LAUD CLINIC

Implanting artificial hip or knee joints made up of specialized steel, Titanium, cobalt chromium alloy and ultra high-density polyethylene (UHDP) in patients is called THR or TKR surgery. These materials are imported and the joints are manufactured in India. Totally imported joints are also available.

When you have two or more of the following symptoms, you need a joint replacement surgery.

• Recurrent pain in the joint which needs medicines on an almost daily basis and/or pain not relieved in spite of taking medicines.
• Presence of night pain or pain on getting up from the chair or climbing downstairs & squatting.
• Pain affecting and limiting social, professional, personal life. (for the fear of pain you are now avoiding things which you normally would like to do)

THR:
A small cut is made on the side of your hip. The hip joint is exposed. It is a ball and socket joint (see diagram). The ball is removed and replaced with a metal ball fixed to the thigh bone with a special material called bone cement. The socket is cleaned and fixed with UHDP socket with cement (See Diagram). The muscles and ligaments are stitched back. The operation takes about one ad half hour. In some patients, an artificial hip joint with a special coating is used without cement fixation. Here the patient’s bone is expected to grow over its surface to hold it rigidly to the body. (Uncemented THR)

TKR:
A small cut is made in front of the knee(about 8 to 10 inches). The knee joint is opened. The damaged surfaces of bones are removed and replaced with a metal surface on the upper side and plastic surface on the lower side. The surface of the kneecap is also replaced with a plastic button. These surfaces are fixed to the bone with bone cement. Muscles and ligaments are stitched back. The operation lasts for 1 1/2 hours.

The patient is thoroughly evaluated by doing a series of blood tests, ECG, chest X-ray, Urine test and Medical Examination to find out fitness to undergo surgery. The patient is admitted to the hospital one day before the surgery. After the operation, the patient is kept for 10-12 days in the hospital by which time the stitches are removed. Movements of the joint are started on the next day of surgery with a specialized machine. Walking is allowed between 4-6 days post surgery with some support. By the time of discharge, the patient is independent to move from bed to toilet and within the room with the support of walker/frame.

The patient is followed up at one month, three months, and then every year to assess the joint function.

Usually Spinal or Epidural anesthesia is used which anesthetize the lower body. There is no pain during the operation. Patients do have some pain for the first two days following the operation. This pain can be controlled by using pain Killer injections or tablets.

Usually one can drive within 6 to 8 weeks following operation, after being assessed by doctor.

With prudent use a cemented hip replacement surgery is known to last for 15-20 years. a knee replacement surgery is known to last even longer. The life of your joint becomes less if you are young, overweight, physically very active or do unusual exercises. You will need an annual review with your surgeon to assess your joint.

Rejection of joint by body is extremely unusual and is not of a practical consideration.

After THR:
You can walk easily up to 1 – 2 miles if your other physical fitness allows it. Normal sitting in the chair without pain is possible. Patient SHOULD NOT sit cross-legged or squat on the ground (like using Indian toilet.)

After TKR:
Walking is possible unlimited, climbing up and down the stairs is also possible without pain. Squatting down and sitting cross-legged is prohibited.

The cost depends on the type of implant, the class of stay (general ward / special ward) and the use of cemented / non-cemented prosthesis. The cost includes the hospital stay of 12 – 14 days, operation theater charge, nursing, routine medicines required for anesthesia, anesthetists charge, surgeon’s charge, physiotherapy cost for the duration of hospitalization, cost of the artificial joint, bone cemented (imported) and disposable material used for the operation. Patients need to arrange for blood transfusion. The operation could be performed as a cost-effective package deal.

Infection:
Extreme precautions are taken to avoid this complication. Patient preparation, operation theater with clean air system, use of board spectrum antibiotics etc is one. Despite the care and diligence taken, about one percent of patients develop an infection in Joint. They can be treated with antibiotics. Those who do not respond will need removal of the joint to clear the infection. Another artificial joint can be implanted later.

Thrombosis:
Development of blood clots in self can occur in 5-6% patient. For their prevention, various techniques are used. Even if they develop, they can be dispersed using medicines. About 1% of the cases, the clot may go to the lungs. This needs treatment with blood thinning agents and a little longer hospitalization. Death of patient as the complication is extremely rare (<0.1%).

Wear, loosening, dislocation of Joint:
Prolonged use can cause loosening and wear of artificial joint. This usually happens over 10-15 years. If this happens and pain returns back, the joint can be changed. In exceptional circumstances, dislocation of the artificial hip in extreme position can happen for which special precautions are advised. The risk is more in the first 3-6 months and becomes less afterward. The dislocated joint can be reduced back and stabilized by the bed rest.

Joint replacement surgery is usually a selective operation, unless the patient has a fracture which requires joint replacement surgery. However, waiting will only cause more deterioration of the joint and subject patient to a further period of painful life. Waiting for a few weeks / months does not damage the joint beyond repair and the operation difficulties will not increase significantly.