Hip and knee replacement surgery has a dramatic effect on patients’ lives. It is generally recommended if conservative measures have been ineffective or are likely to be ineffective. Most patients are able to go back to their former active lifestyle as their pain is relieved and mobility restored. Age is not a bar to joint replacement surgery. Modern materials and techniques have largely overcome the problems of wear and loosening of the implant. This brief introduction to joint replacement surgery will give you a flavour of the different types of joint replacements of the hip and knee performed by our surgeons.
Total Hip Replacement
Total hip replacement is probably the most successful operation performed by any surgeon of any specialty.
It involves replacing both the acetabulum and the femoral head components of the ball and socket joint. It is indicated in painful conditions of the hip such as osteoarthritis, rheumatoid arthritis, avascular necrosis and certain fractures and in a vast majority of cases it results in a dramatic improvement in the quality of life. Modern hip replacements are made of materials like titanium or high grade stainless steel and contain bearings such as ceramics, cobalt-chrome and highly cross-linked polyethylene that make them very durable. Age is not generally a concern when considering someone for a hip replacement as long as they have the right level of fitness and the operation is done for the right indication. The probability of most good hip implants surviving 10 years is over 90%.
Total Knee Replacement
Knee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. This is a well established procedure giving consistently good outcome with long term results often matching and sometimes exceeding those of total hip replacement. In general, the surgery consists of resurfacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee. During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable. In some cases the articular surface of the patella is also removed and replaced by a polyethylene button. Functionally, most patients get back to their formal lifestyle including most non-impact leisure activities like golf.
Unicondylar Knee Replacement
This is an excellent procedure for limited arthritis or the knee. Usually performed through a smaller incision than total knee replacement, only the part of the knee that is diseased is resurfaced. The joint therefore feels and behaves more like a normal knee. Recovery is rapid and the patient is often discharged within 2 -3 days of surgery.
Hip Resurfacing is an alternative to hip replacement surgery in some patients. It is a bone conserving procedure that places a metal cap on the femoral head instead of amputating it. There is no long stem placed down the femur so it is more like a natural hip and may allow patients a return to many activities. It seems the ideal option for young individuals with severe hip osteoarthritis who are likely to outlive any prosthesis that they receive and who are keen to carry on with an active lifestyle. In the unlikely event of the resurfacing failing many years down the line the bone stock that has been preserved in the first instance makes the revision in most cases almost as easy as doing a primary hip replacement. According to the Australian Registry data for 2009, performance of hip resurfacing for men under 65 years of age is better than total hip replacement.
Revision Hip and Knee Replacement
Primary hip and knee replacements do fail in time for a number of reasons. Revising them is highly specialised surgery requiring extensive training and access to sophisticated equipment, implants and hospital facilities. In most cases the old prosthesis is removed and replaced with a new implant. The surgery is often long and the risk of complications is higher than after a primary operation. Patients tend to spend the first 24 to 48 hours after the procedure in the high dependency unit. Surgery may involve the use of ultrasonic devices to remove the old cement used for fixation of the prosthesis, bone graft and/or custom made implants. Identifying failing joint replacements and performing the revision early is crucial for a successful outcome and therefore a regular follow-up by an orthopaedic surgeon is advisable for all patients carrying a hip or a knee replacement.
Frequently Asked Questions
- When is joint replacement surgery recommended?
The reasons are many. Most patients with severe hip or knee pain as a result of advanced arthritis may be candidates for joint replacement. Joints can also get damaged due to previous injury or infection. There are many more indications including congenital disorders, childhood disorders leading to arthritis in later life, avascular necrosis etc.
- How long do joint replacements last?
On average a hip or knee replacement has a 90% chance that it will survive 10 years and a 80% chance that that it will last 20 years if done by a well trained surgeon at a specialist hospital. The survival is highly dependent on the quality of surgery and the implant used.
- What are they made of?
Modern joint replacements are made of many different materials – these include Cobalt-Chrome alloy, surgical grade stainless steel, titanium. Your surgeon should be able to give you more information depending on what joint you are having replaced. All joint replacements done at Udai Clinic are imported at the moment.
- How long will I need bed rest for?
You will almost never need any bed rest. The aim of the surgery is to get you out of bed as soon as possible after surgery. You will need intensive physiotherapy during the recovery phase of 6-8 weeks.
- How long will I stay in the hospital?
On average a patient after joint replacement will stay between 5-7 days in the hospital.
Following complex joint replacement, the stay may be longer.
- Will I be able to sit on the floor?
Many patients can sit on the floor after joint replacement surgery whether it is the hip or the knee. However, your surgeon will guide you on this depending on what you are having done and the complexity of the surgery. Kneeling might be difficult after knee replacement surgery. Again, the quality of surgery is the key. If done well and if the patient is motivated, most activities of daily living are possible.
- Can I ride a scooter or drive a car afterwards?
Most patients can start driving after about 6 weeks but please discuss this with your physiotherapist or your surgeon.
- At what age is joint replacement recommended?
Joint replacement can be done at any age. Most patients are between 55 – 80 years of age but the range can be from teenage to over 90 years. As long as the patient is reasonably fit, joint replacement can be done. Your doctor should be able to advise on this.
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Who is at risk?
Almost 90% have a mechanical reason for their back pain, and in 10% various diseases and disorders are responsible for low back pain. Many risk factors have been identified : lifting weights beyond a workers physical capability, repeated bending and twisting in awkward positions , prolonged sitting especially in slouched position is well known to produce low back pain. Obesity, cigarette smoking, lack of physical exercise, weak abdominal and back muscles are some of the very potent factors in causing low back pain.
What causes back pain?
The very fact that we are born as humans – our upright posture places tremendous stress and strain on the back.
- bad posture
- prolonged sitting : IT industry/ executives
- weak abdominal and back muscles
- weak bones ( osteoporosis )
- driving 2 wheelers with bad shock absorbers
- over weight
- lack of exercises during and after pregnancy
- un-accustomed bending forwards and lifting weights
Let’s get to know some of the common conditions that cause low back pain:
The slipped disc: The human spine consists of individual bones called vertebrae separated by discs- which simply put is a jelly surrounded by fibrous tissue. When the discs get damaged or degenerated, it slips backwards and presses on the spinal cord and nerves causing pain in the lower back or along the leg – known typically as sciatica.
Non surgical management:
Over 90% of patients with slipped discs do not require surgery and get better with rest, physiotherapy and medication. You do not have to sleep on floor or hard beds. A firm bed is all that is required, and rest for more than one week is not advisable. There is no need for strict bed rest and you can move about if pain permits. Exercises should be commenced after the pain subsides and your physiotherapist would be the best person to teach you the exercises to strength the back and abdominal muscles.
Traditional surgeries such as laminectomy have no place in the management of disc prolapse. Surgeries such as Fenestration, Microscopic surgery or Endoscopic microdiscectomy(Key hole surgery) offer the best results. The minimally invasive surgeries do not weaken the back muscles and return to work is much quicker.
As we get older , the spinal canal gets narrowed due to arthritis and degeneration of tissues in the spine-resulting in pressure on the nerves. Typically the patient may experience low back pain, buttock pain and leg pain. Patients find it difficult to walk for long distances and have to rest after walking for a few minutes. He/she can resume walking once the pain subsides. Majority of the patients get better with change in life styles, physiotherapy and epidural steroid injections in to the spinal canal. Modern surgical techniques once again give lasting relief in those who do not get better with non operative treatments.
Spondylolisthesis: This is slipping of one vertebra over the other, resulting in pressure on the nerves and again is responsible for back pain and sciatica. In those who do not get better with non operative measures, surgery offers good relief from pain.
Osteoporosis: Again a common condition in women, is responsible for significant back pain and vertebral fractures. Exposure to sunlight, physical exercise, balanced diet, go a long way in managing this problem. In those who suffer from fractures, minimally invasive procedures such as vertebroplasty – which is injection of synthetic material (bone cement) under local anaesthesia gives excellent results.
Other conditions: Curvature of spine (hunch back-scoliosis, TB, cancers and tumors and a variety of disorders can affect a human spine. Prompt consultation and investigations would help in diagnosis and treatment.
Who should be consulted for spine surgery?
Orthopaedic surgeon or Neuro surgeon? That is the doubt in almost everyone’s mind. Traditionally both operate on Spines.Today we have a sub-speciality – Spine Surgery. Spine surgeons are specially trained to perform spine surgeries and it would not be too long when Neuro surgeons would be operating only on Brain and Orthopaedic Surgeons on bone and joints and Spine surgeons alone would be performing Spine surgeries.
Information on the Internet: Beware! Not all information on the net is accurate and current. Newer technologies that appear on the net, are like fashions that keep changing and are industry driven.
Are spine surgeries safe?
Spine surgery is complicated and needs expertise. One need not worry too much about the complications and a well planned and well executed surgery in an understanding and cooperative patient gives excellent results.
Is there an age limit?
No! Today spine surgeries are performed in infants. Age certainly is no bar.
The second opinion?
When in doubt take a second opinion. But seeing too many doctors is quite confusing.
For a healthy back
- Correct your posture – do not slouch
- Get out of your chair every 20 minutes- stand or walk for a few minutes
- Getting out of chair is more important than buying expensive chairs
- Exercise regularly: yoga/walking/swimming/sports
- Quit tobacco
Dr.Raghava Dutt Mulukutla is consultant orthopaedic and chief spine surgeon at Udai Omni Hospital. He has an experience of over 35 years, his expertise includes spinal deformity surgeries, scoliosis and back pain management.
To consult Dr Raghava Dutt Mulukutla, please email firstname.lastname@example.org
Intermediate Instructional Course on Total Hip Replacement
Dr Udai Prakash was one of the two chief instructors at the intermediate hip replacement course run by the world renowned DePuy Synthes Institute at MS Ramaiah Medical College on 31 October.
This course was for the young surgeons who wanted to learn about the finer aspects of total hip replacement surgery.
The delegates were involved in an interactive session with Dr Udai Prakash and were taken through the procedure on cadavers rather than on plastic bones which is usually the standard in many courses. Hands on experience on cadavers gives young surgeons an opportunity to refine their surgical skills prior to performing surgery on patients.
These courses are certainly not a substitute to being trained in recognised institutions by experienced surgeons but is considered an adjunct to their training.
Dr Udai Prakash was invited as faculty for the recent Oxford Partial (Uni-compartmental) Knee Replacement course held in Pune to teach young surgeons from across the country on how to do this unique surgery.
The course was organised by Zimmer-Biomet – the largest orthopaedic implant manufacturer in the world. Amongst the faculty were surgeons from Oxford University, UK.
The Oxford group from the UK are pioneers in this type of knee replacement where only the worn out part of the knee is replaced. The results in terms of function and complications are far lower for the partial knee replacement when compared to total knee replacement.
At this orthopaedic meeting, Dr. Raghav’s topic of debate was – Post operative recurrent disc must always be instrumented and fused.
Dr Udai Prakash, Chief Joint Replacement Surgeon at Udai Omni Hospital performs the first of its kind knee surgery using Triathlon’GetAroundKnee‘ on patient Mr Arul Swamy with advanced stage 4 osteoarthritis[soliloquy id=”undefined”]
Dr Raghavadutt, Chief of Spine Unit has been invited to deliver a speech in BP:Best Practice of orthopedics about Spinal diseases the 2nd Annual World Congress of Orthopedics 2015 (WCORT-2015) Sep 2015