Hip and Knee replacement surgery

Total Hip Replacement (THR) & Total Knee Replacement (TKR) are wonders of modern surgery for patients affected by arthritis of the hip and knee. These surgeries have been performed for over 40 years now and the technique has been almost perfected. Worldwide there are thousands of patients who have benefited from these operations & life has been transformed.

Indications & Eligibility - Patients with painful hips and knees resulting from arthritis - usually degenerative or inflammatory, will face a remarkable change and freedom from pain without having to rely on painkillers. Generally a patient should be above middle age and medically fit to sustain anesthesia.
Procedure & Recovery -The actual operation takes an hour & a half in my hands to perform. Recovery is usually prompt and the patient is allowed to mobilise on the very second day. Patients are discharged home anytime between the 7th and 10th day after surgery. With progressive mobilisation the patient is asked to give up crutch support by six weeks and the individual is walking comfortably by 6-12 weeks. Patients who are employed can resume work by 4-6 weeks if they have a sitting job. A more strenuous job may require the patient to stay off work for perhaps another few weeks.


72yr old lady with Rt. Hip OA.Click on the X-ray to see the result - a Cemented Charnley THR was done with excellent result.

Typically there is no difference in the patients' walk and they are back to their normal routine. A few minor restrictions do persist such as - not to sit cross legged, use a commode type of latrine. As for follow up, the patient is required to consult me at intervals of 6 weeks, 3 months, 6 months and then once a year. These are artificial joints and unfortunately cannot be as good as the God given joints. However, the success rates for both procedures is impressive. It is presumed that each will last for 15 years in 90% to 95% cases. With modern techniques one can now revise failed hip and knee replacements, so it is not the end of the road if such a complication were to occur, albeit rarely. The total incidence of complications taken from published series is 3% to 4%. Some of the more significant complications can be Infection, Deep Vein Thrombosis leading to Pulmonary embolism, dislocation and loosening of the prosthesis. Precautions are taken to prevent any such complications, such as sterility in OT, prophylactic antibiotics and Fragmin injections to prevent thrombosis.

 


Lt. Knee OA. click on the X-ray to see result with TKR

These operations are routinely done in most metropolitan cities in India. There are various types of THRs & TKRs. Basically the issue with THRs is cemented or uncemented. Cemented THR is being done for well over 40 years successfully. Uncemented THRs are new on the scene comparatively and they have undergone a significant number of changes in design. Hence the success rate of uncemented THRs cannot be compared with Cemented THRs. I personally am in favour of Cemented THRs for very scientific reasons which will be detailed elsewhere on this website. The basic stem of the prosthesis is made of superalloy Co-Cr-Mb and the socket (or cup) is made of High Density Polyethylene. Ceramic heads are available for younger patients to reduce the wear between the head and socket.