 Hi again and welcome to Neaky Bath. Many times as we had told you earlier, pain in the knee is caused by problems of the hip joint. Today, we are going to talk about avascular necrosis of hip joint which unfortunately is becoming more and more common with the onset of problems imposed by the recent COVID pandemic. So what exactly is avascular necrosis of the hip? It is when the ball of the hip joint loses its blood supply. Now why should this happen? About half the cases we don't even come to know why it happens. But increasingly with COVID and people in ICUs, people have been having a lot of steroid drugs to counteract the reactions of COVID and this causes problems with blood supply to parts of the body where blood supply is a little precarious. Now the hip joint is very different in the sense the blood which comes down from our heart to the hip has to go down and make a U-turn to come to the ball of the hip. So when during this U-turn, there is some thickening in the blood or a problem with the blood, part of the blood supply to this bone, the ball gets blocked and the part of this ball, not the entire ball, part of the ball, the bone starts dying. That is when it collapses and can cause arthritis of this central joint at a very, very young age. We will be telling you a little more about modern treatments and how if detected early, we can actually prevent the arthritis from getting worse. So our specialist team at the comprehensive knee and hip care at KMC Hospital Mangalore is actually the first center to have been recognized by Cartledge Research Society for stem cell treatment. Why am I telling you this? Because with AVN of the hip, if we detect it early, we are able to regenerate or reform this dead bone if the surgery is done or detected in the early stage. Now earlier what procedures used to be done even 20 years ago and my colleague here Dr. Fawaz who is an orthopedic surgeon and associate consultant with me would certify to that fact what people would do is drill out dead bone and put new bone in it. But that used to be just about 60 to 70% successful that too in the very early stages. With the new stem cell treatments, they are actually able to get about 80 to 90% success even in moderately advanced AVN disease. So we are managing to save hips in younger people and keep the natural joint in place, which is always great. Having said that many people by the time AVN is detected, it's already late and the hip joint is collapsed. At that stage there is no point trying these injections or even stem cell treatments. What then works and is a well established surgery is replacement of the hip that is the natural ball has to be sacrificed unfortunately and gets replaced by metal. Having said that even if this is done we have excellent technology with hip replacement and in this day and age we could probably with new materials that is instead of metals we actually have new hips with ceramics. These hips if done well potentially can last 40 plus maybe even up to 50 years. So getting the right treatment detection at the right time is of utmost importance. To detect these problems we probably you know we can consult online and see reports but what is important is we need to see and discuss with the patient so that we can customize treatments. We will be back to you with yet another information session on the next Nikibab. Thank you.