Nijin, 38, a native of Palakkad, Kerala State in India had been working as an Assistant Manager at a popular a Mall in Dubai in the United Arab Emirates for several years. His wife Priyanka also had a job in Dubai and was working as a Sr. HR & Finance Executive of a trading firm. Both had a comfortable life. Generally the couple would meet after work and go home together and sometimes would go to sightseeing or similar evening diversion.

As a part of his job, Nijin had to walk a lot inside the mall and it never bothered him. Life continued this way till one day when Nijin during his work felt a shooting pain at the left hip joint. The pain was so severe that he felt he could not keep his left foot on the ground. The pain continued for some time and then eased a bit. In the evening he told his wife of what had happened. The next day they went to a hospital in Dubai. The doctors at the hospital gave some medicines and Nijin felt better. He then was back at work and things continued that way for the next 3 years.

One day in the evening when the couple was entering a mall the shooting pain returned and Nijin almost fell to the ground unable to keep his left leg on the ground. He was immediately rushed to the hospital and after examination, the doctors suggested that it may have something to do with the nerves.

“We did not want to continue treatment in Dubai, as we felt that we had better options in India and therefore we preponed a marriage visit to Kerala and arrived at Palakkad,” Priyanka said.

Back in India, they went to a hospital initially some doctors in Kerala also felt that it may have been a nervous problem. But later a thorough examination revealed that it was an Orthopaedic problem called the Avascular Necrosis (AVN).  

“We then visited a senior Orthopaedics Surgeon in Kerala, who suggested we do one more MRI and he then revealed to us that the left hip had Stage 3 AVN and the right hip had Stage 2 AVN and both the hips needed surgery.

“We had never ever heard of the disease of this name till then. Priyanka’s sister being a student of Swami’s Anantapur Campus, we knew that there was an Orthopaedics department at the Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi,” Nijin said. “So we came to the Swami’s hospital for treatment. We knew that in Swami’s hospital best quality treatment is given totally free of charge to all irrespective of caste, creed, race, religion or nationality,” Nijin added

At the hospital, Nijin and Priyanka met Dr. Prakash Khanchandani, the Head of the Department of Orthopaedics at SSSIHMS, Prasanthigram. All the tests like blood tests, X-rays and MRI were performed and Dr. Prakash came to the same conclusion that it was AVN and the left leg required surgery immediately.

According to Dr. Prakash the blood supply to his both the femoral heads were significantly affected and in usual course a hip replacement surgery, where the diseased hip is replaced with an artificial joint is performed in such cases. With advanced research initiatives there is now a better understanding of the etiopathogenesis of this disease and with the technological advancements, a hip preservation surgery, where the diseased hip is salvaged instead of replacement is gaining momentum. The procedure is done in a staged manner with one hip at a time.

The technique involves removal of the diseased and dead bone by a procedure called core decompression by drilling through the bone. We used many new additions to the existing surgical technique in order to give the best result to the patient. An Arthroscope with a 30-degree camera was used to exactly delineate the necrotic areas after the bone drilling, so that these necrotic areas can be effectively and completely removed, thereby enhancing new bone regeneration. In addition to removal of dead bone, an innovative regenerative therapy I-PRF (Injectable Platelet Rich Fibrin), which was derived from patients own blood taken during surgery, was put in the newly debrided area of the bone, in order to stimulate regeneration of the bone. This was followed by a reverse bone grafting and a specialized medical management protocol of various supplements and drugs (developed over a period of 10 years in collaboration with Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam), which stimulates the regeneration of the bone and controls the progression of this pathology.

A combination of all these therapies led to significant reduction in pain score in this patient and rapid healing of the necrotic area. The patient’s pain scores came down from around 10 to 1 in a short period.

After the surgery and the rehabilitation protocol lasting around 3 months Nijin is again able to walk on his operated leg and has a pain score of 0, which is extraordinary. The patient is now planned for the second hip as well.

We hope that this comprehensive combination therapy can help to preserve the natural hip of the young patients, thereby decreasing the rampant use of total hip replacement to treat this disabling disease of young.

“It is a complex surgery and when we visited other hospitals few surgeons were willing to take up such cases, and the treatment is also expensive,” Priyanka said. “In Swami’s hospital the treatment is totally free and of the best quality, which is boon for so many people, and so many people have benefited because of this,” Priyanka added.

After the successful surgery for the left leg Nijin is in the process of getting the surgery for the right leg at SSSIHMS, Prasanthigram.