Frequently asked questions
Hip replacement surgery is a surgical procedure where a diseased hip joint is replaced by an artificial hip joint. Osteoarthritis is an extremely common disease that affects the hip joint and is also one of the prime conditions that necessitates a hip replacement surgery. Other than osteoarthritis, other conditions that may warrant a total hip replacement surgery are:
• Rheumatoid arthritis
• A hip fracture
• Septic arthritis
• Ankylosing spondylitis
• Bone dysplasia, a condition characterised by an abnormal growth of bones
Hip replacement surgery is a major surgery. It is done only when conventional treatments like the following fail:
-Weight loss regime
The surgery is recommended in situations where the symptoms due to the diseased hip joints severely affect the quality of life. They include:
• Severe pain during activity as well as rest
• Stiffness in the hip joint that severely reduces mobility including inability to lift the leg
• Difficulty in carrying out normal activities like walking, bending etc.
• Emotional and social problems due to the hip condition
• Inadequate pain relief from painkillers during sleep
Hip replacement surgery is a major surgery and you will need all the assistance you can get in the months following the surgery.
To begin with, you will be evaluated by the hospital, who will update you about the entire process and identify your needs to create a planned care chart for you. This chart will consider your living arrangements, overall health, travel, food preparation and sleeping arrangements and based on them create a custom-made plan for post-surgery care. This may also require certain modifications to be made in the house for the ease of movement. Post-surgery a physiotherapist will be assigned to you who can help you walk independently with the aid of crutches or a walker.
Pain associated with hip replacement surgery can last anyway between 3-6 months post the surgery. The first month you will be prescribed a strong pain medication to help alleviate the pain. After the first month, most patients can move on to an over-the-counter pain medication. Physical therapy or physiotherapy can help manage the pain as well. Unless there has been a complication or an infection has set in, you can get back to your normal activities by 12 weeks. However, this does not include any heavy lifting and strenuous activities.
Regular exercise, following a strict healthy diet, checking up with your doctor to ensure there are no blood clot formation, and taking it slow will help ensure a successful recovery.
Hip replacement surgery is a major surgery and it requires post-operative stay in the hospital. Even though the cost of getting a hip replacement surgery abroad can be quite expensive, in India, the same level of expertise can be received at a fraction of the cost. Depending on the city, hospital, surgeon and type of hip replacement surgery selected, the price will vary.
The cost of hip replacement surgery in India would be in the range of 9,000 to 11,000 USD. The cost would depend on the period of stay in the hospital, type of implant used, type of surgery etc. The duration of stay in hospital would be determined by the doctor after analysing the patient condition in detail.
Hip replacement surgery is usually undertaken by patients suffering from acute arthritis pain, ankylosing spondylitis or has fractured their hip. Surgery is usually done when all other treatments options have failed. During a hip replacement surgery, surgeons remove the painful part of the hip joint or the damaged bone surface and cartilage and these are replaced with artificial implants. This helps in restoring the mobility of the patient and also help reduce pain.
If understood from a procedural point of view, hip replacement surgery is of two kinds:
· Total Hip Replacement Surgery:Total hip replacement surgery is comprised of four parts – socket, liner, ball/head and stem. These four components come together to replicate the natural joint. Our hip functions as a ball-and-socket joint, so, during the surgery, the cup is fitted into the natural hip socket, the head replicates the ball of the joint and the stem is fitted into the femur.
· Partial Hip Replacement Surgery:A partial hip replacement surgery is usually undertaken to repair a hip fracture. In this kind of surgery, just the ball of the hip joint is replaced. The socket remains untouched, since it is still strong.
If understood from a technique-used point of view, hip replacement surgery is of two kinds also:
· Open Surgery:This is the traditional method of performing the surgery in which a long 10-12-inch incision is made on the side of the hip. The muscles are then split to enable a clear view of the dislocated/injured hip. The ball and socket are then replaced with artificial counterparts and screws are sometimes used to hold the ball in place.
· Minimally Invasive Surgery:A minimally invasive surgery requires the surgeon to make small incisions to conduct the same surgery. Special sets of equipment are used to place the implants through this small incision. Minimally invasive surgery can be done by making either one or two small incisions, thus ensuring there is very little tissue disturbance. However, this kind of surgery may not be suitable for all patients and before the surgery, the surgeon will conduct a full evaluation.
Once you are discharged from the hospital and are recovering from your surgery at home, it is important to be physically active without exerting yourself. Following the guidelines provided by your doctor and physical therapist is very important.
· It may take 3-4 weeks before you can start putting weight on your leg while walking, however, follow your doctor’s advice on how soon or late you can start doing so.
· You can start driving automatic cars after about two months from the date of your surgery; however, if you have a gear-car, then drive it only after receiving the all-clear from your doctor.
· Depending on your surgery, your doctor may recommend some sleeping positions to you and ask you to avoid certain positions. You may also need to use a pillow between your leg when you sleep on your side for some time.
· While sitting down, make sure you sit on comfortable chairs with arms
· Avoid climbing stairs for as long as possible. Your physical therapist may show you the correct way to climb the stairs, however, it’s advisable to avoid until the time you are healed.
· Returning back to work will depend on the kind of work you do. Your doctor will advise you on the correct time to get back to work, however it may be weeks before you can do so.
· All the while that you are recovering, it is important to stay active and continue to do the exercises your physical therapist recommends. Lower impact activities such as cycling, swimming, walking and jogging can also be undertaken, once approved by your doctor.
Once the patient’s vital signs are checked, general or epidural anaesthesia as per plan is administered. The surgeon makes an incision 10 to 12-inch-long, at the side or back to expose the hip joint. The hip joint is then dislocated by removing the head of femur from its socket in the pelvis, the acetabulum. The arthritic femoral head is then cut off with a bone saw.
The acetabulum is then prepared to receive the acetabular cup prosthesis. The acetabular cup, containing a ceramic or plastic liner to facilitate the smooth movement of the joint, is then placed into the prepared socket. A prosthetic femoral stem is attached to the top of the femoral bone that is cut off. A prosthetic ball that acts as the head of the femur is then attached to the prosthetic femoral stem. The surgeon then checks for the ease in various types of movements. Once satisfied, the length of both the legs is checked for any disparity which is the last step. The surgical incision wounds are then sutured or stapled. The patient will remain in the hospital for a period of 10-14 days depending on the improvement in hip function. The total recovery period is in the range of 2-3 months.
Complications of surgery
Other than the usual complications associated with any surgery like bleeding, pain, swelling, injury to adjacent nerves or blood vessels, some of the complications specific to a hip replacement surgery are:
• Infection in the surgical wounds or joints
• Development of blood clots in the deep veins called deep vein thrombosis of the legs. Pulmonary embolism is a major complication of deep vein thrombosis.
• Unequal length of the legs, one leg may feel longer or shorter than the other.
Things to remember
• The replaced hip will not last forever, they usually have a life span of 10-12 years
• For some patients, they may require revision surgery
• Physical therapy is a must for recovery from the surgery
• There may be a necessity to change certain things around the house for ease of movement
• There will be a necessity to walk with a cane or a walker during the initial healing period
• If patients live alone, then arrangements should be made to have someone come over and live with them during the recovery period, since they will need help with most household chores and walking/driving