TOTAL HIP REPLACEMENT
A painful hip can severely affect your ability to lead a full active life. Over the last twenty-five years, major advancements in hip replacement have improved the outcome of the surgery greatly. Total hip replacement is becoming more and more common as the population of the world begins to age. Total hip replacement relieves pain from most kinds of hip arthritis, improving the quality of life for the large majority of patients who undergo the operation. This troublesome hip can be surgically removed and replaced with an artificial one. Osteoarthritis, which causes the wearing down of hip, is the most common cause of painful hips. There are other conditions, which can also join hands to make a hip joint painful and dysfunctional. Some of these are rheumatoid arthritis, avascular necrosis, injury, and bone tumours.
Basics Of Hip Replacement
The hip is basically a ball and socket joint, linking the ball at the head of the thigh bone called as femur with the cup-shaped socket in the pelvic bone. A total hip prosthesis is surgically implanted to replace the damaged bone within the hip joint. Hip replacement is not always the first choice. Non-invasive methods like medications and physiotherapy are definitely given a try before resorting to surgery. However, medications and physiotherapy may do little to relieve a severely damaged hip joint.
Therefore if pain and loss of function interfere with daily activities, a surgical replacement of hip is considered. The complete surgery takes one to two hours and carries minimal anaesthetic risks. The procedure of replacing the hip involves removing the arthritic parts of the joint replacing the ball and socket part of the joint through a surgical incision The artificial components are made from metal alloys, and places high-performance bearing surface between the metal parts. Most commonly, the bearing surface is made from a very durable polyethylene plastic, but other materials including ceramics, newer plastics, or metals; have been used. Ceramic on Ceramic 'hips' have the least wear rate, about .001 mm per year. Metal on metal wear rates are about .1 mm per year. Patients typically spend a few days in the hospital after the procedure, and some patients benefit from a short inpatient stay in a rehabilitation facility after that to help transition back to living independently at home.
Minimally Invasive Surgery: is it for you?
Minimal invasive Hip surgery is a recent concept. It is done in some cases and the recovery is quicker than conventional one. The incisions done for replacing the hip are smaller and in general, it is considered in patients who are relatively younger and slimmer. However since this procedure is a very recent introduction, long term fellow up results are not available. Most of the hospitals, are doing this on selective basis. Currently the conventional method is still preferred. Ultimately, it is the discretion of the Surgeon concerned who determines the suitability of Minimally Invasive Surgery in the case of a specific patient, as the specific risks and long term benefits of this procedure over the traditional surgery have not been established.
Post Surgery Activities
Physical therapy typically starts the day after surgery. A physical therapist will teach you exercises, such as contracting and relaxing certain muscles that can strengthen the artificial hip. Because the new hip has a limited range of movement, the physical therapist also will teach you proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to the new hip. Most patients will walk with a walker or crutches for 4 to 6 weeks, most will use a cane for another 4 to 6 weeks after that; after that, the large majority of patients are able to walk freely. The full recovery takes about three to six months.
What about Post Sugrical Care? How do we make sure you have a quick recovery?
After you have the Surgery with us, we take the best care for you to make you fit as soon as possible. There is a airplane flight involved while you get back home. Can it be safely done? Absolutely!
The exercises that our Physiotherapist will recommend will start typically 24-48 hours after the operation, under the careful supervision of the Physio. These will be light exercises like gently moving your leg up and down, squeezing your posterior muscles together and so on. The Physiotherapist will carefully monitor your recovery to tell you when you can put more weight on your hip and sit on a chair, move independently, use the toilet and take a gentle walk. Typically, you will get out of bed about 3 days after the operation. The discharge stage is about a week after the operation.
However, we keep in mind that our patients may have to take a flight back home and we keep on this process for about 28 days. The usual thumb rule is, as soon as you can sit down comfortably, you can fly and usually this stage is reached about 15 days after surgery. Just to be on the safe side, we keep a 28-day schedule. In a vast majority of patients, the fourth week should be safe for flying. This is not to say that everything is normal by the fourth week: you have to take your medicines regularly, you have to continue with exercises, you have to follow your doctor’s advise and you have to take certain precautions like not crossing your legs. During flights, you might walk on the aisle of the plane to avoid blood clots. In any case, the blood thinners that are prescribed drastically reduce the possibility of blood clots.
Last but not the least, for patients who opt to recover more before taking a flight and want to continue with their aftercare, we have excellent facilities very close to the Hospital that will accommodate them at par with 5 star hotel standards for a very reasonable charge. During the time they are staying there, all Physiotherapist treatments, medicines and Doctor consultations are absolutely free. To give a general idea, after 12 weeks of the surgery the chances of any dislocation have fallen by about 97%
Each month, on an average, about 500 Patients take an airplane flight, get their surgeries done in India, and then fly back after 4 weeks or so. This has become a phenomenon called the 'Medical Tourism'. With proper precautions and following Doctor's orders, the whole process is quite safe and most importantly, of the same high quality as in the UK or USA.
What about precautions once you are back home? How will these affect your lifestyle?
Usually, after the patient is discharged from the hospital after regular Physiotherapy sessions, it is necessary to take some precautions which ensure a successful operation and prevention of potential complications. While these so not mean that you will have to change your lifestyle, but certain simple actions can make all the difference. For example the maximum chance of dislocating the new hip joint (prostheses) is if you were to cross your legs. A simple precaution like not crossing your legs can solve this problem.
Generally speaking, we reccommend retun to office work or other work at a desk or stationary position after about 4 weeks (6 weeks if possible), if there are no complications, but you would have to take certain precautions.