The hip joint is a ball and socket joint, which provides a multidirectional range of movement enabling us to sit walk and run. This joint gets damaged due to a variety of causes including fractures of the hip. Modern day hip replacement surgery is very advanced and sophisticated. Total Hip Replacement Surgeries are done by smaller incisions.

Patients have minimal pain in the post operative pain and are able to have as good a lifestyle as he or she was having before surgery when the hip used to be normal. Newer materials like Ceramic and Oxinium have improved the life expectancy of the implant many fold. Gone are the times when young patients used to suffer in pain as they were considered too young to be replaced. Gone are those times when the young patients used to suffer due to lack of long lasting implants. Young patients of today roam the world after total hip replacement.

HIP REPLACEMENT IN THE YOUNG

New bearing material like ceramics and highly cross-linked polyethylene increase the longevity of the hip implants many folds. Thanks to these newer generation material and fine tuned surgical techniques even younger patients in their twenties can undergo this surgery. With modern implants they can lead a near normal life including married life. Do walk in for a consultation on what is the latest technology available which can be useful for you or your patient.

HIP REPLACEMENT IN THE ELDERLY

In the very elderly people hip replacements after fractures of the hip, enables them to start walking and doing activities of daily living like going to the washroom and being able to walk independently as early as the next day of surgery.

What is a Hip Replacement

The hip is a ball and socket joint between the pelvis and the thigh bone. The upper end of the thigh is the ball part and fits into the socket in the pelvis. During the operation the worn or damaged joint will be replaced with an artificial one.

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such hip joint replacement orthopedic surgery in India is generally conducted to relieve arthritic pain or fix severe physical joint damage as part of hip fracture treatment or Avascular Necrosis.

A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement in India is currently the most successful and reliable orthopedic operation with 97% of patients reporting improved outcome even after 10 years. Dr. Sanjay Gupta has extensive experience in performing these surgeries and his results have been very satisfactory.

Pre-Operation

Post-Operation

A hip replacement is usually carried out when the joint is worn and severe pain restricts mobility. The benefits of surgery include:

• 1. Reduced pain
  The majority of patients experience significant pain relief. It is normal to have some temporary discomfort following surgery but our techniques aim to make the surgery as comfortable as possible, in most cases allowing you to walk on the very next day.
• 2. Improved stiffness
  The new joint will have highly engineered metal and plastic surfaces designed to allow the joint to move smoothly and freely. The aim would be for you to have less stiffness than before the surgery.
• 3. Increased mobility
  With a combination of reduced pain and improvement in stiffness your overall mobility is likely to be improved. This will help you return to a more active lifestyle.

As in any operation, there are some risks associated with this operation as well and although rare, it is important that you understand them.

Deep Vein Thrombosis (DVT)

A DVT is a blood clot in the deep veins of the leg. To reduce the risk of developing a DVT, you will be given stockings to help with your circulation and medication that thins the blood. The physiotherapist and nursing staff will show you how to exercise your legs and ensure that you start to move about quickly after your operation. Most people start ambulating on post-op day One thus improving the circulation in the legs and minimizing the chances of getting DVT. You would also be advised to maintain good hydration by taking plenty of oral fluids which further helps in minimizing risk of DVT.

If a clot develops and part of it breaks off, it can travel to the lungs where it is termed a Pulmonary Embolus (PE). This can compromise respiratory function and hence everything is done to prevent DVT from developing.

Infection

There is a small chance (less than 1%) of an infection and all possible precautions are taken to avoid infection during your operation. Mostly it is a superficial infection which can be treated with antibiotics, however, if deep, it may need further washout and change of implants. The redo surgery with the advanced modern technology has a very good success rate.

Dislocation of the joint

Very rarely, following hip replacement the ball can dislocate from the socket. Normally the hip is relocated with a short anesthetic. Very rarely in extreme cases patients need to undergo further operations to make the hip more stable.

Unequal leg length

It is not uncommon after hip replacement to have a difference in your leg length of a few millimetres. In the majority of cases it is less than 1cm and therefore not noticeable but occasionally your leg will feel slightly longer or shorter. Occasionally this is treated with either a raise in, or on, the heel of your shoe.

Hip precautions

For the first 12 weeks care must be taken to prevent the hip dislocating:



• 1. Do not cross your legs in sitting, standing or lying. In the early stages of recovery do not roll onto or lie on either side. It is advisable to lie on your back for the first 6 weeks.
• 2. Do not bend more than 90 degrees at your hip, for example, do not attempt to pick up anything off the floor, do not reach down to put shoes on and do not put your leg onto a high stool. When sitting, make sure your knee is level or lower than your hip.
• 3. Do not twist your hip when sitting, reaching for things, walking or changing direction.

Pre-assessment

Shortly before your operation you will be asked to undergo a battery of investigations such as Blood and Urine tests, ECG ECHO and X Rays. You will then see the Anesthetist for PAC (Pre Anesthetic Check Up). May be required to see a physician or cardiologist to check your fitness for surgery. If you are deemed suitable for knee surgery, you will be given the date for surgery.

What will happen when you arrive at hospital?

You will be admitted to hospital a day before your surgery. Occasionally, it is necessary for patients to have further tests before surgery.

On admission, you will be greeted by a member of the team. You will also see several members of the treating team including the anesthetist. If you have any questions, please do not hesitate to ask a member of staff.

The day of your operation

You will be told not to eat or drink for approximately six hours prior to your operation. The anesthetist will come to see you before your operation. If you are on any regular medication, please ask the anesthetist what you can take on the day of surgery.

The GDA will take you to the operating theatre and a nurse will accompany you and hand you over to the care of the theatre team. The operation is usually carried out under spinal anesthetic and the procedure usually takes approximately 45 minutes to one hour. Including the anesthesia time and positioning plus prepping time you will stay in operation theatre for about 1.5 to 2 hours. You will then be shifted to Surgical ICU for one night.

Your legs will feel numb for few hours after the completion of surgery. This is the normal time required for the effect of anesthetic medicines to wear off. Approximately 2 hours after surgery you will be allowed to have liquids and after 4 hours normal diet will resume. You would be encouraged to do breathing exercises and ankle foot movements. You will meet your attendants after the completion of surgery and once again after few hours.

On first post op day, you will be shifted to the ward and the physiotherapist will teach you the first stage of your exercises. They will also help you out of bed and make you walk a few steps with the help of walker. Over the next 5 days you will be taught further exercises, how to walk using appropriate aids and toilet training will be done on commode chair. By the time of discharge our team of physiotherapists will ensure that you achieve independence for activities of daily living such as getting up and about in the house with the help of walker, sitting on chair, using the washroom etc. In normal course you will be discharged home in about 5-6 days.

A member of physiotherapy team will attend you at home daily and take you through further exercises to improve the range of motion as well as strength in the knee. Most people need Walker for ambulation for approximately 2 weeks. It is advisable to use high Commode chair or an elevated Toilet Seat for approximately 4 weeks post surgery.

You will be asked to attend OPD after 2 weeks when your knee stitches will be removed and you will get a chance to see the surgeon. Further medications and knee exercises instructions will be given to you. You will be encouraged to start walking with the help of a walking stick. In approximately 4-6 weeks’ time after surgery, most people start walking independently without any walking aid.

Please remember you have undergone major surgery and your recovery can take up to 12 months. It is important that you follow these guidelines when you return home:

1. Continue to take painkillers as prescribed to enable you to mobilise effectively and manage your pain and swelling
2. Use Walker when mobilising. The length of time these are needed may vary and could be up to 8 weeks.
3. When it is time to gradually wean yourself off your aids do so as your leg becomes stronger and your confidence increases. If you are using two crutches/sticks and you wish to try with one, always use it on the opposite side to your operated leg
4. Gradually try to increase your walking distance. Walk frequently throughout the day
5. Your operated leg will feel stiff each morning when you wake up. Do not worry about this; the stiffness should wear off given time

Why have I still got swelling?
It is normal for healing tissues to be swollen. The swelling may last for many months. When you take a step the calf muscle works to help pump blood back to the heart. If you are not putting full weight on your leg the pump does not work as well and you may get swelling around the ankle especially at the end of the day. You may also find that bruising starts to come out in the first few weeks following surgery. This is normal. Do your circulation exercises as advised. When resting keep the leg elevated, ideally above the level of your heart while maintaining your hip precautions.

WHY IS MY SCAR WARM?
When tissues are healing they produce heat. This can be felt on the surface for many months.

How long will I have pain for?
It is likely that you may continue to experience some discomfort for several weeks. If the pain is out of proportion please consult your surgeon.

Is it normal to have disturbed nights?
As with sitting, when you are in bed your hip may stiffen up and the discomfort may awaken you. Your sleep pattern may also be disturbed if you are not used to sleeping on your back. It is not advisable to sleep or lie on either side for the first 6 weeks following your surgery.

Is it normal to have numbness around my scar?
Small nerves are disrupted during the surgery, which can cause numbness around the incision. This should resolve but may leave a small area of permanent numbness.

Why does my joint click?
Your new hip works in a different way. The clicking should improve as recovery continues. Some patients may always be aware of some minor clicking as the cartilage has been replaced with metal and plastic bearings.

When can I drive?
You should usually wait 6 weeks before driving. Before you consider driving you must feel confident that you have sufficient movement and strength so that you could perform an emergency stop.

Exercises

It is essential that you commence the following as soon as you can after your operation and whenever you are resting to help prevent blood clots.

Ankle exercises

This should be done every hour for approximately 5 minutes or longer if possible. This helps maintain the circulation in your calf muscles.

Deep breathing exercises

This helps to keep your chest as clear as possible. Take 3 or 4 deep breaths. every hour.

Buttocksqueezes

Squeeze your buttocks firmly together, hold for 3 seconds then relax. Repeat 10 times, at least 3 times a day.

Tightening thethighmuscles

Sit or lie with your leg straight out in front of you. Point your toes towards you and tighten the muscle on the front of your thigh by pushing your knee down. Hold the muscle tense for 5 seconds and then relax. Repeat 10 times at least 3 times a day.

Stairs

Once you are walking well you will be taught how to manage stairs or a step (according to your needs) Take one step at a time.

Going upstairs: Use the banister on one side and the crutch/stick on the other side. Leading with your non-operated leg, first place your foot on the step; then with your operated leg, place your foot on the same step, and lastly your crutch/stick.

Going downstairs: Use the banister on one side and the crutch/stick on the other side. Place your crutch/stick first on to the step, then your operated leg onto the step and then the non-operated leg onto the same step.