Hip Replacement Unit

A healthy hip joint is must to perform everyday movement, failure to which, can lead to pain and limit your movement. We at the Centre for Hip Replacement at Nanavati Max Super Speciality Hospital, Mumbai, provide affordable, accessible, and quality healthcare services to patients requiring a hip replacement. We have a team of highly- trained orthopaedic surgeons who hold expertise in providing personalised care to patients suffering from hip-related conditions.

We offer compassionate care, technical expertise, and a wide range of treatment solutions using state-of-the-art diagnostic and therapeutic facilities.

What is a Hip Joint?

The hip is a ball-and-socket joint formed by the thigh bone (femur) with hip bone (pelvis). A healthy hip joint has a layer of smooth cartilage that covers the bony surfaces forming the joint, to allow the ball of the femur to glide smoothly in the pelvic socket. Muscles around the joint help move the joint mechanically, and you can walk without friction between the bony ends of the bones.

What is a Degenerative Hip Joint?

When the smooth cartilage layer wears down or degenerates, the rough underlying bone gets exposed. Instead of gliding smoothly during movement, the ball grinds in the socket causing pain due to friction, affecting daily activities like walking and leading to a limp, sitting and getting up from chair or stair-climbing. The debris resulting from wear and tear of the hip joint may be responsible for pain at rest too. The surfaces forming the joint become increasingly damaged and the pace of repair cannot keep up. The joint may even become deformed, leading to an unsightly appearance. This process of joint destruction is termed as Hip Arthritis.

How is Hip Pain Treated?

In the early stages of hip arthritis, intermittently occurring pain can be controlled with medications, weight reduction, physiotherapy, and mild medication.
During the latter stage of arthritis, when the degeneration is near complete, there’s a more continuous type of pain and daily activities and mobility become severely limited. A patient may become dependent on pain relief medications, risking damage to the stomach and kidneys from overuse. The patient may also become dependent on others for basic care, leading to poor quality of life.

What is Total Hip Replacement?

Termed as “the Operation of the Century,” total hip replacement is a procedure that replaces the worn out or damaged bony ends of the joint socket and the ball of the femur with a Prosthetic Hip (artificial joint) made from biocompatible proven materials which do not react (in situ) in body (tissue) materials.

These materials used in the hip replacement surgery are inert and have proven excellent results. At Nanavati Max Super Speciality Hospital, Mumbai we offer compassionate care which involves choosing the right type of prosthesis (depending on various factors like age, sex, bone mineral density, and femoral anatomy etc.). Our surgeons always prefer the best cement-less implant which is made of proven titanium metal. The ball of the implant is made of 4th generation modern implants with longevity against tearing up to 3 decades. The other biocompatible materials are also used like metal - Cobalt-Chromium, Titanium, Oxinium; the previous plastic sockets have been outdated & presently highly cross-linked polythene (plastic) sockets are being used for patients which have longevity against wear up to 15 to 20 years.

The hip replacement surgeries can be done for unilateral or bilateral involvement in the same sitting of surgery.

Why choose Nanavati Max Hospital for Total Hip Replacement Surgery in Mumbai?

• State-of-the-art modular operation theatres
• Dedicate Operation Theatre for Arthroplasty surgeries
• Continuous sterile airflow with HEPA-filter
• Spacesuits for surgeons

We are one of the rarest centres in the country who perform bilateral hip replacement in the same sitting. The centre is also well known for the revision hip arthroplasties – revision hip replacements (the indications are failure surgeries, fracture of hip joints etc). The expert consultants perform revision hip replacements with excellent results.
The centre believes in quick ambulation and all the patients are made to walk on the same day of surgery, with full weight-bearing (under supervision of physiotherapist).

What are the Benefits of Total Hip Replacement Surgery?

Provided the patient follows post-operative precautions during seamlessly integrated rehabilitation program, after the operation, he can experience:

• Improved quality of life
• Greater functional mobility
• Significant reduction in pain
• Any deformity of the joint and difference in Limb Length is also addressed at the surgery

Prerequisites for Surgery:

• Surgeon should make sure that a patient doesn’t have any source of infection in the body, such as skin boils, dental, urine or chest infection.
• A patient must inform the doctor if he/she is taking any blood-thinning medicines. As a patient must stop taking these medicines a few days before surgery.
• A patient must also inform the doctor about any medical issues like diabetes, asthma, hypertension, hypothyroidism, etc. so that a doctor can take appropriate measures to control the same before surgery.

What is The Procedure of The Surgery?

• A patient is admitted one day before surgery.
• Relevant investigations are done.
• The patient is assessed by the multidisciplinary team (Surgeons, Anaesthetists, Physicians, Cardiologist, and Endocrinologists etc) and posted for surgery.
• The patient is shifted to preoperative hold area about an hour before being taken to the operation theatre.
• The surgery takes about 50 minutes excluding anaesthesia time.
• After the operation, a patient is kept in the recovery ward for 1 hour and then sent back to the room; the only high-risk case may be sent to ICU if necessary.

What is The Recovery Process?

Under the proficient guidance of the treating team of a multidisciplinary team including orthopaedic surgeons, dieticians, physiotherapists, etc. patients are taught proper physiotherapy exercises, lifestyle changes, ergonomics etc to keep them fit and lead a normal life.

• Walking: The centre believes in assisting patients in making them walk on the same day of surgery, with full weight-bearing (under supervision of Physiotherapist). This can help in preventing complications like thrombosis/oedema (swelling )
• Pain Relief: We provide adequate treatment for pain relief in the form of epidural pump, patient control analgesia (PCA) and a combination of oral and intravenous drugs. The patient should inform when in pain. The pain management team at Nanavati Max is there to offer assistance at any given time.
• Deep Vein Thrombosis (DVT) Prevention: Adequate measures are taken for prevention of thrombosis, such as DVT pump (pressure cuff around the calf), certain drugs, and early mobility.
• Discharge from Hospital: in case of single hip replacement patient will get discharged from the hospital in 3-4 days after surgery. However, it may take 4-5 days if both hips are operated.

What Precautions Should be Taken at Home After Surgery?

Short-term precautions

• The temperature should be monitored. Doctor to be informed if it goes above 100.5 degrees Fahrenheit.
• Doctor to be informed if there is an excessive pain.
• Inform the doctor if there is excessive swelling, redness around the operated area or discharge from the wound.
• Use of walking aid is recommended until advised otherwise.
• Low chairs or commodes should not be used.
• After the hip replacement surgery, it may take some time by the surrounding muscles and tissue to heal. After this, a patient may be able to resume normal activities.

The following movements must be avoided for the first 12 weeks to reduce the risk of hip dislocation:

• Bending the hip beyond an ‘L’ shape ( 90 degrees)
• Sitting in cross leg position
• Make sure there is no movement of the operated leg across/over the midline of the body
• wisting the operated leg / turning leg inside

Long-Term Precautions

• Make sure to inform your treating doctor if you are undergoing any surgical/ dental procedures requiring antibiotic cover.
• High impact exercise such as jumping, running should be avoided.
• Inform your doctor if you experience any pain, swelling or instability.
• It is advisable to use a toilet seat with a high commode attachment or a high commode chair at home.
• Physiotherapy should be done regularly to facilitate walking and strengthening of muscles.
• The patient should be mobilised as much as comfortably possible.

What are The Risks/Complications of the procedure?

All types of surgical and anaesthetic procedures carry some risks, particularly if there are other medical problems that a patient may be suffering from. However, our healthcare team has been trained to make sure that these are minimised and the treatment is carried out safely. Patients must be aware of some specific risks related to hip surgery. However, chances of immediate complications are less than 2 %

• Infection: Sometimes despite strict precautions, infection can occur. Superficial infection may occur at the wound site.
• Deep Infection: May occur in the early postoperative period or sometimes, later. Therefore, a patient must immediately see a doctor if he/she experiences an infection that may develop in any part of the body.
• Deep Vein Thrombosis (DVT): Despite taking precautions to prevent blood clot (thrombosis) formation in veins of the leg post-surgery, it remains a common risk after hip replacement surgery. Rarely, these clots can dislodge and travel through the heart to the lungs. This is known as pulmonary embolism which can cause serious complications in rare cases.
• Loosening of the Prosthesis (Without Infection): This is a risk common to all artificial joints. It weakens the bond between new joints and bones. Although it is expected that the new hip will last for many years, it can become loose earlier than anticipated, particularly if a patient is obese, or have damaged joint following an injury, or start performing daily activities without taking proper rest. If the joint becomes loose then it can generally be replaced by another. This is a more complex procedure that involves greater risks. With newer implants, it is common to see hip replacements last more than 15 years

Persistent Pain: The operation may not relieve a patient of all pain, and he or she may continue to experience some mild discomfort. Complex regional pain syndrome, although rare, can cause pain, stiffness, swelling, and skin changes. Other recognised risks of hip surgery include bone fracture, urinary retention, bruising, anaesthesia, and blood transfusion.

How Soon Does a Patient Recover From Surgery?

• After single hip replacement, a patient can stand with the assistance of a physiotherapist on the same day after surgery and start moving under the supervision of a physiotherapist.
• Toilet seat (raised) can be used after 3-4 days of surgery, independently by the patient.
• In case both hip replacements were done together, the recovery process is a little longer but same principles would apply in this condition as well.