For Vishal Kumar, 34, what started as a dull ache in his lower back and hips 12 years ago—diagnosed as ankylosing spondylitis (AS)—has progressed into a serious illness restricting even the simplest of the movements like squatting and sitting cross-legged.
AS is an auto-immune disorder that is witnessing an increasing incidence in India. The most affected are young men, in their late 20s and early 30s. Vishal, after a long struggle, saw a ray of hope when he was told about total hip replacement (THR) therapy. Today, after the THR therapy, he leads a normal life without any discomfort.
It is a form of arthritis that affects the spine leading to constant pain and stiffness from the neck all the way down to the lower back. The condition can lead to an overgrowth of bones, and abnormal fusion of bones, which can impair a person’s ability to perform routine activities.
This condition is predominantly seen in individuals who carry HLA-B27 antigen in the blood. The HLA-B27 antigen is a protein located on the surface of the white blood cells that contribute to the dysfunction of the immune system. It causes the immune system to attack healthy cells, resulting in an AS-like condition.
Watch out for:
✔ Severe pain in lower back, buttock, hip and thigh on one or both sides
✔ Unexplained and sustained pain in the lower back
✔ Pain that gradually moves up the spine
A healthy spine allows one to bend, turn, and twist; while in an AS-affected spine, ligaments calcify. Spinal bones, due to calcification, can fuse together, making it impossible to move the spine in any direction, and the individual is totally disabled as the disease advances. What makes youth vulnerable to this condition are awkward sitting postures, sedentary lifestyle, immense stress and long working hours.
Dealing with the condition
The condition is usually diagnosed through physical examination, X-ray of the back and pelvis, and lab tests. While there is no cure for the ailment, there are treatments available to manage pain and stiffness, prevent deformity and preserve the individual’s ability to perform normal activities through occupational therapy, exercise and medication. The physical therapy helps strengthen muscles around the affected joint, which in turn aids in improved movements of the joint.
However, in severe cases, a total hip replacement therapy is usually the only option to alleviate pain. In this procedure, afflicted parts of the hind joints are replaced with artificial implants. This helps to restore the functional movement of the joints and relieve pain. It restores the alignment and balance of the spine, and the natural posture of the patient is regained.
For three weeks after THR, the patient, though still in bed, is made to sit up and do small exercises. In the case of Vishal, by the fourth week he could walk. He underwent physiotherapy for a couple of months to regain muscle strength and improved mobility.
Gupta is director, orthopaedics, Max Hospital, Shalimar Bagh, Delhi.