City hospitals see surge in hip replacement surgeries among Covid-19 survivors
Dr Eknath Pawar, head of the orthopaedic department at JJ Hospital, said though there’s been a rise in AVN cases in the pandemic, they have witnessed a delay in reporting by the rural population.
Mumbai: City’s JJ Hospital has reported a surge in hip replacement surgeries, especially in patients who were infected with Covid-19. Malubai Ghogare (64), resident of Junnar in Pune, visited JJ Hospital on Tuesday for her first follow-up post a hip replacement surgery. In February, she visited the hospital where she was diagnosed with an advanced stage of avascular necrosis (AVN) or osteonecrosis -- the death of bone tissue due to a lack of blood supply -- and its treatment necessitated a hip replacement surgery.
Hospitalised for Covid-19 in the second wave, Ghogare, who is presently living with her daughter in Byculla, said, she experienced a sudden pain in the hip and thigh region in September and was unable to walk. “My legs were swollen. Initially, I visited local doctors but no one could diagnose it. It was in November that I was advised to go to a tertiary care hospital. With the third wave around, I delayed but finally had a hip replacement done,” she said.
Similar to Ghogare, Aurangabad resident Bhausaheb Navgire, 50, underwent a total hip replacement surgery on May second week. “I was hospitalised for Covid-19 a year ago. While I felt the pain in the hip region within four months of being discharged, I delayed the treatment initially. But by September, the pain progressed into stiffness and affected my mobility. I was diagnosed with AVN and advised hip replacement later,” he said. Navgire said he waited for Covid-19 cases to settle to come to JJ Hospital for the surgery.
According to doctors at the state-run JJ Hospital, many Covid-19 recovered patients like Ghoghare and Navgire have been visiting the orthopaedic department for a total hip replacement surgery. AVN is a part of ‘long Covid-19’, and many studies are underway globally on to understand the cause and clinical explanation behind it.
Dr Nadir Shah, associate professor, orthopaedic department, JJ Hospital, said, “In the first and second wave, life-saving corticosteroids was used in the management of Covid-19. It is one of the factors that led to the development of AVN post-recovery.”
The hospital’s orthopaedic department said they have especially seen the rise in such cases from rural Maharashtra in the last three months with pandemic curbs being lifted and people willing to travel from interior parts of Maharashtra.
Dr Eknath Pawar, head of the orthopaedic department at JJ Hospital, said though there’s been a rise in AVN cases in the pandemic, they have witnessed a delay in reporting by the rural population.
“We have been treating AVN cases for last one year but have observed that unlike people from the metro cities, who have consulted early, people from interiors of Maharashtra delayed the treatment leading to the progression of the disease requiring a hip replacement. We have seen six months to a year delay by such patients,” he said. Dr Pawar added that there might be multiple factors including fear to travel due to Covid, misdiagnosis etc.
“If diagnosed at an early stage, it can be treated with medication and the disease progression can be stopped. But at a later stage, hip replacement is the only option,” he said.
Dr Shah said at present, they are operating twenty cases a month. “We earlier operated on eight cases a month and saw 10-15 patients with a hip problem in each outdoor patient department (OPD). We are now operating twenty cases a month and seeing 25-30 cases per OPD in last two three months,” he said.
Dr Shah further elaborated that 50% of these cases have had a Covid-19 history along with hospitalisation in the past. “While taking the clinical history, we found that 50% of these patients had Covid-19 in the second wave and were hospitalised. Their symptoms like pain in the groin, thigh or buttock region and stiffness in joints within months of getting discharged,” he said.
JJ Hospital is one of the public hospitals doing the total hip-replacement surgeries under the Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY).
Dr Shubranshu Mohanty, professor, orthopaedics, KEM Hospital- Parel, which also performs total hip replacement surgeries under MJPJAY, said before the pandemic, 60-70% of the overall hip replacement surgeries done were related to AVN.
“While we do not know the cause, we are genetically prone to it. It is also seen in chronic alcoholic patients, chronic tobacco chewers, deep-sea divers and people who were on steroids. In the pandemic, the cases went up because of Covid-19 and treatment related to it,” he said.
Dr Mohanty said Covid-19 causes hypercoagulation- a condition that causes the blood to clot more easily than normal. “It is one of the causes that led to AVN. In some cases, Covid-19 aggravated the already existing mild form of AVN. Steroid usage too added to rise in AVN cases in Covid-19 recovered patients,” he explained.
Dr Mohanty said that earlier he used to operate on eight cases a month which has risen to 20 in the last few months. “50% of them have a history of Covid-19 and hospitalisation. More research needs to be done on AVN and Covid-19. For now, if we find Covid-19 and hospitalisation in the medical history as the only reason, we term it Covid-19 AVN,” he said.