Arthritis is a debilitating and painful condition. Joint Replacement Surgery allows total relief from pain and improved quality of life for the patient. Arthritic knee and hip joints are regularly replaced; elbow and shoulder are less commonly operated.

From our experience of more than thousand patients who have undergone Joint Replacement Surgery, we have answered commonly asked questions about arthritis and joint replacement surgery.

Hip joint is in the groin. Pain from hip joint is referred to the groin, back, inside of the thigh and occasionally to knee. Pain from the knee joint is usually referred to the knee itself.
Wearing out of the smooth lining (cartilage) and exposure of bone underneath is arthritis. The joint react to this wear by forming new bones (osteophytes), causing thickening of joint cover (synovium) which produce excessive fluid in joint. arthritis can develop because of old age , previous injury, birth defects, accidents, fracture, infection in joint, diseases like Rheumatoid arthritis , etc.
In early stage, medicines, physiotherapy, splints, diathermy, weight reduction can control pain. When these methods are unable to give relief, patient may need Joint Replacement Surgery.
When you have two or more of the following symptoms, you need a joint replacement surgery.

  • Recurrent pain in joint which needs medicines on almost daily basis and/or pain not releaved inspite taking medicines.
  • Presence of night pain or pain on getting up from chair or climbing down stairs & 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)
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, over weight, physically very active or do unusual exercises. You will need annual review with your surgeon to assess your joint.
Rejection of joint by body is extremely unusual and is not of a practical consideration.
Implanting artificial hip or knee joints made up of specialized steel, Titanium, cobalt chromium alloy and ultra high density polyethelene (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.
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 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 metal surface on the upper side and plastic surface on the lower side. The surface of knee cap 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 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 wit 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.
After THR:
You can walk easily up to 1 – 2 miles if your other physical fitness allows it. Normal sitting in 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 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 artificial joint, bone cemented (imported) and disposable material used for operation. Patients need to arrange for blood transfusion. Operation could be performed as cost effective package deal.

For more information on this pls see our expense section click here

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 patients develop infection in Joint. They can be treated with antibiotics. Those who do not respond, will need removal of joint to clear 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% cases, the clot may go to the lungs. This needs treatment with blood thinning agents and a little longer hospitalization. Death of patient as 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 his happens and pain returns back, the joint can be changed. In exceptional circumstances, dislocation of 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 afterwards. Dislocated joint can be reduced back and stabilized by the bed rest.

Joint replacement surgery is usually an elective 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.