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HIP Table of Contents   
Year : 2002  |  Volume : 36  |  Issue : 4  |  Page : 274-275
Hip Joint restoration


Consultant Orthopaedic Surgeon, Kachletstrasse. 50, Passau 94034, Germany

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   Abstract 

Hip pain due to arthritis is a common problem. Total hip arthroplasty is successful but failure still cannot be excluded. Since resources are scarce, alternative methods are looked for. We have described the alternative and to encourage to consider economic evaluation in the future. We have treated 560 patients (717 hips) hip joint-disease-pain with the new non-surgical treatment. On the basis of the results the use of the enzyme appear to be successful alternative treatment.

How to cite this article:
Adusumalli C. Hip Joint restoration. Indian J Orthop 2002;36:274-5

How to cite this URL:
Adusumalli C. Hip Joint restoration. Indian J Orthop [serial online] 2002 [cited 2019 Jul 22];36:274-5. Available from: http://www.ijoonline.com/text.asp?2002/36/4/274/35951

   Introduction Top


There are a number of options for the preservation of hip-joint including bone grafting, decompression, rotational osteotomy. [1],[2],[3] The number of procedures indicate the lack of a successful treatment as the capacity of the articular cartilage to repair is limited. Cartilage defects result in pain, swelling and leads to osteoarthritis. An alternative treatment is to inject solutions directly in the synovial cavity, which dissolves damaged cartilage and improve lubrication between the joint surfaces, and regenerate the cartilage to some extent.

The treatment of arthritis discloses a number of therapeutical approaches such as medical-plants, physiotherapy through the aid of low temperatures, by means of diet of raw vegetables, an exclusive diet of juices or by means of extracts arnica, hot pepper, camphor with essential oils and the use of vegetable enzymes. [4],[5]

Different methods, and techniques have been proposed in the past for the health care. Since economic resources cannot meet all demands, it is important to ensure a maximal overall social benefits. The purpose is to help to those methods, and inventions which gives maximal benefit to health from given resources.If the treatment is considered as equal or almost equal, the objective is to find out which minimises the cost. Economic evalution of interventions in health care are becoming common and unavoidable.Orthopaedics has seen only a limited number so far,but this will change in the future.


   Patients and Methods Top


Between December 1986 and December 2000, we treated a total of 717 patients with painful hips using enzymes under the supervision of a single surgeon. The patients have been followed up for a minimum of 24 to 48 months. The treatment was carried out on patients from 31 years till 76 years of age. All the patients had a diagnosis of osteoarthritis, injury-necrosis and arthrose. Before treatment all patients had severe pain on weight bearing, night pain, and some degree of pain even at rest.

Technique

Prior to the operative treatment, the patients are given twice weekly intraarticular injections (A+B solution "Enzimic" Cartilase A - Cefak Drug Co., Germany Cartilase B - Heel Drug Co., Germany) for a period of 5 weeks, which dissolves only the damaged cartilage. After the course is completed, the patient is put under anaethesia to extend the hip-joint with the help of 15 kg. Weight. The hip joint was filled with normal saline or Makrodex 10% or Ringer lactate 5% for cleaning intracapsular adherence. After cleaning arthroscopic examination findings are documented, and then a dye is injected for radio­arthrography documentation. We describe the survival and radiological findings 2 to 3 years after restoration treatment. The outcome allow in general and comparative of the hip-arthroplasty. [6],[7]

Results were calculated as follows: Good- walking without a stick for one hour,no pain,free movements in the joint for 6 months, Satisfactory- walking ability without pain, but discomfort in the night.Patient is happy and Poor-radiographs poor, less pain, later operated .


   Results Top


We studied 717 hip restoration between December 1986 and December 2000, At a mean fallow up of 36 months, there was a 85% good and an additional 5% satisfactory, walking ability without pain, 10% patients had unsatisfactory results and were treated with hip replacement.

Comparative study after 10 injections between the combination of the drug A + B and the drug Xylocaine 1% showed that the affect of Xylocaine was restricted to only a few hours of pain relief. After 10 more injections the patient showed no signs of pain relief or improvement. The pain relief after the first injection with the combination of drug A+B lasted for four days. After 10 following injections the patients were relieved of pain and the movement in the hip joint improved. In 1999 two patients turned up to show their hip joints.The clinical results are excellent.

Not much difference was observed between the three solutions (Makrodex, Normal saline and Ringers lactate) applied to clean the joint after the first six weeks. After six months the first two solutions showed a deterioration of the joint. The ten intraarticular injections combined with ringers lactate and the treatment without cleaning showed equally good results both after the 6 weeks as well after 6 months. This evidently indicates that a cleaning is not necessary.


   Discussion Top


Severe arthritis and arthrosis could only be treated through surgery involving replacement of the affected joint. These surgical procedures however, involve high expenditure in terms of time, costs, and are painful. Thus the cost for hip arthroplasty average € 12,500 in western countries while 10 injections of Enzimic costs €11 only. There, moreover exists a risk of infection and the risk of the inserted joint-prothesis being dislocated or coming loose. Many factors may be responsible for prothesis loosening and revision surgery. An increased number of complications are encountered in old age patients.We have not experienced any complication in our joint treatment. One should give a chance for this nonsurgical treatment before joint replacement. Orthopaedicians have seen only very limited number of this enzyme treatment. The success of non-surgical treatment is achieving prolonged pain free survival for the patients.

 
   References Top

1.Chandler HP ,Mecarty JC. Total hip replacement in patients younger than 30 years old. J Bone Joint Surg [Am] 1981; 63- A: 1426- 34.  Back to cited text no. 1    
2.Frankel A, Booth RE, Balderson RA, Cohn I. Complications of trochanteric osteotomy. Clin Orthop 1993; 288:209- 13.  Back to cited text no. 2    
3.Matsuri M, Matsuri K, Nakata K, Nishii T. Early deterioration after modified rational osteotomy of the dysplatic hip. J Bone Joint Surg [Br] 1997; 79- B:220- 4.  Back to cited text no. 3    
4.Drummond MF, O'Brien BJ et al. Methods for the economic evalution of health care programmes. Second Edition. New York; Oxford University Press,1997.  Back to cited text no. 4    
5.Posnett J, Jan S. Indirect cost in economic evaluation:the opportunity cost of unpaid imputs. Health Econ 1996;5:12-23  Back to cited text no. 5    
6.Fitzpatrick R, Shortall E, Sculpher M, et al. Primary total hip replacement surgery. Health Technol Assess 1998;2:1-134.  Back to cited text no. 6    
7.Scher MA, Jakin I. Intertrochanteric osteotomy and autogenous bone grafting for avascular-necrosis of the femoral head. J Bone Joint Surg [Am] 1993, 75- A:1119-33.  Back to cited text no. 7    

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Correspondence Address:
C Adusumalli
Consultant Orthopaedic Surgeon, Kachletstrasse. 50, Passau 94034
Germany
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Source of Support: None, Conflict of Interest: None


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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    References
 

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