Hip replacements of all kinds are done at Udai Omni. Hip replacements have been done since 1995 with excellent results. Chief joint replacement surgeon, Dr Udai Prakash has unparalleled experience when it comes to primary and revision total hip replacement. He has gained reputation for performing complicated hip surgeries. He lectures around the world on this subject and his patients come from across and length and breadth of this country and abroad.

Hip replacement surgery is considered as a treatment for severe pain and functional limitations in :

  • Avascular necrosis
  • Hip fractures
  • Rheumatoid and Osteoarthritis
  • Ankylosing spondylitis and other inflammatory conditions
  • Developmental dysplasia (congenital dislocation of the hip) in later life
  • Secondary arthritis resulting from childhood infections, tuberculosis, trauma and fractures, tumours etc

The hip is a ball-and-socket joint, which allows a wide range of movement. Arthritis damages the cartilage-covered surfaces of the joint so the ball moves less smoothly and less freely within the socket. Full function of the hip joint depends on the successful coordination of many interrelated parts, including bones, muscles, tendons, ligaments, and nerves. Even though the hip joint is exceptionally stable, it can be injured by overuse in sports, or due to aging disease and trauma. In a hip replacement or resurfacing operation, the surgeon replaces the damaged surfaces with artificial parts, which may be made of metal, plastic or ceramic materials.

WHO NEEDS A HIP REPLACEMENT?

Hip replacement is most commonly recommended for severe osteoarthritis, but it’s sometimes used for inflammatory conditions such as rheumatoid arthritis or ankylosing spondylitis or for problems with development of the hip during childhood. Hip surgery may also be needed for fractures of the hip, including those resulting from osteoporosis. Your doctors will always try other measures before suggesting a hip replacement – for example, painkillers, physiotherapy and/or walking aids, or occasionally a steroid injection into your hip joint. Typically, a diagnostic X-Ray shows whether a hip replacement is required or not. The doctor will also assess your fitness for surgery based on several parameters.

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HIP JOINT SURGERIES

In addition to conservative management, we offer various surgical treatments which include:


TOTAL HIP REPLACEMENT (THR)

This is performed for painful conditions of the hip like osteoarthritis, rheumatoid arthritis, avascular necrosis, certain fractures etc. Modern hip replacements make use of materials like titanium, ceramics, and cobalt-chrome that make them tough and durable. Age is not generally a concern when considering someone for a hip replacement as long as they have the right indication. Ten year survivorship in general is more than 95% for most established prostheses.


REVISION TOTAL HIP REPLACEMENT (FOR PREVIOUSLY FAILED HIP JOINT SURGERY)

Primary hip and knee replacements do fail in for a number of reasons. Regular follow-up is essential for people with primary joint replacements. Revising them is highly specialised surgery requiring extensive training and access to sophisticated implants and hospital facilities. The old implant removed and replaced with new. Surgery may involve use of bone graft and/or custom made implants. Identifying failing joint replacements early is crucial for a successful outcome and therefore a regular follow-up by an orthopaedic surgeon is advised.


PRE-OPERATIVE PREPARATION

Patients have to undergo a full medical assessment prior to surgery. This includes and complete physical and psychological examination, x-rays and blood investigations, cardiology, physician and anaesthetic assessment.

Patients are also encouraged to engage with the physiotherapists to understand the exercises involved after surgery and the precautions they should take after surgery.

Conditions like diabetes and blood pressure should be well controlled prior to the surgery.

POST OPERATIVE INFORMATION

Following hip replacement surgery, patients usually remain in the hospital for 3 to 7 days. The length of recovery depends on the type of surgery performed (e.g., traditional, minimally invasive), the patient’s overall health, and the success of rehabilitation. After the procedure, patients must limit movement and the hip usually is braced in the correct position. Patients usually are required to do simple breathing or coughing exercises to reduce the risk for fluid in the lungs. Physical therapy often begins the day after surgery. Within 2 days, most patients are able to sit up, stand, and walk with assistance.

LIFE AFTER HIP REPLACEMENT

 

TOTAL HIP REPLACEMENT IN AVASCULAR NECROSIS

Mr AM, 40 years, was suffering with pain in both his hips due to avascular necrosis. For years he was avoiding surgery thinking it would not be successful as he had heard “stories” from his friends and relatives. However, when pain became unbearable he agreed to have both his hips replaced. As you can see from the video, a year later, he leads a normal life.

PRIMARY BILATERAL (BOTH SIDES AT THE SAME TIME) HIP REPLACEMENT – UNCEMENTED

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A 42 year old lady presented with pain in her hips for over 2 years. For the last 3 months she could hardly walk and was moving around in a wheelchair. She was depressed and had lost over 20 kilos in weight. She lost her job and was literally in tears in the clinic. An x-ray of her pelvis showed that both her hips were destroyed due to rapidly progressive osteoarthritis. This is a rare condition when the hips fail for unknown reasons. She was admitted as an emergency a few days later with intractable pain.

She underwent complex hip replacement surgery of both her hips using un cemented prosthesis. She did extremely well and was discharged within 7 days. She was able to walk with crutches. By six weeks she was walking independently without an aid and had put on 10 kilos in weight. At 2 years, she continues to do well and has taken up Salsa dancing and has put all her weight back on and has got a job as a teacher.

PRIMARY HIP REPLACEMENT – CEMENTED

A 70 year old lady presented to us with increasing pain in her left hip over 2 years. The pain was interfering with her daily activities like walking, standing up from a chair, getting in and out of a bath, putting on her shoes etc. It also started to wake her up at night on a regular basis. She had tried many the pain killers with minimal benefit.

On clinical examination, she clearly walked with a limp and appeared to be in considerable pain. Her hip was stiff and all movements caused severe pain. An X-ray clearly showed severe osteoarthritis affecting her right hip. She underwent a cemented hip. At six weeks she was pain free. Five years later, she remains pain free and is delighted with the result.

COMPLEX PRIMARY HIP REPLACEMENT WITH BONE GRAFTING

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A 65 year old lady came to us with severe pain in her left hip which developed rapidly over the last six months. She also noticed significant shortening of her left leg and noticed that her foot was pointing outwards as she walked. X-ray of her hip showed that the socket of the hip joint had weakened to such an extent that the ball of the joint was protruding into the pelvis. Urgent surgery was undertaken and bone from the ball of the hip was crushed and used as a graft to build up the socket. A cemented hip replacement was done. She did extremely well postoperatively and at 3 years, remains delighted with the outcome. He leg length was restored with surgery and her foot progression angle is also now normal.

REVISION HIP REPLACEMENT

Hip replacements sometimes fail and require a revision to a new one. In this case, a 63 year old man came to us with a six month history of severe pain in his thigh 15 years following a hip replacement. An x-ray showed loosening of the stem with multiple areas of weakness within the femur. During surgery, the femur was split open to remove the stem and the cement. A new hip was implanted and six weeks later, this gentleman was walking around without pain once again.

OPEN HIP DEBRIDEMENT

This case is that of a 28 year old man who presented with pain his right hip deep in his groin whenever he played certain sports and also when driving. Clinically there was very little to find. Deep flexion and internal rotation with adduction (Impingement test) did result in pain in the groin. X-ray revealed a bony bump at the head / neck junction of the hip. He underwent an open debridement through an approach described by Dr Ganz in Switzerland.

HIP RESURFACING SURGERY

Hip Resurfacing is a well established technique of replacing the hip joint. It is suitable for the younger active patient suffering from severe hip pain resulting from a variety of conditions including avascular necrosis, primary osteoarthritis, secondary arthritis to trauma, Perthes disease, skeletal dysplasia etc. It is a bone preserving procedure and allows patients to get back to an active lifestyle including sports. It also allows the Indian patient to sit on the floor and has a much lower dislocation rate than conventional hip replacements. Unfortunately, this surgery recently got bad press coverage due to a couple of implant designs that resulted in a relatively high failure rate. As this surgery is technically demanding, it should only be done by well trained hip surgeons. Its use is now restricted to younger active males in the UK and a few other countries including India. Dr Udai Prakash has been performing hip resurfacing surgery since 2002 and has had very good results with none of his Indian patients requiring revision surgery to date.

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