Hip Replacement

Normal Hip Joint : The Hip Joint is a joint which allows movement between the thigh bone (Femur) and the Hip bone (Pelvis). The bones are covered by a smooth shiny surface called the cartilage. This facilitates painless free mobility in all directions and planes. The cartilage acts a cushion (shock absorber).

Arthritic Hip : Wear & tear of the cartilage leads to arthritis, which is painful, as the damaged bones rub against each other. Patients feel pain in the groin and buttock area. Patients may also develop a limp. An arthritic hip hampers daily activities.

THR : It means Total Hip Replacement Surgery. It is being done for the past thirty years. The results are improving every year. In an arthritic hip the cartilage is worn out. The ball and the surface of the cup are replaced to restore the smooth gliding movements. Most patients will have THR without cement but in some cases cement is required for fixation. Excellent results are expected in 90 to 95 percent of patients at the end of 15 years and more.

Indications : Common indications in our country are : Avascular necrosis (AVN), Rheumatoid Arthritis, Ankylosing Spondilytis and after severe injury to the hip joint. Degenerative disorders needing THR are not very common.

Goals : The goals of THR surgery are first and fore-most to restore motion to the hip and ultimately help the patient walk without a limp and pain.

Before Coming : Orthomax Hospitals will notify you when to arrive for admission prior to THR. Please bring a list of your current medications, their dosage and medical information from your physician regarding adverse reaction to anesthesia in the past. Bring all the x-rays of your hip and other relevant medical records. A complete medical history and thorough examination will be done and if needed special tests may be done prior to surgery. Pre-Operative ECG, blood counts and blood clotting functions will be tested and in case of patients with high blood pressure or diabetes mellitus, additional blood test may be done.

Medication : Medicines used for arthritis like asprin, Ibuprofen, Diclofenac, Naprosyn or any other anti-clotting mechanism and hence need to be stopped 4-5 days before surgery. Paracetamol may be used as it has no effect no blood cloting. Iron pills may be prescribed twice a day a month prior to surgery to improve the blood haemoglobin. They may cause constipation, which can be overcome by soluble fibre foods and fruit juices. Some patients may need mild laxatives like milk of magnesia.

Anaesthesia : Our Anaesthesiologist will meet you and discuss the options of general anaesthesia and spinal anaesthesia along with their pros and cons. The type of the anaesthesia and its safety will be decided by the anaesthesiologists. No surgery is painless. After your surgery, Pain Clinic Specialists will relieve your post operative pain and make you comfortable.

Surgery : Our anesthetists will make you comfortable throughout the surgical procedure, which lasts for about one and a half hours. After surgery you will be shifted to the Surgical Intensive Care Unit (SICU) for observation. Our physicians and nursing staff will monitor your progress round the clock for 24 hours. After your condition is stabilized you will be shifted to a room. Anti coagulants which prevent blood clots will be given for 7 days after surgery.

Pain Management : The Pain Clinic Specialists will regularly visit to make you comfortable. Usually up to the second day after the operation, your pain medication given as injections are replaced with oral medicines.

Exercise : On the first day after surgery, you will be visited by the physical therapist, who will start static, general exercises and deep breathing respiratory exercises which are vital for your health. You will be given a spirometer of your own for respiratory exercise. On day two, you will get out of bed and begin walking. Initially, you will walk with a walker or crutches. As your balance improves and your discomfort decreases, you will progress to a cane. You can put as much weight on your operated leg as you feel comfortable with. A physical therapist will work on the range of motion of your hip strengthening of your operated leg and restoring your balance while  working. The therapist will also teach you how to position you leg to prevent hip dislocation. You should not cross your knee and bend at the waist over an angle of 90 degrees. After you progress from a walker to a cane, you will use the cane on the non operated side until you limp goes away entirely.

What to do and what not to do : Certain precautions are necessary during your stay in the hospital. The Nursing Staff, Physiotherapists and your attending surgeon will instruct you about them repeatedly.

Do This – While Lying Down

• Keep a pillow between your legs so that your legs are apart
• Try to keep your knee cap facing the ceiling
• Keep your bed flat when you exercise
• After surgery you are allowed to turn on the non operated side with pillows between your legs. This will be initially shown to you by your physiotherapist and attending doctors.

Sitting –

• Sit on a high armchair, which is between 18 to 20 inches high.
• When you sit keep your knees at lower level than your hips

Don’t –

• Raise the head of your bed by more than 45 degree from the horizontal.
• Do not turn and lie on the operated side
• Do not cross your legs
• While sitting on a chair, do not bend forward form the chair
• Do not flex or bend your hip by more than 45 degree in bed

Discharge from Hospital : It will be our goal to discharge you home within eight days after your hip replacement. For some patients, because of arthritis in the other leg and/or other medical conditions, a longer stay in the hospital may be required. The day of discharge for each case will be decided by the surgeon on the merits of each case.

Diet : In order to maintain your health you need to have balanced diet. You must have plenty of liquids, green vegetables, fruits and adequate proteins. Many patients ask for a special diet for quick recovery, there is no special diet for quick recovery for a Total Hip Replacement patient.

Follow Up Visits :Your wound staples will be removed 14 days after surgery. After that you can shower regularly. You will be checked by your doctor six weeks after surgery. Top Hip Replacement surgeon in Varanasi.

• On your first visit after THR an x-ray will be low up for better and longer life of your hip joint as per the following schedule:
• First follow up visit is at 6 weeks from the date of discharge
• Second follow up visit is after three months. After that the follow-up should be once a year.
• These follow up visits will help you and your surgeon.

FAQs : These are some of the Frequently Asked Questions (FAQs)

What is Hip Replacement? Your damages socket will be reshaped and an artificial socket will be implanted in your bone. The material used for this can be polyethylene, metal or ceramic used for this decision depends on quality of bone, your age and the surgeon’s Choice. The femoral head is replaced by metal or ceramic. Different types of prosthetic material is available; the surgeon will choose the ideal material for you. The final decision will be taken during the surgery. Experience and scientific research literature guides the surgeon to select the correct prosthesis. Younger patients will be given un-cemented Hip Replacement. Elderly patients will be considered for cemented ,Best Hip Replacement surgeon in Varanasi.

Am I a candidate for THR? After considering your medical history and evaluating your hip problem your orthopaedic surgeon will order appropriate x-rays which are the gold standard for determining your need for hip replacement.

Are there any risks? This is a major surgical procedure. There is a possibility of complications. Although unlikely, complications is to follow your physician’s advice carefully. How many days do I spend in the Hospital? Normally, you will be admitted one day prior to the operation, and by the 7^th day you’ll be discharged.

When will I be able to walk after the surgery? You will be able to walk two days after surgery with the help of a walker. You will have to use the walker for four to six weeks. After that you will use a stick for the next two weeks or till you feel confidant to walk without the stick.

Will I require blood transfusion? Most patients do not need blood transfusion in their hemoglobin level is adequate. Usually few patients need blood transfusion.

How log will the operation last? Normal surgical time is one hour. The patient’s preparation, anaesthesia and positioning for surgery and later post surgical recovery etc may involve one and a half to two hours. You will be shifted to the SICU afterwards.

Is this Operation painful? How long will the pain last?Yes, this operation is painful but you will be given medicines for pain relief. During the first few days you will be given injections for pain relief by various routes. Later you will be given oral medicines for about two weeks. You will experience a gradual relief of pain with the passage of time.

How long will the implant last?The average life of a hip implant is 15-20 years in more than 95% of patients. Its life will also depend on how carefully you use it.

When can I resume my day to day activities? After going home on 7^th or 8^th day you will be walking in the house more than 4 to 5 times a day. You will be explained how to walk during your stay in the hospital. Tow days after suture removal you can have a bath. Other activities like swimming, car driving, riding a two-wheeler and kitchen activities are permitted after 6-8 weeks. You may resume your work, if it is sedentary, after 6 weeks.

When can I travel overseas? Most patients are fit to travel three weeks after surgery. Domestic air travel can be done after discharge from the hospital.

How much can I walk or Stand? You may walk and stand for as you want depending on your level of comfort. There are no major restrictions. You should not stand for more than 1 hour. Walking 2 to 3 km is permitted.

What type of sports can I play? You have an artificial hip. Any impact sports like running, jogging, tennis, football & cricket should be avoided. Light weight lifting is allowed. You may play golf, walk briskly and swim without any problem.

What should I not do? If you want to have a long life for the newly replaced joint, you should not squat down in an Indian toilet, sit on the floor and sit cross legged (lotus position). Your newly replaced joint will allow this type of mobility, but we do not recommended it for your own benefit.

What type of joint will I have? You will have the best quality implant which has been tested all over the world for more than 20 years. Innovation is a continuous process in medical science. We will use the best implants which suit you. We will decide which implant to use on the operating table. The decision will depend on your bone quality, muscle strength and various other factors.

When to contact your doctor? After you go home, contact the doctors of Shalby Hospitals if you suffer from the following conditions :

• • You have fever which is more than 101 degrees Farenheit and which continues for more than 48 hours.

• • Pain at the site of operation increases and if it is not relieved by your usual medicines.

• • If there is abnormal swelling around the operated joint with redness.

• Any discharge from the wound.
• After your surgery if you take any medical or dental treatment, do this:
  • • Always inform any doctor or dentist who treats you for any disease that you have an artificial hip prosthesis. This will help them decide treatment for you.
  • • If you undergo any major or minor surgery or a dental extraction, you must be given antibiotics before and also after the procedure. Inform your doctor that you have an artificial hip in your body.
  • • In case you have any infection in the body at any site, for example an abscess in the toe, a dental abscess, respiratory infection, infection in the ear or throat or urinary tract infection, kindly consult your Family Physician Immediately. Antibiotics must be started as soon as possible to prevent the infection spreading to your artificial joint.
  • In general, In patients who have undergone Total Hip Replacement surgery, all infections must be aggressively treated.