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All Posts in Category: Orthopedics

Joint Replacement Shoulder

Understanding Shoulder Arthritis

The shoulder is very flexible because it is a ball-and-socket joint made up of three bones: the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). It moves your arm a variety of directions — in front, above, to the side, and behind your body. It is the most flexible joint in your entire body. This flexibility can make the shoulder prone to injury from overuse, repetitive motions, falls, or strain from excessive weight. Due to anatomic and physiologic changes related to the aging process, the shoulder is among the more common joints affected by active lifestyles. The symptoms of pain and soreness can be the same, whether the problem is related to an old injury or degenerative conditions such as arthritis. Initially, pain may limit usage, but can progress to pain at rest and at night.

Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.

  • Osteoarthritis (Degenerative Joint Disease): This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people. The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful.  Unfortunately, there is currently no way to prevent the development of osteoarthritis.
  • Rheumatoid Arthritis:This is an autoimmune disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthropathies.”
  • Post-traumatic Arthritis: This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or injury of the shoulder tendons or ligaments may damage the articular cartilage over time, or the damage can be so severe that the bones cannot be put back together. This causes shoulder pain and limits shoulder function, and may require a shoulder replacement.
  • Rotator Cuff Tear Arthropathy: A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.
  • Avascular Necrosis (Osteonecrosis): Avascular necrosis is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are risk factors for avascular necrosis.
  • Failed Previous Shoulder Replacement Surgery – Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.

Is Shoulder Joint Replacement for You?

There are several reasons to consider shoulder replacement surgery. Patients who benefit from surgery often have:

  • Severe shoulder pain from arthritis that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing.
  • Moderate to severe pain while resting. This pain may be severe enough to prevent a good night’s sleep.
  • Loss of motion and/or weakness in the shoulder.
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.

Depending on the underlying cause of your shoulder arthritis, type of shoulder replacement is decided. The type of procedures performed at Vachhani Hospital include:

  • Total Shoulder Replacement
  • Shoulder Hemiarthroplasty (replace humeral head or “ball” only)
  • Reverse Total Shoulder Replacement

Treatment options for shoulder, elbow and upper extremity pain during the early stages easily include non-surgical options such as injections and anti-inflammatory medications along with physical therapy.

More resistant pain symptoms may lead to further diagnostic testing by MRI. When surgery is recommended for the treatment of your shoulder arthritis, a type of shoulder replacement will likely be recommended. For younger patients with a healthy rotator cuff (four small muscles in your shoulder) a total shoulder replacement is the best option.

If the rotator cuff is injured and cannot be repaired, a slightly different operation called a reverse total shoulder replacement may be needed.

At Vachhani Hospital, we approach your diagnosis and education with open communication and shared decision-making. It is important that you are fully aware of all of the options that are available to you.

Shoulder Pre And Post Surgery

What to Expect Before Shoulder Replacement Surgery

Joint replacement can help relieve pain and enable you to live more active life. If you are deemed a good candidate for joint replacement and decide to have surgery, it is good to be prepared, both mentally and physically before surgery. Planning ahead for the challenges of surgery and recovery will help ensure a more successful outcome. Below are answers to some frequently asked questions before surgery:

  • What tests are needed before surgery? Prior to shoulder replacement, you will complete a variety of tests such as x-rays, and ECG, and blood tests. These medical studies ensure that you are healthy enough for surgery and enable your providers to ensure the best care after surgery.
  • What type of anesthesia will I receive? Most of our patients receive a general anaesthesia for shoulder replacement.
  • What type of implant or prosthesis will be used? We use implants with a design that has been shown to have good long-term survival. We do not use any implants that have been recalled. If you want specific brand names please discuss this with your surgeon before surgery.
  • How long will I stay in the hospital? Most patients stay in the hospital about 2 days following shoulder replacement.
  • How long will my recovery take? Most patients will obtain almost full recovery by 3 months after surgery. By 3 months, you can except to return to your activities of daily living. If you have a sedentary job, you should be able to return to work within 3-6 weeks. More physical jobs often require more time off for recovery.
  • How will my pain be managed after surgery? We use “multimodal” pain management, meaning that we use a combination of medications such as opioid analgesics, and anti-inflammatories as well as ice to control your pain.
  • Do I need physical therapy before surgery? Formal physical therapy is not required before surgery, but it is advised to get in the best physical shape possible before surgery to lessen the change for complication and shorten your recovery time.
  • What medications should I stop taking before surgery? You will stop all medications that thin your blood 3 days before surgery such as aspirin and clopidogrel.
  • What if I smoke or drink alcohol? If you smoke, cut down or quit. Smoking affects blood circulation, delays healing and slows recovery. Eat a nutritious, well-balanced diet. If you drink, do not consume any alcohol for at least 48 hours before surgery. If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can cause complications and impact your surgery.

What to Expect After Shoulder Replacement Surgery

The day after surgery, you will begin working with physical therapy to become comfortable using your new shoulder. For the first 3 weeks after surgery you will be in the “healing” phase and will primarily keep your arm in a sling to allow for healing. After your check-up at 3 weeks, we will start more physical therapy.

Joint replacement is major surgery and your recovery will take several weeks, but there are steps you can take now to make your time at home safer and more comfortable:

  • If you live alone or have special needs, consider going to a specialized rehabilitation facility after discharge from the hospital.
  • Arrange for someone to drive you home from the hospital and stay with you for several days after your surgery. Do not drive until cleared by your surgeon.
  • Place items that you use frequently within easy reach.
  • Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Consider modifying your bathroom to include a shower chair, gripping bar, or raised toilet seat. Place items that you use frequently within easy reach so that you do not have to reach up or bend down.
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Joint Replacement Knee

Your knee consists of three “compartments” or sections:

  • Medial compartment (inner half of your knee)
  • Lateral compartment (outer half of your knee)
  • Patellofermoral compartment (behind the knee cap)

Osteoarthritis can affect one, two or all three compartments. Osteoarthritis (often abbreviated to OA) is a form of arthritis and a degenerative joint disease characterized by the breakdown and eventual loss of joint cartilage. Cartilage is a protein substance that serves as a cushion between the bones of a joint. With OA, the top layer of cartilage breaks down and wears away, allowing bones under the cartilage to rub together.

What causes osteoarthritis of the knee?

Although the root cause of osteoarthritis is unknown, the risk of developing symptomatic Osteoarthritis is influenced by multiple factors such as age, gender etc. that can affect the shape and stability of your joints.

Other factors can include:

  • A previous knee injury
  • Repetitive strain on the knee
  • Improper joint alignment
  • Being overweight
  • Exercise/sports-generated stress placed on the knee joint

Symptoms of osteoarthritis of the knee include:

  • Pain with standing or walking short distances, climbing stairs, getting in and out of chairs
  • Pain with activity
  • Getting up from a sitting position
  • Sudden pain while sleeping
  • Joint stiffness after getting out of bed
  • Swelling in one or more areas of the knee
  • A grating sensation or crunching feeling in the knee during use

How is osteoarthritis of the knee diagnosed?

Your doctor will begin by reviewing your medical history and symptoms. He or she will observe the natural movement of your knee, evaluate your knee and ankle joint alignment, muscle strength, range of motion and ligament stability in the affected knee. Your doctor may order X-rays to determine how much joint or bone damage has been done, how much cartilage has been lost and if there are bone spurs present. In some cases additional medical imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) may be ordered for further study of your joint. Your doctor may also order blood tests to rule out other causes of arthritis if required.

How is osteoarthritis treated?

Whether your osteoarthritis is mild or severe, your doctor will most likely recommend certain lifestyle changes to reduce stress on your knee joints such as weight loss. Additional disease and pain management strategies may include: physical therapy, steroid injections, pain medications such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) or topical pain-relieving creams or sprays. Please speak with your doctor if your symptoms aren’t responding to non-surgical solutions, or your pain can no longer be controlled by medication. You could be a candidate for surgery. The most common surgical knee intervention performed for osteoarthritis is a TOTAL KNEE REPLACEMENT. During this procedure, the diseased bone and cartilage is removed and the joint is resurfaced with an artificial implant. This treatment option is usually offered to patients with advanced osteoarthritis of the knee.

Total knee replacement is not always optimal for patients with early- to mid-stage osteoarthritis in just one or two compartments of the knee.

At Vachhani Hospital, we approach your diagnosis and education with open communication and shared decision-making. It is important that you are fully aware of the effects of osteoarthritis, and know all of the options that are available to you.

Traditional Knee Replacement

If it is determined that your knee is too worn, a total knee replacement is the best procedure to treat your arthritic knee. Total knee replacement utilizes precision cutting guides to remove the diseased bone and cartilage from your knee and replace it with an artificial joint. As shown in the picture, an artificial knee consists of a metal cap on the end of your thigh bone (femur), a metal plate on the top of your shin (tibia), and a plastic liner between the two metal parts.  To perform a traditional knee replacement, surgeon use an 8- to 10-inch vertical incision over the front of the knee to expose the joint. The surgeon will then:

Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending on the case.
Insert a spacer. A plastic spacer is inserted between the metal components to create a smooth gliding surface.

  • Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants. The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending on the case.
  • Insert a spacer. A plastic spacer is inserted between the metal components to create a smooth gliding surface.

you will be up and walking with assistance on the day of surgery or very next day, on the day two you will be climbing up and down the stairs.

You should return to light activity after 3 weeks, and should return to most activities after 3 months. After after 6 months, patients return to full activity and can resume strenuous activities as tolerated. Although the lifespan of a knee replacement is dependent on many factors, a knee replacement should last 15-20 years. Most often, if another operation is required after 15-20 years, it is a simple operation that replaces the worn plastic between the metal parts.

Please call our hospital at +91 7621012785 for more information or make an appointment.

Partial Knee Replacement

Partial knee replacement is an innovative treatment option for those living with mid-stage knee osteoarthritis (OA) that has not yet progressed to all three compartments of the knee. You may be a good candidate for a partial knee replacement if you have:

  • Knee pain with activity in only one part of your knee, usually on the inner knee and/or under the knee cap.
  • X-rays that show arthritis in only one compartment of your knee.
  • Start-up knee pain or stiffness when activities are initiated from a sitting position.
  • Failed to respond to non-surgical treatments such non-steroidal anti-inflammatory medication, therapy and injections.

How does partial knee resurfacing differ from Traditional Joint Replacement Surgery?

In partial knee replacement, only the arthritic portion of the knee is resurfaced. This preserves healthy bone and tissue, giving you more options for the future and a more rapid recovery. Recent advancements in orthopedics have brought revolutionary changes in joint replacement procedures.

How is the procedure performed?

The procedure is performed through a four to six inch incision over the knee. In many case, patients are permitted to walk soon after surgery, drive a car within two weeks and return to normal daily activities shortly thereafter.

Knee Revision Surgery

Hundreds of thousands of knee replacement surgeries are performed in the India each year, and they are highly successful in eliminating pain, restoring mobility and improving quality of life. If a knee replacement is properly done, over 90% of knee replacements will last at least 15 years.

However, problems do occur with knee replacements. When the implant wears out or another problem develops, people often need a second “revision” surgery in which the existing implant or components are taken out and replaced. The surgeon at the Vachhani Hospital is trained in joint replacement and have the expertise and knowledge necessary to evaluate and treat failed or problematic knee replacements. If you have a knee replacement that needs evaluation, we are happy to assist and provide treatment recommendations.

What are the common reasons for revision knee replacement?

  • Loosening of the implant – the knee replacement may become painful after many years because the components have begun to wear and loosen.
  • Fracture – a fall or severe blow can cause a fracture of the bone near the hip or knee replacement that may require a revision of the knee replacement and/or or operative fixation of the fracture.
  • Infection – this can be a very serious complication. If a deep infection develops in a hip or knee replacement, revision is often needed to eradicate the infection and to implant new non-infected components.

Be aware of warning signs that there may be a problem, such as pain that comes on suddenly, trouble walking, a sensation that the knee replacement is loose, or increased swelling or fluid in your knee.

A revision joint replacement is more complicated than the initial operation.

How can you make the replacement last longer?

  • We advise patients to avoid high impact activity such as running, which can shorten the lifespan of the joint replacement. Walking or biking for exercise is better than running.
  • Maintain a healthy weight. Being overweight, especially obese, is a main factor in developing arthritis in the first place. People who are overweight are more likely to experience loosening of an implant.
  • Once the initial healing has taken place and discomfort has diminished, see your orthopedic surgeon if pain develops suddenly. Do not wait to have a problem evaluated.
  • If you develop a bacterial infection in another part of your body after joint replacement, be sure to see your doctor for appropriate antibiotics.
  • Pay a visit to your orthopedic surgeon every few years after hip or knee replacement, even if the joint feels good. The physician can check for early loosening of the implant or another minor problem before it causes a major headache, such as dislocation.

Muscle Sparing Approach to Knee Replacement

Dr. Vivek Vachhani is expert in the “subvastus” muscle sparing approach. We are one of the only practices in the Gandhinagar and Ahmedabad that utilizes this technique. The muscle sparing or “subvastus” technique combines minimally invasive instruments with a surgical approach that leaves key muscles and tendons intact. Instead of cutting the quadriceps tendon, surgeons make a 3-5 inch incision on the knee and split or dissect under a single quadriceps muscle. Because no major tendons or muscles are cut, recovery is faster and less painful.

The main potential benefits of quadriceps-sparing total knee replacement include:

  • More rapid return of knee function. Patients who undergo this procedure seem to get muscle strength and control back more quickly than patients who have had traditional total knee replacement. This is because the quadriceps muscle and tendon are not divided in the course of the surgical exposure like in traditional knee replacement and the kneecap is not everted (flipped out of the way) as it is in traditional total knee replacement.
  • Decreased post-operative pain. This is a function of the smaller incision and the fact that the incision stays out of the important quadriceps muscle/tendon group.
  • Same reliable surgical implants as Traditional Knee Replacement. Much has been learned about implant design in the nearly 40-year history of contemporary knee replacement. Minimally-invasive quadriceps-sparing total knee replacement is an evolution of surgical technique which permits the use of time-tested implant designs. This gives some reassurance that while the surgical approach is new the implants themselves have a good proven track record.

What to Expect Before Knee Replacement Surgery

Joint replacement can help relieve pain and enable you to live a fuller, more active life. If you are deemed a good candidate for joint replacement and decide to have surgery, it is good to be prepared, both mentally and physically before surgery. Planning ahead for the challenges of surgery and recovery will help ensure a more successful outcome. Below are answers to some frequently asked questions before surgery:

  • What tests are needed before surgery? Prior to knee replacement, you will complete a variety of tests such as x-rays, and ECG, and blood tests. These medical studies ensure that you are healthy enough for surgery and enable your providers to ensure the best care after surgery.
  • What type of anesthesia will I receive? Most of our patients receive a spinal block and intravenous sedation for knee replacement surgery. This combination ensures a safe and rapid recovery with a lower likelihood of nausea and vomiting, respiratory complications, prolonged sedation, and other issues often seen with general anesthesia.
  • What type of implant or prosthesis will be used? We use implants with a design that has been shown to have good long-term survival. If you want specific brand names please discuss this with your surgeon before surgery.
  • How long will I stay in the hospital? Most patient stay in the hospital 3-4 days following knee replacement. The majority of patient will go home on day 4 and will continue physiotherapy at home.
  • How long will my recovery take? Most patients will obtain almost full recovery by 3 months after surgery. We advise you avoid high-impact activities such as running after a knee replacement. If you have a sedentary job, you should be able to return to work within 3-6 weeks. More physical jobs often require more time off for recovery.
  • How will my pain be managed after surgery? We use “multimodal” pain management, meaning that we use a combination of medications such as opioid analgesics, and anti-inflammatories as well as ice to control your pain.
  • Do I need physical therapy before surgery? Formal physical therapy is not required before surgery, but physiotherapy done before surgery helps shorten your recovery time.
  • What medications should I stop taking before surgery? You will stop all medications that thin your blood 3 days before surgery such as aspirin and clopidogrel.
  • What if I smoke or drink alcohol? If you smoke, cut down or quit. Smoking affects blood circulation, delays healing and slows recovery. Eat a nutritious, well-balanced diet. If you drink, do not consume any alcohol for at least 48 hours before surgery. If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can cause complications and impact your surgery.

What to Expect After Knee Replacement Surgery

The day after surgery, you will begin working with physical therapy to become comfortable using your new knee. They will begin basic movements and walking with either a walker or crutches. You will also be started on a “motion machine” called a CPM that helps to decrease swelling and maintain motion in your knee. Physical therapy is a critical component of your recovery, helping to restore joint strength and mobility.

Joint replacement is major surgery and your recovery will take several weeks, but there are steps you can take now to make your time at home safer and more comfortable:

  • If you live alone or have special needs, arrange for someone to drive you home from the hospital and stay with you for several days after your surgery. Do not drive until cleared by your surgeon.
  • Place items that you use frequently within easy reach.
  • Use a walker or pair of crutches to see how well you can maneuver through your home. You may need to rearrange furniture or temporarily change rooms (make the living room your bedroom, for example).
  • Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Consider modifying your bathroom to include a shower chair, gripping bar, or raised toilet seat. Place items that you use frequently within easy reach so that you do not have to reach up or bend down.
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Joint Replacement Hip

Are You Living with Hip Pain?

The hip is called a ball-and-socket joint because the round ball-shaped head of the thighbone (femur) moves inside the cup-shaped hollow socket (acetabulum) of the pelvis. These bones are covered by cartilage, a layer of strong tissue that cushions the bones and allows smooth, easy movement of the joint.

Degenerative joint disease (DJD) can cause a loss of cartilage, resulting in bone-on-bone contact that may result in pain, swelling and stiffness.

What causes degenerative joint disease?

The risk of developing symptomatic DJD is influenced by multiple factors such as age, gender and inherited traits that can affect the shape and stability of your joints. Other factors can include a previous hip injury, repetitive strain on the hip, improper joint alignment, being overweight and/or sports-generated stress placed on the hip joint.

There are different types of arthritis that may cause hip pain. An orthopedic surgeon may diagnose:

  • Osteoarthritis (OA), also called “wear-and-tear arthritis,” in which cartilage wears down over time, is the most common type of hip arthritis
  • Post-traumatic arthritis, which results from a severe fracture or fracture or dislocation of the hip
  • Rheumatoid arthritis (RA), an inflammatory arthritis of the joints
  • Avascular necrosis (AVN), a condition where the “ball” or femoral head has lost a healthy supply of blood flow, causing the bone to die and the femoral head to become misshapen
  • Hip dysplasia, a condition in which bones around the hip did not form properly, which may cause misalignment of the hip joint

Cartilage has no nerves, so the break-down itself does not directly cause pain. However, the decreased “shock absorption” that results from a loss of cartilage causes increased stress to surrounding structures such as bones, muscles and the lining of the joint. This can lead to sudden “flares” of pain when these tissues get irritated.

Joint replacement surgery is considered a treatment option to relieve arthritis pain and restore function to the affected joint. Conservative treatment options are usually tried before surgery is recommended. Joint replacement surgery is recommended when pain is no longer well-controlled and joint damage significantly affects quality of life.

How do you know if you need a joint replacement? Ask yourself these questions:

  • Have I tried medication and other conservative pain-relieving treatment options?
  • Do I have unrelenting pain in the affected joint?
  • Do I have significant difficulty with usual daily activities, such as walking, climbing stairs, cooking, cleaning, and more?
  • Has my quality of life suffered due to arthritis pain and joint damage?

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

  • The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or “press fit” into the bone.
  • A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
  • The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place. The position of this cup is critical to the stability and longevity of the hip replacement
  • A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

Is Hip Replacement Surgery for You?

The decision to have hip replacement surgery should be a cooperative one made by you, your family and your orthopedic surgeon.

Candidates for Surgery

There are no absolute age or weight restrictions for total hip replacements.

Recommendations for surgery are based on a patient’s pain, disability, and x-ray findings of arthritis. Most patients who undergo total hip replacement are age 50 to 80, but orthopedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

When Surgery Is Recommended?

There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

  • Hip pain that limits everyday activities, such as walking or bending
  • Hip pain that continues while resting, either day or night
  • Stiffness in a hip that limits the ability to move or lift the leg
  • Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living. Realistic activities following total hip replacement include unlimited walking, downhill skiing, swimming, golf, driving, hiking, biking, dancing, and other low-impact sports.

The surgeon at Vachhani Hospital will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.

In addition, we will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.

Hundreds of thousands of hip replacement surgeries are performed each year, and they are highly successful in eliminating pain, restoring mobility and improving quality of life. If a hip replacement is properly done, over 95% of hip replacements will last at least 15 years.

However, problems do occur with hip replacements. When the implant wears out or another problem develops, people often need a second “revision” surgery in which the existing implant or components are taken out and replaced. The surgeon at the Vachhani Hospital is fellowship trained in joint replacement and have the expertise and knowledge necessary to evaluate and treat failed or problematic hip replacements. If you have a hip replacement that needs evaluation, we are happy to assist and provide treatment recommendations.

What are the common reasons for revision hip replacement?

  • Loosening of the implant – the hip replacement may become painful after many years because the components have begun to wear and loosen.
  • Fracture – a fall or severe blow can cause a fracture of the bone near the hip replacement that may require a revision of the hip replacement and/or or operative fixation of the fracture.
  • Infection – this can be a very serious complication. If a deep infection develops in a hip replacement, revision is often needed to eradicate the infection and to implant new non-infected components.
  • Dislocation – for a variety of reason a hip replacement can become unstable, meaning that the ball and socket become dislocated. If this is a recurrent problem, it may require a revision surgery to make the replacement more stable and prevent future dislocations.
  • Implant recall – on occasion, the implant used in joint replacement is found to have a problem. As a result, patients with a recalled implant should be closely monitored by their surgeon to evaluate if the recalled implant is causing a problem. Revision surgery is sometimes necessary when an implant is recalled.

Be aware of warning signs that there may be a problem, such as pain that comes on suddenly, trouble walking, a sensation that the hip replacement is loose or unstable, or changes in the wound appearance.

A revision joint replacement is more complicated than the initial operation and many physicians who perform primary joint replacements will refer their patients to the revision surgery experts at Vachhani Hospital.

How can you make the replacement last longer?

  • We advise patients to avoid high impact activity such as running, which can shorten the lifespan of the joint replacement. Walking for exercise is better than running.
  • Maintain a healthy weight. Being overweight, especially obese, is a main factor in developing arthritis in the first place. People who are overweight are more likely to experience loosening of an implant.
  • Once the initial healing has taken place and discomfort has diminished, see your orthopedic surgeon if pain develops suddenly. Do not wait to have a problem evaluated.
  • If you develop a bacterial infection in another part of your body after joint replacement, be sure to see your medical doctor for appropriate antibiotics.
  • Pay a visit to your orthopedic surgeon every few years after hip replacement, even if the joint feels good. The physician can check for early loosening of the implant or another minor problem before it causes a major headache, such as dislocation.
  • Have your primary hip replacement with an experienced surgeon who specializes in the procedure and at a center that performs a high number of joint replacements to ensure the best outcome and lower the risk of complications.

Mini-Posterolateral Total Hip Replacement

The most common approach today is referred to as the “posterior approach,” which is done from the back of the hip. Recent improvements to this approach allow a smaller incision and less tissue trauma, enabling a more rapid post-operative recovery. This modification of the posterior approach has been called the “mini posterior approach.” The mini-posterior approach allows our surgeons to perform total hip replacement through a relatively small incision without cutting the important abductor muscles that are critical to hip stability and gait. Since this is the most commonly used approach, it is very safe with minimal risk of nerve damage, femur fracture, and less blood loss in comparison to other approaches. In addition, if needed, this approach can be quickly expanded to access the pelvis or femur in more complex cases such as hip revision surgery. Not every patient is a candidate for every surgical approach, and excellent outcomes can be obtained with any approach. As a result, we work with our patients to ensure the surgical approach is customized to meet the patient’s needs and provide the safest, most successful hip replacement possible.

What to Expect Before Hip Replacement Surgery

Joint replacement can help relieve pain and enable you to live a fuller, more active life. If you are deemed a good candidate for joint replacement and decide to have surgery, it is good to be prepared, both mentally and physically before surgery. Planning ahead for the challenges of surgery and recovery will help ensure a more successful outcome. Below are answers to some frequently asked questions before surgery:

  • What tests are needed before surgery? Prior to hip replacement, you will complete a variety of tests such as x-rays, and ECG, and blood tests. These medical studies ensure that you are healthy enough for surgery and enable your providers to ensure the best care after surgery.
  • What type of anesthesia will I receive?Most of our patients receive a spinal block, intravenous sedation for hip replacement surgery. This combination ensures a safe and rapid recovery with a lower likelihood of nausea and vomiting, respiratory complications, prolonged sedation, and other issues often seen with general anesthesia.
  • What type of implant or prosthesis will be used? We use implants with a design that has been shown to have good long-term survival. If you want specific brand names please discuss this with your surgeon before surgery.
  • How long will I stay in the hospital? Most patient stay in the hospital 3-4 days following hip replacement.The majority of patient will go home on day 4 and will continue physiotherapy at home.
  • How long will my recovery take? Most patients will obtain almost full recovery by 3 months after surgery. We advise you avoid high-impact activities such as running after a knee replacement. If you have a sedentary job, you should be able to return to work within 3-6 weeks. More physical jobs often require more time off for recovery.
  • How will my pain be managed after surgery? We use “multimodal” pain management, meaning that we use a combination of medications such as opioid analgesics and anti-inflammatories as well as ice to control your pain.
  • Do I need physical therapy before surgery? Formal physical therapy is not required before surgery, but it is advised to get in the best physical shape possible before surgery to lessen the change for complication and shorten your recovery time.
  • What medications should I stop taking before surgery? You will stop all medications that thin your blood 3 days before surgery such as aspirin and clopidogrel.
  • What if I smoke or drink alcohol? If you smoke, cut down or quit. Smoking affects blood circulation, delays healing and slows recovery. Eat a nutritious, well-balanced diet. If you drink, do not consume any alcohol for at least 48 hours before surgery. If you use any other types of controlled substances, tell your doctor. Narcotics and other drugs can cause complications and impact your surgery.

What to Expect After Hip Replacement Surgery

The day after surgery, you will begin working with physical therapy to become comfortable using your new hip. They will begin basic movements and walking with either a walker or crutches. Physical therapy is a critical component of your recovery, helping to restore joint strength and mobility. If you have a posterior approach, there will be three “motion restrictions” that you must follow for 3 months to allow for soft tissue healing and prevent dislocation after surgery:

  • Do not cross your legs
  • Do not bend your hip past a 90 degree angle
  • Do not twist your hip inwards – keep knees and toes pointed upwards

Joint replacement is major surgery and your recovery will take several weeks, but there are steps you can take now to make your time at home safer and more comfortable:

  • If you live alone or have special needs, consider going to a specialized rehabilitation facility after discharge from the hospital. Your doctor can suggest appropriate places to consider.
  • Arrange for someone to drive you home from the hospital and stay with you for several days after your surgery. Do not drive until cleared by your surgeon.
  • Place items that you use frequently within easy reach.
  • Use a walker or pair of crutches to see how well you can maneuver through your home. You may need to rearrange furniture or temporarily change rooms (make the living room your bedroom, for example).
  • Remove any throw or area rugs that could cause you to slip. Securely fasten electrical cords around the perimeter of the room.
  • Consider modifying your bathroom to include a shower chair, gripping bar, or raised toilet seat. Place items that you use frequently within easy reach so that you do not have to reach up or bend down.
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Trauma

Fractures can happen in patient’s of all age groups, secondary to Road traffic accidents, households falls, etc., and we as an Institution are recognized for management of all types of standard and complex fractures.

We have a State-of- Art facility from modular operation theatre with laminar airflow (First in Gandhinagar) to instrumentation use special and advanced implants like Locking Compression Plates (LCP), which helps the patients to mobilize faster.

Fracture healing is a NATURAL process. As surgeons we attempt to optimize the alignment of the bone so that NATURAL healing can proceed in the best possible way.

Older techniques of holding fractures with plaster could not align and hold the fracture as accurately except for un-displaced fractures. Surgical fracture fixation is a superior technique.

Before Operation

After Operation

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Deformity Correction

A deformity of the limb, which is usually a result of improper fixation of fracture, implant failure or bone and joint infections. Deformed limb can lead to very much discomfort to the patient. It also leads to many restriction of day to day activities. A deformed limb can also affects other bone and joint due to unequal load transfer of the body and change in gait pattern.

Here we are trained enough in diagnosing the exact site and amount of the deformity, planning of correction and implementation with latest implant and instrumentation.

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