Low Cost Total Hip Replacement Surgery in India

Total Hip Replacement Hip Joint replacement or Total Hip Replacement is surgery to replace all or part of the hip 
joint with an artificial device to restore joint movement (prosthesis).
There are different types hip replacements. If a hemi-arthroplasty is performed, either the femoral head or the hip socket (acetabulum) will be replaced with a prosthetic device. In a total hip replacement, both the femoral head and the hip socket is replaced by the prosthetic device. 

WHAT IS ARTHRITIS AND WHY DO JOINTS WEAR OUT?

The normal joint in our body is made up of two bones which are lined by surface cartilage. The joint is surrounded by a capsule which has a thin lining of synovial cells which produce a thin layer of lubrication film. The lubrication film (synovial fluid) together with the surface cartilage (articular cartilage) acts as a shock absorber and allows the joint to move smoothly and lasts for many, many years. 
If the surface cartilage is badly damaged or if the joint surfaces are not aligned properly (example, in a shallow hip) then the cartilage will wear out much more quickly than the normal wear and tear and as a result the bone under the cartilage layer is exposed. The exposed bone starts to rub against each other and the process of osteoarthritis (wear and tear) is established. 

Osteoarthritis is therefore the result of mechanical wear and tear on a joint. The main feature is a loss of surface cartilage with bone rubbing on bone. This process produces pain. The body tries to relieve this pain by increasing the amount of fluid in the joint. This is why joints are sometimes swollen. The formation of bone spurs and cysts around the joint is another hallmark of osteoarthritis. 

In an arthritic hip
The cartilage lining is thinner than normal or completely absent. The degree of cartilage damage and inflammation varies with the type and stage of arthritis.

• The capsule of the arthritic hip is swollen

• The joint space is narrowed and irregular in outline; this can be seen in an X-ray image.

• Bone spurs or excessive bone can also build up around the edges of the joint.

The combinations of these factors make the arthritic hip stiff and limit activities due to pain or fatigue.Diagnosis

• The diagnosis of osteoarthritis is made on history, physical examination & X-rays

• There is no blood test to diagnose Osteoarthritis (wear & tear arthritis)

Surgical procedure 

You are admitted to the hospital and after appropriate pre-operative tests and admission procedures you will be taken to the operating theatre. The anaesthetist will discuss with you the type of anaesthetic. Anaesthesia may be either general or regional. With a general anaesthetic you are asleep and with a regional (spinal or epidural) your legs and hips are numb allowing you to have the operation without pain. Usually the anaesthetist will either sedate you or give you a full anaesthetic if you have a spinal/epidural procedure. 

Most approaches to the hip are done with the patients lying on their side. When you are asleep you are positioned in a special brace that stabilises your pelvis and keeps you on your side. An incision is made along the side of your hip joint and the muscles carefully split and divided to expose the hip joint. 

The worn out joint is exposed and the femoral head is resected. This allows visualisation of the acetabulum (socket). The socket is then cleared of debris and a reamer is inserted to appropriately fashion the socket to accept the artificial acetabular component. 
After reaming is complete, the artificial socket is inserted. There are two types of sockets, (a) a cemented socket or (b) an uncemented socket. A cemented socket is cemented into the bone and an uncemented socket allows bone to grow into it. Your surgeon will advise you which is the most appropriate socket for your bone quality. 
An uncemented socket has the ability to accept a socket lining which is either polyethylene (special plastic), ceramic or metal. The liner is inserted into the socket. Ceramic and metal articulating joint surfaces have lower wear rates than plastic sockets and therefore tend to be used in younger patients. The newer plastics last a lot longer than the older ones and are appropriately used in older patients.
After preparation of the socket, the femoral bone is prepared with various instruments to accept either a cemented or an uncemented femoral component. Once the canal is prepared the femoral stem is inserted with or without cement. A trial femoral head is placed on the stem and the hip is reduced. During the trial reduction the hip is tensioned appropriately and put through a range of motion. At the same time leg lengths and stability are examined. 

Advantages of Total Hip Replacement Surgery

Hip replacement improves quality of life. Age is no barrier to hip replacement benefits. Hip replacement is cost effective. High rate of patient satisfaction associated with hip replacement The artificial hip often improves the movements in a hip joint that has become increasingly stiff from the effects of long term arthritis and this permits the patient to resume at first gentle activity and then their favourite leisure hobbies Improves mobility Independence of arthritis sufferers

FAQ's For Knee Replacement Surgery in India | Best Orthopedic Hospital in India

Q. How do I know I need a Total Knee Joint Replacement Surgery?

A. If you have knee deformities or severe X-ray changes, or advanced symptoms of arthritis, you require a total knee replacement surgery.

Symptoms of advanced knee arthritis are pain, crepitus, stiffness, limping, muscle weakness, limitation of motion, and swelling. Total Knee replacement surgery is generally delayed by the doctors in favor of less invasive procedures. But, if you have difficulty walking or performing everyday activities such as getting dressed, you do require knee replacement surgery. Total knee replacement surgery offers great relief from pain and it restores normal activities in life.

Q. How common is total knee replacement surgery?

A. Knee replacement is a routine surgery performed on over 650,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

Q. How old is the average patient for knee joint replacement surgery?

A. The average knee joint replacement patient is around 65-70 years old; however patients of all ages have received knee implants.

Q. What is a total knee replacement surgery?

A. The total knee replacement surgery involves resurfacing the parts of the bones of the knee that rub together with metal and plastic implants. Using special, precision instruments, the surgeon will remove the damaged surfaces of all three bones. The replacement surfaces will then be fixed into place. 

The surface of the femur is replaced with a rounded metal component that comes very close to matching the curve of the natural bone. The surface of the tibia is replaced with a smooth plastic component. This flat metal component holds a smooth plastic piece made of ultra-high-molecular-weight polyethylene plastic that serves as the cartilage. The undersurface of the kneecap may also be replaced with an implant made of the same polyethylene plastic.

Q. Are all knee joint replacements the same?

A. No, there are six different types of knee replacements:

• ·         Uni-compartmental
•        Posterior cruciate ligament (PCL) retaining 
•         Posterior cruciate ligament (PCL) substituting
•         Rotating platform
•         Stabilized
• ·         Hinge

These different prostheses can be made of cobalt chrome, titanium, and polyethylene (plastic), and can be fixed to the bone with acrylic cement or can be press-fit, which allows bone to grow into the implant. Use of a particular implant design, material, and fixation method depends on many factors related to each individual patient.

Q. Which knee replacement is ideal for me?

A. The type of knee replacement and implant best suited for depends on your age, the degree of involvement of each of the three compartments of your knee, choice of your orthopedic surgeon and your level of activity. This would be discussed with you and analyzed by your surgeon before you choose to come here for the surgery.

Usually, total knee replacements are ideal for severe osteoarthritis affecting all the three compartments of your knee and rheumatoid arthritis.

Q. How is the knee replacement surgery done?

A. The knee replacement surgery starts with an incision over the knee that exposes the joint. The special precision guides and instruments are used to remove the damaged surfaces and shape the ends of the bones to accept the implants.

The implants are then secured to the bones. When the surgeon is satisfied with the fit and function of the implants, the incision is closed. The surgery takes two to tree hours to complete, which varies from patient to patient.

A bandage is applied and a special drain is usually inserted into the wound to drain the fluid that naturally develops at the surgical site. You would then be taken to the recovery room, where you would be closely monitored. When you regain consciousness, you would be taken to the hospital room, where a nurse would be with you. You would also be given pain killers and the knee might remain swollen for a few days.

Q. How is the knee rehabilitation done?

A. A total knee replacement rehabilitation program is begun after the surgery.

To help regain strength, balance and range of movement in your knee, a specifically designed rehabilitation programme is started when you are back in the hospital room. The physical therapist will help you perform appropriate exercises. About 24 hours after surgery, you will probably be asked to stand.

Within the next 24 hours, you will probably begin to walk a few steps with the help of a walker. You can expect to stay in the hospital for about five to six days after your surgery. You may or may not be transferred to a rehabilitation facility for a few more days, as determined by your surgeon. Your bandages and sutures will usually be removed before you leave the hospital. At home, you will need to continue your exercises.

Q. When can I return to normal activities after knee joint replacement surgery?

A. Most patients start walking with the cane within six weeks of the surgery. Few patients also start driving within seven to eight weeks after surgery.

But, there are some precautions to be taken even after you have fully recovered. One should not put excessive strain on the knee like jogging, skiing, high impact aerobics and other sports which put strain on the knee joint.

Q. What precautions do I need to take after knee replacement surgery?

A. Though this is not an exhaustive list of the precautions, these are the general guidelines to be followed after the surgery. The surgeon and the physical therapist will guide you in details about the do's and don'ts after the surgery

·         Avoid heavy lifting and excessive stair climbing

·         Maintain appropriate weight

·         Avoid "impact loading" sports such as jogging, downhill skiing and high impact aerobics, twisting or impact stresses.

·         Consult your surgeon before beginning any new sport or activity

·         excessive bending when weight bearing, like climbing steep stairs

·         not lift or push heavy objects

·         Do not kneel

·         Avoid low seating surfaces and chairs.

Q. What is the life of a replaced knee?

A. The longevity of the prosthetic varies with every patient depending upon physical condition, activity level, weight as well as the accuracy of implant placement during surgery.

Though total knee replacement has become a common and predictable surgery, with very high success rates, it should be kept in mind that there is no guarantee that a prosthetic joint will last the rest of patient's life.

As with any mechanical joint, the knee components move against each other. Natural fluid in the joint space, called synovial fluid, helps to lubricate the implants just as it lubricates the bones and cartilage in a natural joint. Still, the prosthetic components do wear as they roll and slide against each other during movement. As with car tires or brake pads, the rate of wear depends partly on how the knee joint is used. Activities that place a lot of stress on the joint implants, as may be the case with heavier and more active patients, may reduce the service life of the prosthesis. Implant loosening and wear on the plastic portions of the implant can lead to the necessity for revision surgery to replace the worn components, or all of the components.

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