Dr Kaushal Malhan, knee and hip surgeon at Mulund’s Fortis Hospital

Woman, 56, needs knee replacement after being over-prescribed steroids

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The Nigerian national was ministered 10 steroid injections in a matter of months, when not more than 3-4 are recommended in a year for one joint

November 20, 2013

MUMBAI

Anuradha Varanasi

In yet another case that points to the dangers of indiscriminate steroid use to treat medical conditions, a 56-year-old woman had to undergo a bilateral knee replacement after she was over-prescribed steroid injections for almost two years, leading to severe ligament damage in both of her knee joints.

On the road to recovery: Rebecca is now undergoing physiotherapy at the hospital and is able to walk short distances without any support. Pic/Sameer Markande

Rebecca Ihejieto, a Nigerian national, had been suffering from osteoarthritis in both knees since 2006, for which she was undergoing treatment back home. While Rebecca, a secondary school teacher, had retired in 2011 due to health problems, she has been wheelchair-bound for the last two years, after her local doctor administered her 10 steroid injections in a matter of months. Usually, a patient should be given steroid injections not more than three to four times a year in a single joint area.

“I would get relief from the pain for a few hours after the injections, but after several months, my knees became even weaker and started bending outwards, due to which I couldn’t walk,” shesaid. With her knees protruded at 45 degree angles, she had to use a stick for support. Rebecca found the pain increasingly difficult to bear — this is when her family friend suggested she visit India for treatment.

Shortly after arriving in the city for her treatment, Rebecca underwent bilateral knee replacement in the first week of November. Dr Kaushal Malhan, knee and hip surgeon at Mulund’s Fortis Hospital, said, “The X-Rays revealed that that there was severe knee joint damage and the ligaments were not supporting her knees any more due to more than 50 steroid injections being administered to her in a span of around two years.” “We performed a tissue-preserving technique before the replacement surgery to preserve her bone, and did not require any blood transfusions,” added Dr Malhan. 

He added that the intra-articular steroids prescribed to her are the standard steroid used all over the world to treat osteoarthritis. Rebecca is now undergoing physiotherapy in the hospital and is able to walk short distances without any support. “I am relieved as the pain has reduced and I am getting better,” she said.  

Woman walks again, thanks to bilateral surgery

Tabassum Barnagarwala : Mumbai, Thu Nov 07 2013, 01:55 hrs

In probably a first-of-its kind knee surgery in the country, a 43-year-old woman has regained her ability to walk after almost four years.
Ujwala Khatavkar has been suffering from osteoarthritis for the last four years now. "I could not walk, stand or sit on the floor for more than a minute. Several doctors prescribed medicines. But the pain was unbearable," she said.
She was advised to undergo knee replacement surgery. However, her case was a little different. "She had lost cartilage in the inner side of her knees. Since the whole of the knee was not affected, it was not wise to perform a total knee replacement surgery," said Dr Kaushal Malhan, orthopedic surgeon at Fortis hospital, Mulund.
In February, Khatavkar underwent microplasty uni-compartmental knee replacement — a surgical procedure to replace just a part of the knee.
While her right knee was partially replaced in February, the procedure was repeated in the other knee in March.
"While I still have to avoid sitting on the floor, I can walk and stand for longer than before without anybody's help. Also, the pain has reduced to a great extent," said Khatavkar. Malhan said this is probably the first such bilateral surgery in the country. "Total knee replacement is common. But in this case, we decided to replace only the affected portion," Malhan said.
A four-cm incision was made in the inner side of both her knees through microplasty, a surgical procedure which reduces the size of the incision required. "The surgery lasted for less than an hour. Through this method, the recovery period is fast. She was able to walk within three days," said Malhan.
tabassum.barnagarwala@expressindia.com