What is
Hip Replacement Surgery?

Simply put, any patient who has advanced arthritis of the hip due to any reason , in whom the pain and swelling is not responding to other means of treatment including medicines, physiotherapy, or hip conserving surgery etc. and in whom the symptoms are affecting the quality of life and not allowing activities of daily living needs a hip replacement surgery

As a general dictum we try to postpone the hip replacement surgery as much reasonably possible. However the decision of surgery has to be made as per the symptoms and age is secondary

Post surgery one can expect relief of pain, correction of limb deformity, improvement in stiffness and being able to do activities of daily living without any discomfort

Yes very much. NORMAL sexual activity and pregnancy is possible after a hip replacement surgery

Complications that may be associated are as follows

•  Infection- Infection is a known complication post operatively . World wide the infection rates are noted to be around 1.5%. As a surgeon one takes utmost care to make sure that infection is avoided
• Deep Vein Thrombosis (DVT) – This is an uncommon complication wherein there is formation of blood clots in the deep veins of the leg which in turn results in pain and swelling of the lower limb. Rarely the clots migrate to the veins of the lungs leading to pulmonary embolism. However in our peri operative protocols we take utmost care to avoid DVT. Early mobilisation, Blood thinner injections/ medicines , faster rehab protocols have reduced the world wide incidence of this problem
• Wound healing problems- This is generally seen in patients who have an underlying risk factor like morbid obesity, smoking, anaemia, protein deficiency , previous surgeries etc. As surgeons we identify the risk factors and take utmost care peri operatively to prevent this issue
• Medical complications- These are the rarest of the rare and include cardiac issues like post op Myocardial Infarctions, strokes etc. These are best prevented. Pre operative work up, optimisation of the patient, protocol based monitoring and management of the patient by the surgeon and the anaesthetist and close monitoring post operatively by a physician help to avoid these problems. Hips replacement surgery should therefore is therefore undertaken in facilities where these issues can be identified and tackled at the earliest. Availability of ICU back up in house is therefore undertaken in facilities.
•  Dislocation of the hip joint post operatively- A known complication which was previously a common issue. However with newer implant designs , proper planning and execution of the surgery and well supervised rehab protocols the incidence of this complication is pretty low.

Limb length discrepancy is a described complication after hip replacement . However with proper planning, and proper execution during surgery the chances are minimal. In exceptional cases where it is likely to be an issue even after surgery , we inform our patients well in advance.

A variety of implants are now available in the market. Based on method of fixation we have cemented, uncemented and hybrid fixation for the hips. Based on the articulating surfaces we may have  metal on poly , or a ceramic on poly or a ceramic on ceramic articulation. Of late dual mobility articulation hip is available which provides more stability and range of motion but has slightly lower longevity.  All have their own design rationales, advantages and indications. Choice of implant is a combined decision of the surgeon and the patient as per the patient need

The aim of surgery is to make it as long lasting as possible. With that in mind following activities are discouraged. Sports , jumpimg, running , skipping, cross legged sitting, squatting and using the Indian style toilets. Normal activities other than these are perfectly possible. Cycling, swimming, short treks, brisk walking is perfectly fine

Immediately after surgery- Good rehabilitation and physiotherapy is essential for getting a good outcome after surgery. Bathing is not allowed till sutures are removed. Follow the instructions of your surgeon carefully. Sudden increase in pain, fever, increase in joint swelling, has to be immediately reported. Avoid sitting on low chairs/stools and avoid sleeping on your side for 4-6 weeks .

Long term- Maintain a daily routine of walk/exercises. Avoid sports, jerky movements and activities with risk of injury. Cycling, swimming, walking are perfectly fine. If undergoing any other surgery, dental procedure or you have any other systemic infection, its important to let your doctor know that you have undergone hip replacement and take antibiotics as early as possible.

Yes. With proper pre operative optimisation and peri operative care patients with these problems can safely undergo hip replacement surgery

After your decision to go in for a hip replacement you should be aware of the basic things to be done before surgery. Such as –

• Suitable prosthesis for you as decided by the surgeon and the patient
• The cost of your prosthesis.
• Total Hospital stay & cost of hospital stay.
• Routine pre operative Blood, Heart Urine and Chest investigations.
• Get this investigations 2-3 weeks before the date of surgery & get them checked by a physician who then certifies the patient fit for surgery
• It is necessary to confirm that there is no active infection in your body.
• If you have mediclaim facility, you should contact hospital’s mediclaim department at least one week before surgery with your policy documents.
• You should show the drugs which you are already taking. Some types of medicines like steroids & blood thinning medicines are to be stopped 5-7 days prior to surgery.
• For admission in hospital take admission letter from your surgeon.
• You may advised to get admitted 1-2 days prior to the surgery. Take all investigations report, previous medical records & drugs with you.