1. |
Where
is my “Hip” Joint? |
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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. |
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2. |
What is Arthritis? |
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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. |
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3. |
What is the cure for Arthritis? |
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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. |
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4. |
How do I know that
I need a Joint Replacement now? |
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When you have two or more of the following symptoms, you need
a joint replacement
surgery.
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Recurrent
pain in joint which needs medicines on almost daily basis and/or pain
not releaved inspite f taking medicines . |
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Presence
of night pain or pain on getting up from chair or climbing down stairs & squatting. |
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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) |
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5. |
How long will my Joint last?
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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. |
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6.
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Is there any rejection? Can my body reject
the joint?
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Rejection of joint by body is extremely unusual and is not of
a practical consideration. |
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7.
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What
is Total Hip Replacement (THR) / Total Knee Replacement
(TKR)? |
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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. |
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8.
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How exactly is the operation done?
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THR
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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) |
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TKR
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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. |
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9.
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What happens to me before and after the surgery? How soon can
I regain my activities? |
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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. |
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10.
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How painful is the operation? What Anesthesia is used? |
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Usually Spinal
or Epidural anesthesia is used which anaesthetize 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. |
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11. |
How soon can
I drive? |
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Usually
one can drive within 6 to 8 weeks following operation;
after being
assessed by doctor. |
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12. |
How normal can I become after the operation? |
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After
THR
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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.)
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After
TKR
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Walking
is possible unlimited, climbing up and down the stairs
is also possible without pain. Squatting down and
sitting cross legged is prohibited.
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13. |
How much will the operation cost me? |
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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
theatre 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 |
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14.
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How
dangerous is the operation? (Complications of Joint
Replacement Surgery)
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All major operations involve some amount of risk. However
with advances in anesthesia ad surgical techniques, there risks
are quite low. Patient however should be aware of them.
a |
Infection |
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Extreme
precautions are taken to avoid this complication.
Patient preparation, operation theatre 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 repond, will need removal of joint to clear
infection. Another artificial joint can be implanted
later. |
b |
Thrombosis |
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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%) |
c |
Wear,
loosening, dislocation of Joint |
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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. |
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15.
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What
if I do not undergo operation? Will it be difficult
to do the surgery if I wait for a long time?
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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.
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