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Hip Replacement Surgery in India

Total Hip Replacement Surgery

Hip joint is a ball and socket joint formed by a socket/cup like structure in pelvic bone called acetabulum and the upper end of the thigh bone called femur. Wear and tear to this ball and socket joint can result in pain and stiffness and can affect wide range of motions - sitting, standing, walking, climbing stairs and other daily activities. Joint replacement therapy is performed to relieve severe joint pain or fix severe damage in fractures.

During the surgery lasting for 2-3 hours, leaving the healthy parts intact, diseased bone and cartilaginous tissue from femoral head and acetabulum are removed and replaced with prosthetic implants to allow natural gliding movement in the joint. Head of the femur is replaced with metal ball and stem while acetabulum is replaced with plastic or metal and plastic implant.

Stem of the femoral implant fits into the femoral shaft while the ball fits into the acetabular implant. These implants can be held in place through a cemented procedure (new parts of hip joint are glued to existing healthy parts using a special glue or cement) or un-cemented procedure (new bone grows into the pores of the porous implants used) or hybrid procedure (cemented femur and un-cemented acetabulum).

Decide if you need the surgery. Are you an ideal candidate for hip replacement surgery?

Osteoarthritis, the most common cause of the wear and tear in cartilage surfaces or the hip joint leading to an advanced surgical procedure called Total Hip Replacement (THR) or Hip Arthroplasty. Decreased blood supply to the joint, rheumatoid arthritis, injury/trauma to the joint, infection, bone tumors that break the joint and developmental abnormalities of hip are the other common reasons that can lead to THR.

Limping, dull aching pain in the groin, outer thigh or buttocks sometimes radiating to the front of the knee are most common symptoms that mandate a thorough screening through MRI or X- ray scans. These symptoms may be aggravated by activity and decreased with resting in traumatic arthritis or osteoarthritis, whereas, in rheumatic arthritis worsening morning pain that decreases with activity is more common.

If conservative management fails in chronic hip pain resulting in disability, hip replacement therapy can help with good long term results in 90 percent of cases. It is important to contact an orthopedic surgeon with all the medical and radiological records - if there is trouble standing from seated position,  there is little or no relief from pain medicine and if pain keeps you awake at night and causes hindrance to routine activities like walking.

How to prepare for surgery?

To make everyday tasks easier and faster during the recovery process, one can do many things before and after they have surgery. Before surgery, arrange for help at home for a week or two and after back coming home, set up a recovery station (telephone, medicines, remotes, television, water at arm’s level to avoid reaching up or bending down) at a place you will spend most of your time recovering.

Also stock up and prepare some food in the kitchen that can be served with simple heating. After surgery, request written information on doctor instructions and follow them, work with physiotherapist and other healthcare professional to rehabilitate. For the hip, wear an apron to carry things, so that hands are kept free to balance the crutches and use long handled ‘reacher’ for turning the light bulbs or reaching things beyond arm’s length. 

What to expect from a hip replacement surgery? Complications, After Care, Recovery and Rehabilitation

Pain relief, return to function and routine daily living activities are the goals of hip replacement therapy. Completely free of pain with or without mild occasional discomfort in their hips, most of these patients can resume their work to complete their daily tasks, walk more than six blocks without stopping and participate in normal social activities and also in some sports like swimming, cycling and dancing. Even though the stiches and staples running across the wound will be removed in 2 weeks after the surgery, it is important to remember about complications in any major surgical procedure.

Though blood clots and dislocation are some common complications, short term postoperative infection is a major concern. However, deep infection can result in 2-3 stage revision surgery that can result in extended antibiotics and hospital stay. With a potential loss of appetite for several weeks after the surgery, it is important to promote wound healing and muscle strength restoration by monitoring a balanced diet with iron supplements and plenty of fluids.

To prevent dislocation of the prosthesis and aid for a proper recovery, one should not cross legs or bend hips to more than 90°, to prevent excessively turning the feet inward or outward, one must use a pillow between legs at night when sleeping until advised by your orthopedic surgeon.

With proper exercise regimen and rehabilitation that starts right after the surgery on same or next day, you must be able to resume normal light daily living activities within 3-6 weeks. Physical therapist and respiratory therapist will help recover through mobility and preventing collection of fluids in the lungs respectively.

It is important to realize that the new artificial hip will have limited range of motion compared to the un-diseased natural hip. To cope with the difference, the physiotherapist will teach simple activities of daily life like, bending and sitting to prevent injury to the new hip and exercises to contract and relax certain muscles which help strengthen the hip.

Within one to two days after the surgery, the person can start to sit on the edge of the bed, stand and walk with assistance. Once discharged, physical exercise being a critical home care component, it is important to follow the physiotherapist’s instructions during the first few weeks after the surgery.

This will include walking program (to increase mobility and endurance), resume sitting, standing and walking up and down the stairs, specific exercises several times a day to restore movement and strengthen the hip joint. Overall health of patient, proper rehabilitation and after care, will aid in full recovery within three to six months after the surgery.