In a remarkable medical feat, KIMS Hospitals, Thane, successfully performed a high-risk right total hip replacement surgery on a woman in her 60s suffering from multiple comorbidities, including osteoporosis, Sjogren’s syndrome, renal tubular acidosis, hypokalemia, and anemia. The surgery was conducted after a missed diagnosis and nearly many days of immobility and pain.

The patient, recently diagnosed with Sjögren’s syndrome and pneumonia elsewhere, had initially shown some improvement with treatment. However, she later developed persistent pain and weakness in her right hip. Despite multiple consultations at other centers, she continued to experience discomfort and was unable to walk pain-free for the past three months, leading her to seek care at KIMS Hospitals. An MRI revealed a full-thickness impacted undisplaced linear subcapital fracture through the neck of the right femur—an injury that had gone undetected for weeks—along with associated edema and mild hip joint effusion.

What made the case more complex was the presence of advanced osteoporosis, chronic anemia, electrolyte imbalances, and a background of Sjogren’s syndrome with distal renal tubular acidosis (RTA). Such conditions can further complicate healing and recovery. A multidisciplinary team comprising experts in orthopaedics, rheumatology, endocrinology, nephrology, pulmonology, and cardiology conducted a thorough preoperative assessment to stabilize her condition and minimize surgical risks.

The surgery was successfully performed under general anaesthesia by Dr. Parth Agrawal, Consultant – Arthroscopy, KIMS Hospitals, Thane. Postoperatively, the patient was monitored in the ICU and later shifted to the ward after achieving hemodynamic stability, infection control, and favorable response to physiotherapy.

“Despite her multiple comorbidities and a delayed diagnosis, the patient responded well to our multidisciplinary management. We meticulously planned the surgery to minimize risks, and I’m pleased to share that she has regained mobility and is now fit for discharge,” said Dr. Parth Agrawal.

“Patients with Sjogren’s syndrome, especially those with distal RTA, often present with fluctuating potassium levels and musculoskeletal complications. This makes them vulnerable to fractures and delayed healing. A coordinated medical approach played a key role in her recovery,” said Dr. Natasha Negalur More, Consultant Rheumatologist, KIMS Hospitals, Thane.

Adding to this, Dr. Vijay Negalur, HOD – Diabetology, KIMS Hospitals, Thane, said, “This case highlights the importance of early diagnosis and a multidisciplinary approach in managing complex patients. Comorbidities like anemia, electrolyte imbalance, hypothyroidism with fluctuating TSH levels, and autoimmune disorders demand personalized care plans. The successful outcome was possible only because of timely intervention and seamless coordination between departments.”

Following the surgery, the patient underwent structured physiotherapy and rehabilitation, showing progressive improvement without nausea, vomiting, or excessive pain. She was discharged with tailored dietary, medication, and physiotherapy advice to aid long-term recovery.

This case exemplifies the importance of early diagnosis, collaborative medical intervention, and individualized care plans in managing high-risk orthopedic procedures, particularly in elderly patients with autoimmune disorders and multiple systemic complications.