In India Total hip replacement is a common surgical procedure with a high success rate. In an arthritic hip, the damaged ball (the upper end of the femur) is replaced by a metal or ceramic ball attached to a metal stem fitted into the femur (with or without cement), and a plastic or ceramic socket (fitted into a metal socket) that is implanted into the pelvis, replacing the damaged socket.
Using a combination of metal and plastic, the joint implant surgeon creates a new ball and socket joint, which will glide smoothly and painlessly. During the past two decades, multiple advances in hip arthroplasty have been accomplished and many types of prosthesis are available and currently used. The metals used are chrome cobalt alloy and/or titanium alloy. These are super metals initially developed for the aerospace industry and now adapted for the orthopedic industry. The plastic is a high-density plastic polymer called polyethylene. In younger patients a ceramic ball is used with a polyethylene or ceramic socket.

Methods of total hip replacement surgery:

Modern Total Hiip replacement surgery is divided in two different methods. With elderly people it is often more reasonable to put in and fix the total hip in a softer bone by using bone cement. The advantage of this method is that the prosthesis holds from the very first day and will not loosen itself in the relatively soft bone of an elderly person. This represents a very stable and reasonable construction. Today, a stainless steel prosthesis is inserted into the bone of the upper leg by using a little amount of bone cement and is immediately stable.

The inverse of the hip bone will be shaped and a piece of synthetic material will be fixed with bone cement. The connection is immediately stable. This method has been approved worldwide for over 40 years and is still recommended. The life expectancy of a prosthesis of this kind is a minimum of 10 years, normally 15 years and very often 20 years.

A well established second method is a system of joint replacement without bone cement. In this case titanium trunks are fitted into the upper leg bone (femur) and are fixed by exact insertion into the femur. This method of the cementless prosthesis normally takes a couple of weeks until it is fixed to the upper leg bone. We recommend the use of crutches for 6-8 weeks.
In Rheinfelden a titanic cup which is screwed into the bone and also not fixed by bone cement has proved true. In this type of titanic cup either plastic or ceramic inlay is fitted in exactely.
The slide bearing (so called „Gleitpaarung“) means that materials for bonehead and inlay of the cup can be different. In most cases the slide bearing plastic and metal has proved to be good. The stay in the clinic in case of a hip replacement usualy is 2 weeks.

Alternatives to Total Hip Replacement Surgery.

Conservative treatment

One alternative is not to have an operation. If your pain can be controlled with medication (pain killers: such as paracetamol, or non steroidal anti-inflammatory drugs; or disease management medication: like glucosamine-sulfate), physiotherapy, and adapting your physical activities, so that you are sufficiently comfortable and you are content with your present activity level and motion in your hip, then you may decide to wait (AKA watchful waiting).
Femoral/acetabular osteotomy

For patients with developmental dysplasia of the hip (DDH), cutting the thigh bone (femoral astronomy) or pelvis (Ganz, Berne or Bernice osteotomy) in order to realign the hip may be indicated if the hip weight-bearing area can be broadened or made more congruent. This is often useful in young patients. Recovery following osteotomy may be longer than with joint replacement, implicating no weight bearing for 6 weeks up to 3 months!

Arthrodesis

Arthrodesis is rarely performed, but is an especially effective procedure for younger patients, particularly those who are of short stature and who are otherwise healthy. “Arthrodesis” relieves pain by fusing the femoral head to the acetabulum. It has none of the limitations that a joint replacement or other procedure has in terms of restrictions in activity level. If the patient’s back is mobile and without symptoms, it is a very worthwhile procedure. The procedure generally requires internal fixation with plate and screws and occasionally cast immobilization while healing takes place. An arthrodesis can be converted to a total hip replacement at a later date, usually 15 years on average after the operation.

Why go to India for total hip replacement surgery?

Orthopedic surgery in Western countries cost 5 to 6 times as much as in India. Over the years, India has become a global centre of excellence in orthopedics surgery including the total hip replacement surgery by promoting the notion that medical services in India can be bought off the shelf from the lowest priced provider anywhere in the globe, care. The concept has broad appeal, as Indian private facilities offer advanced technology and high-quality procedures on par with hospitals in the major industrialized countries at a fraction of the cost It is a deepening of the whole notion of health care that is being pushed today which emphasizes on technology and private enterprise. More and more western patients seeking surgery are looking towards eastern destinations such as India, for their medical needs, including orthopedic procedures like the hip replacement surgery. Once in India you can be rest assured about your proper diagnosis and medication. Furthermore, if situation demands, surgery packages are also within your reach. Medical Treatment in India is amid the best in the world, facilitated by the most skilled doctors and up to the minute super sphere hospitals of India.

Costs for Bilateral Hip replacement surgery:

The total cost of the Hip Replacement Surgery in India is very less as compared to USA or UK. The patient can go back to his country by the 12th day in case of single hip joint replacement and by 20th day after a bilateral hip replacement. The stay is shorter after double hip replacement surgery as the intervening period between sequential knee replacements is avoided.

Dheeraj Bojwani MD is an International Patient Consultant to foreign patients who want to travel to India for getting low cost medical treatment and surgery. More than 400 patients from across the globe have taken the benefits of his services till date.

Forerunners Healthcare Consultants is the premier most medical tourism company of India arranging medical and health tours for International Patients in India. More than 300 patients treated have been treated by Forerunners healthcare Consultants.

Hip dislocation after hip replacement surgery rarely occurs, but to reduce the risk even further it’s essential to strictly follow your hip precautions (restrictions of certain hip positions/movements) taught to you by your physical therapist. Your new hip needs time to heal in place, particularly during the first 6 weeks following surgery. During this period, your hip muscles and bones are healing up around your new hip joint to keep it securely in place.

There are usually three main total hip precautions.

1) Don’t turn your toes inward, 2) don’t cross your legs, 3) and
don’t bend your new hip more than 60-90 degrees. Your surgeon
will also instruct you on how much weight he wants you to
place on your surgery leg while walking.

1) Don’t turn your toes inward. Where your toes go, your hip follows. If you turn your toes in on your surgery leg (pigeon-toed), your hip will internally rotate. This motion can pop your hip out of its new joint. Internal rotation can also occur while standing in place and twisting toward the direction of your new hip. Let’s say your right hip was just replaced. If you reach across your body with your left arm, maybe to answer the telephone or lay an object down on the table, you’re at risk of dislocating your new hip due to internal rotation.

2) Don’t cross your legs. Moving your surgery leg across your body’s midline can cause your new hip to dislocate. This includes sitting in a chair with your ankles crossed or reclining in bed with your legs crossed.

3) Don’t bend your hip beyond a 60-90 degree angle. The best way to know if you’re complying with this precaution is to take a look at your surgery leg when you’re sitting down. Your knee should be
lower than your hip. If your knee and hip are level with each other, your hip is at a 90 degree angle. The closer you move your knee to your chest, the greater your risk of dislocating your new hip. And reaching down toward your shoes or the floor also creates this same risk of dislocation. One way to reduce the chance of hip dislocation is to straighten your leg out in front of you when you’re sitting. This reduces the bend of your hip.

While you’re in a standing position, don’t bend down to retrieve something from the floor or a low cupboard. There are devices, called “reachers”, that aid you in picking things up from the floor or getting objects from high cupboard shelves. Your occupational therapist will train you in the proper use of this equipment along
with equipment to aid you in putting on your socks, shoes, and pants.

If you have low chairs at home, use pillows to add height. Chairs with arm rests make it easier to sit down and stand up. Don’t sit on a low couch. The top of your bed mattress should be 27″ from the floor. Getting on and off your toilet seat can be difficult and hazardous if it’s too low. While in the hospital, you’ll be using
a raised toilet seat. You’ll need one at home as well until your hip has healed. Your physical therapist will order one for home use before you get discharged from the hospital.

If you dislocate your hip, call 911. You want to get to the hospital as quickly as possible so your surgeon can pop your hip back into place. This will require another surgery and rehab. If your surgeon is concerned about another dislocation, he can fit you with a hip brace. Once the hip completely heals, the brace will no longer be needed.

After your hip replacement, your doctor will let you know how much weight you can safely place on your leg while walking. This is known as your “weight bearing status”. It should be strictly followed, as putting too much weight on the leg can damage your new hip. Your doctor will allow you to increase your weight
bearing as the hip heals. The following are some common

“Weight bearing” terms:

* non-weight bearing- no weight at all on the leg
* toe touch or toe down weight bearing- only your toes touch the floor, usually about 10% of your weight through your surgery leg
* partial weight bearing- toes and front part of your foot down, about 25-50% of your weight through your surgery leg
* weight bearing as tolerated- you’re allowed to put as much weight on your surgery leg as your pain level allows, heel down when walking/standing (heel/toe gait pattern)
* full weight bearing- no weight bearing restrictions, heel down when walking/standing (heel/toe gait pattern)

Your surgeon will discuss your hip precautions with you before and after your surgery. Your physical therapist will teach you how to safely get in/out of bed, transfer, walk, sit, climb stairs, and get in/out of your car while maintaining your hip precautions.

Following your hip precautions in the hospital and at home is an important part of your rehab and will greatly reduce your risk of hip dislocation.

Some of the above information may vary from patient to patient. Your doctor and physical therapist will instruct you in all total hip replacement precautions.

The Minimally Invasive Anterior Approach

The anterior approach to hip replacement has been quite successful with the vast majority of total hip replacement patients, including hip fractures. After the surgery, the patient is free to move his hip without restrictions, and, in most cases, is up and walking later that same day. A patient’s hospital stay is also shortened to 2-5 days.

After traditional hip replacement, patients must strictly follow their hip precautions.

Minimally invasive hip replacement is performed while the patient is lying flat on his back. A small incision (about 4 inches) is made at the front of the hip joint, as opposed to the traditional lateral or posterior incision. During the anterior approach, the hip is replaced without detachment of muscle from the femur or
pelvis. The hip is reached through a natural opening between the muscles. This results in a quicker rehab and a shortened hospital stay.

Traditional hip replacement requires a large incision through the gluteal muscles, which are the most important muscles for hip function. This places restrictions on hip movement for a period of time after surgery. Restrictions (referred to as hip precautions) include no internal rotation, no leg crossing, and
no bending of the hip beyond 90 degrees. Often times there are also limitations on the amount of weight a patient is allowed to place on his leg while walking. These restrictions are in place to prevent dislocation of the new hip.

Minimally invasive hip replacement (anterior approach) eliminates restrictions because muscles and tissue
are left intact in the lateral and posterior areas. This provides stability for the hip and greatly reduces the
chance of dislocation.

Minimally invasive hip replacement doesn’t necessarily refer to the size of the incision. It has more to do with the minimal amount of tissue damage during surgery. The incision can’t be made too small or else the incision area becomes too stretched in an attempt to reach the hip joint.

ProFX Operating Table

The ProFX is a special operating table that positions the patient’s leg for the anterior approach. Not all hospitals have this table. Without it, the anterior approach isn’t performed. For instance, in California there are less than 10 hospitals that perform this minimally invasive hip replacement. Another reason for the scarcity of this approach lies with surgeons. Most orthopedic surgeons have been trained in the lateral and/or posterior methods only.

Advantages of Minimally Invasive Hip Replacement (anterior approach)

* No limitations on hip motion
* No weight bearing restrictions
* Decreased chance of hip dislocation
* Reduced hospital stay
* Shorter rehab time
* Quicker return to functional mobility
* Quicker return to driving your vehicle
* Much less pain from surgery
* Reduces chance of leg length discrepancy

Disadvantages/Complications

Complications are rare but are similar to complications from traditional lateral and posterior approaches. These include infection, DVT (deep vein thrombosis), nerve damage, femur fracture, and revision surgery.
Dislocation is a complication, but is much less likely to occur.

A standard hip replacement operation takes 2-3 hours. The patient may be given a choice of general, spinal, or epidural anesthesia.

An incision is made of 8-12 in (20-30 cm) long down the side of the patient’s upper thigh. The surgeon may then choose to enter the joint itself from the side, back, or front. The back approach is the most common. The ligaments and muscles under the skin are then separated.

Once inside the joint, the surgeon separates the head of the femur from the acetabulum and removes the head. The doctor removes the head from the femur (thigh bone) and reams away the surface of the socket.

The modular prosthetic hip replacement system used today has three components - the femoral stem, the femoral head, and the acetabulum. Each component has multiple available sizes which allow for a custom fit. The components are made of cobalt chrome stainless steel and ultra high molecular weight polyethylene. Prosthesis implantation may be cemented or cementless (press-fit).

After selecting the correct size for the patient, the surgeon inserts the acetabular component. The acetabulum is then reamed to accept a plastic cup. The ball and socket are then replaced into normal position. Both of these implants can be fastened into the bone with or without special cement.

Today, both cementless (also called uncemented and porous-coated) and cemented hip replacements offer patients effective, long-term relief.

1. Cemented Procedure:

The cemented procedure utilizes a doughy substance mixed at the time of surgery that is introduced between the artificial component and the bone. This type of fixation in total hips remains the gold standard. Depending upon their health and bone density, people over the age of 60 will receive this type of joint fixation.

2. Noncemented Procedure:

Despite its common use, not all individuals are candidates for a cemented hip. A tight bond of scar tissue if formed, which anchors the metal to the bone. This is called a cementless total hip replacement. This type surgery is technically more sensitive, requiring a more exact fit of the metal component to the femur. The surgeon then secures a metal head (ball) and stem into the femur either by a press fit or with bone cement. The doctor places the ball into the cup and takes your new hip through a range of motion to ensure proper stability and mobility.

You will then be sent to the recovery room where your health care team will monitor your heart rate, blood pressure, and respiration.

The cost of a total hip implant varies, depending on the type of implant used. Typically, a total hip procedure includes four major implant components and the total implant price ranges from $4000 to $6000 (USD). Standard total hip replacement surgery is generally covered by most insurance plans.

In wockhartdt hospital, Mumbai for hip resurfacing cost will be approximately as under:

In India ($) 8,500 or USA ($) 55,000 or UK (GBP) 15,000

There are approximately 150,000 artificial hip joints implanted annually in the United States, with the success rate over 90%. New materials used in total hip replacement are very durable and are expected to last more than 10 years in 90% of individuals receiving total hips.

Total hip replacement, hip resurfing and other most advanced computer navigated joint replacement surgery is done at well know and JCI accreditation hospitals in India such as Apollo Hospital in Mumbai, Wockhardt Hospital in Mumbai, Apollo Speciality Hospital in Chennai, MOIT hospital, Chennai etc. which compares with the USA & U.K.