the support of a walker, and later he walked independently.

Dr. S. Ramakrishnan, M.D., DM Senior Consultant Rheumatologist at Apollo Hospitals, Chennai, further added that "Ankylosing Spondylitis treatment requires a holistic approach with medications and a regular physiotherapy program. Regular swimming is a very good exercise for these patients. At present in India we have wonderful medications called Biologics, which not only confer relief of pain, improve physical activity but also control the disease process. The important problem in India with respect to the treatment of Ankylosing Spondylitis is delayed presentation to the Rheumatologist when the disease is already advanced. This delayed presentation to the doctor is due to poor awareness of this disease in the society. Patients with Ankylosing Spondylitis will lead a good quality of life with early diagnosis and a regular treatment program ‘Life is mobility and mobility is life."