TOTAL HIP REPLACEMENT WITHOUT BLOOD TRANSFUSION

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Dr Orlin Filipov, MD, chief doctor of Vitosha Hospital Dr Orlin Filipov, MD, chief doctor of Vitosha Hospital

Dr Orlin Filipov, MD, chief doctor of Vitosha Hospital, on the innovative method for total hip replacement applied by his team

Established 19 years ago, Vitosha Hospital specialises in orthopedy and traumatology, with narrow specialisation in hip and knee endoprosthetics, geriatric orthopedy, leg lengthening. The hospital offers methods for fast recovery of the patient's movement developed in Israel. A boutique facility located in one of Sofia's most prestigious neighbourhood, Vitosha Hospital offers outstanding quality of the treatment. It has a large, modern reanimation ward and a larger number of staff taking care of each patient in comparison with ordinary orthopedy clinics.

Dr Orlin Filipov, MD, chief doctor of Vitosha Hospital, is the driving force behind Vitosha Hospital's excellent healthcare services. He has years of experience in orthopaedics, traumatology, arthroplasty and reconstructive surgery. He has worked there since the hospital's opening in 2001 and has specialised orthopedics and traumatology in Sofia. In 2010, he attended a training in reconstructive surgery at the Rambam University Hospital, Haifa, Israel, led by Prof. Michael Soudry, Prof. Doron Norman and Prof. Danny Levin. Dr Filipov's dissertation was on femoral neck fractures. His research has been published in some of the most renowned European and USA orthopaedic magazines and has been recognised on many specialised international congresses. He also authored an orthopaedy book published in New York. Dr Filipov is a member of 5 international orthopaedic associations, and has also patented a method for treatment of femoral neck fractures, called BDSF.

What is arthroplasty of joints and in the treatment of what cases is it used?

Arthroplasty is a surgery in which the joint is replaced with an artificial one, endoprosthesis. Most often, it is needed in osteoarthritis of the hip joints (coxarthrosis) and in osteoarthritis of the knee joints (gonarthrosis). Arthroplasty is often required in fractures of the neck of the hip bone in healthy patients over 65–70 years of age.

When hip arthroplasty is applied, the acetabulum of the joint is replaced with an acetabular cup. The damaged head of the hip bone is removed together with the neck of the bone. On their place are implanted the hip stem and the spherical part (head). Respectively, in knee arthroplasty, the joint surfaces of the two bones are removed, and replaced with the tibial and femoral components.

In principle, arthroplasty is a large surgical procedure that continues for over an hour, following a strict algorithm and protocol of the performed actions. These should be performed by a highly specialised, trained team lead by an orthopaedist who has been specifically certified for this and has a significant experience in such surgeries. In their first years of working in the field of arthroplasty, young professionals can only assist during the surgery, while they acquire the needed skills and knowledge.

Is joint arthroplasty possible without blood transfusion?

In theory, yes. This has been done during the recent years with the use of the so-called minimally invasive surgery (MIS), mostly in the US. In it, a direct anterior or an anterolateral surgical approach (access) to the joint is used. As the incision is very small, the method is reported to be associated with difficult or insufficient preparation of the bone and also with difficulties in the correct positioning of the endoprosthesis components. This leads to a risk of complications like early loosening and need of early replacement of the endoprosthesis with a new one. That is why instruments for MIS are produced by only a few companies.

Vitosha hospital, Sofia

We, at Vitosha Hospital, apply a new method. It uses a small incision that doesn't impede the proper placement of the endoprosthesis. The results are excellent, and blood loss is downcast to the absolute minimum. In our method blood transfusion is not needed, just like in minimally invasive surgeries, but with our techniques are avoided all the risks associated to the too small incision with the MIS surgery.

What are the complications of blood transfusion?

Blood loss during surgery requires transfusion of blood from donors. This is a type of transplantation of foreign tissues, it is not harmless and has its risks. Of course, all blood products are an object of strict control in the Blood Transfusion Centre in regard to diseases such as AIDS, hepatitis and many other parameters. Anyway, a number of risk factors that cannot be examined still remains. That is why blood transfusion is never completely safe. For safe sex, people use condoms to stop about 2-3 ml of contaminated semen. But think about the transfusion of a large volume of 300 or 600 ml of foreign blood, directly in the patient's veins!

At Vitosha Hospital we apply

a new method with minimal blood loss.

Unlike other hospitals in the world, where routinely are transfused 1 to 3 blood units, in our method there is not any need of transfusion.

You say that patients recover faster?

Yes, our patients have a relatively quick recovery. In other hospitals in the world it is a normal practice for a month after arthroplasty of hip joint between the legs of the patient to be placed a pillow or a wood construction (abduction triangle) to keep the legs separate. Besides, patients are forbidden of lay on their side, and to sit on low chairs. These routine measures are required because there is a significant risk of displacing the endoprosthesis, which is a very serious complication.

Vitosha hospital, Sofia

Unlike other leading international centres, at Vitosha Hospital we apply a surgical method that achieves high stability of the prosthesis. Thanks to this, the recovery period is shorter and the risks for the endoprosthesis are minimised. That is why our patients are allowed normal movement of the joint; they can lay on their side and can bring together their legs. In 5 years, we have not had a single case of displaced endoprosthesis. We achieve a high stability of the joint, which allows faster recovery.

Is leg lengthening possible and how do you achieve it? How long does the treatment take and in what medical cases is it applicable?

At Vitosha Hospital we perform leg lengthening using several methods. The llizarov Method is minimally invasive and has a low risk of complications. We also apply a new method that uses a novel kind of implant. Magnetic nails are also used but due to the really high cost of the procedure patients usually prefer the other two methods.

Regardless of the used method, the extension adds 1 mm of new bone per day, meaning 6 cm in 2 months. These are followed by 3 months without weight-bearing while the extended bone heals.

 

Sofia, 108B Simeonovsko Shose Blvd

phone: 02 962 22 92 (round the clock)

www.vitosha-hospital.com

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