Chisom, a fourteen year old Nigerian boy was not unduly worried when he noticed a slight pain in his thighs after returning from school one day. However, over a period of a few weeks, his pain & limp got progressively worse till he was unable to get out of bed or walk. His worried parents consulted several doctors in Nigeria but were unable to come to a diagnosis. Finally Dr. Anaka, a local Orthopaedist took a hip Xray and diagnosed him to have bilateral slipped capital femoral epiphysis (SCFE). Realizing the emergency nature of the condition and aware that it required expert management, Dr. Anaka decided to refer the patient to the Paediatric Orthopaedic Unit of Kokilaben Ambani Hospital in Mumbai. Rushing through their visa formalities, Chisom was airlifted to India and was immediately admitted to Kokilaben Ambani Hospital on 22nd May.
Says Dr. Alaric Aroojis, the Consultant Paediatric Orthopaedic Surgeon at Kokilaben Hospital under whom Chisom was admitted, “I was shocked to see Chisom’s condition when he first arrived. The plucky teenager was obviously in severe pain and unable to move in bed, but he still flashed a warm smile. I knew right away that this boy was a fighter!”¿ Chisom was quickly stabilized and sent for an emergency Xray & CT scan which revealed that he had suffered a severe displacement of the ball of both hip joints.
Slipped capital femoral epiphysis (SCFE) is an uncommon condition seen in adolescents, wherein the ball begins to separate from the rest of the thigh bone due to a weak growth plate. It is more common in boys, African Americans & very obese children. Untreated, this condition can disrupt the blood supply to the ball of the hip joint and result in a lifetime of pain & disability. Considering the severity of his condition, Dr. Alaric Aroojis decided to offer a newer but more complex method of surgical correction which involved opening and dislocating the hip joint, trimming the excess bone and realigning the displaced ball back in position – all the while taking care to meticulously preserve the blood supply.
According to Dr. Alaric Aroojis, who has completed his Paediatric Orthopaedic fellowship training at reputed centres in the US, Singapore and Australia, “This is a very complex reconstructive hip surgery which has become popular only since the past few years. It requires a great deal of precision and skill to execute and is thus performed in merely a handful of centres in India. The biggest challenge in Chisom’s case was the fact that that he had severe displacement of both hips and we had to get the timing between the surgeries right”¿.
After a grueling 5 hour surgery, the right hip was treated successfully, followed by a similar operation on the left hip two weeks later. Chisom’s pain disappeared within a few days of surgery and he was soon able to sit up independently and turn himself in bed. Once satisfactory healing was seen on the Xray, he was gradually made to stand and walk with the help of a walker, for the first time after several months.
According to Dr. Alaric Aroojis, “what makes Chisom’s case unique is that this is the first time a patient has undergone this complex procedure on both hips. To the best of my knowledge and after a detailed search of scientific literature, I have been unable to find a similar case performed elsewhere in the world and certainly not in India. It goes to show that with the proper infrastructure, we in India, are on par with the best in the world”¿. Dr. Wudbhav Sankar, Asst. Professor at he Children’s Hospital of Philadelphia, who recently reported on the largest multicentre series of treating severe unstable SCFE with this complex procedure in the reputed American volume of the Journal of Bone & Joint Surgery concurs “In my experience, I have not encountered a single case where this procedure was performed on both hips”¿.
Chisom is quite unaware of what all the fuss is about. Like a normal teenager, all that he wants to do is get back to his football game as soon as possible.