HIP ARTHRITIS AND JOINT REPLACEMENT

Arthritic condition of Knee and Hip is the main cause of disability. Hip arthritis is next common to knee arthritis. 40 % of patients do suffer from arthritis, either Hip or Knee.

Osteoarthritis in white population is around 6% in females and 16% in males (UK). It is much lower in Indian population.

The common cause of hip arthritis in western world is due to advanced age and due to wear and tear. But in India the main cause of arthritis, almost 50 % is due to avascular necrosis (bone becomes dead).

Cause of this is due to chronic consumption of alcohol and use of steroids for various medical conditions. Small percentages of people also suffer from rheumatoid arthritis (Gathiya Va) and ankylosing spondylitis. Ankylosing spondylitis is almost 1% in general population which is comparatively high than the western population. Due to high speed vehicular accidents, number of joint replacements after trauma has been on the rise.

Hip joint is a ball and socket type of joint which is supported by the muscles and ligaments. (Fig 1A, B) Joint surface is very smooth, glistening white with some fluid which allows lubrication and prevents

arthritis. Its smooth surface is due to cartilage and if the cartilage gets damaged due to various reasons, patients develop arthritis. (Fig 2 A, B).

Treatment of hip arthritis can be medical in little percentage of patients but many patients will go for hip replacement.

Avascular necrosis of femoral head

We do MRI and in early stage, medical line of treatment is advised. The new line of treatment of stem cell transplant is also considered in early stage but at present it is more in experimental phase. To prevent avascular necrosis people should stay away from alcohol. Secondly, if they are using any other methodology like ayurvedic or unani they should not be used as most of these medicines do contain steroids. The younger boys who are involved in gymnastics are consuming some form of powder which mostly contains anabolic hormones to increase their bulk of muscles. They should not use such products and fall into trap of hip arthritis. Most of these patients in higher grade will go for hip replacement. (Fig 3 A, B)

Rheumatoid and ankylosing arthritis

These are very young patients, they have morning stiffness and multiple joint pains and also runs in families. (Fig 4) Today it is possible to treat them with medical drugs with gratifying results. Consult your doctor or rheumatologist for any multiple joint pain or morning stiffness for more than 6 weeks. The new drugs have given a new lease of life. Advanced arthritis will need hip replacement. Results and happiness of patients are much more satisfying in these patients. These patients are more grateful and always have smiling face in-spite of their disability.

What is hip replacement?

Damaged part of arthritic hip is removed and replaced with an artificial joint. On the ball side we replace with metallic or ceramic ball and on socket side we replace with a shell and a liner which represents auricular cartilage. This surface is made up of high quality polyethylene which can sustain for many years. (Fig 5A, B ,C). This operation has become very safe, reliable, with low complications and long lasting. The average life of the joints will be 20 years if precautions are taken.

How long will this operation and recovery take?

This operation takes around 30-45 minutes and they are allowed to start walking the next day morning. Due to good pain management, hip replacement has become a painless operation; hence they have very rapid recovery. They will be given walking training and toilet training within the shortest time and discharged on 4th or 5th day. Initially they will be given some walking aid for protection. The recovery period is around 6 to 8 weeks and after this they can continue with their normal duties.

What exercise?

Hip replacement does not need any exercise. Frequent walk and activities are the food for the hips.

What are the Do’s & Don’ts?

After hip replacement, most of the daily living activities done by common man are allowed, except squatting & crossed leg sitting. (Fig 6B) These two activities will damage the joint early. Contact sports like football, volley ball, cricket should be avoided as there are chances of getting injury which might damage the joint. Light sport, swimming, and cycling and walking are allowed. Keep your weight under control.

Shalby Hospitals is one of the leading joint replacement centres in Knee and Hip replacement. This surgery is done in state- of – the art operation theatre with laminar flow and space suits to avoid infections. (Fig 7) Shalby has excellent infrastructure for providing pre op, post op and rehabilitation care. This hospital also provides revision hip services which needs highly skilled team and supportive infrastructure.

Dr  J.A. Pachore

Director, Department of Hip Replacement

Shalby Hospitals, Ahmedabad

Contact:   96240 88814