Frequently Asked Questions
Hip replacement involves replacing the painful, damaged parts of the hip with artificial parts or implants. A hip replacement has three parts: socket (outer shell and inner liner), ball, and stem. These parts imitate the action of your original joint.
Healing times depend largely on the patient’s overall health, body type and lifestyle. With proper care, rest and therapy, patients heal sufficiently to return to most activities of daily living within several weeks of their procedure. The duration of hospitalization ranges from two days for a shoulder replacement to three to five days following a knee or hip replacement.
The primary goals of joint replacement surgery are to restore mobility and to relieve pain. Good evidence-based medicine data reveals that a typical total hip or knee replacement lasts at least 20 years in about 80 percent of patients, which lets patients enjoy their favorite activities without pain. Joint replacement care at Sibley is a truly comprehensive experience; it encompasses the entire process from evaluation through rehabilitation. Care at Sibley includes diagnostic imaging, patient education, surgery and both inpatient and outpatient physical therapy. Sibley also has a skilled nursing facility, The Renaissance, for inpatient rehabilitation, which can be used to assure that any postsurgery issues are completely addressed.
Flex-ion is the action of bending a joint, such as your knee or elbow. The opposite motion is extension, which is the act of straightening a joint, such as the knee when you are standing.
Your need and desire for high flexion may be dictated by your favourite activities or cultural background. Many daily activities require the ability to bend the knee beyond 125 degrees. Climbing stairs, for example, requires a range of motion from 75 to 140 degrees while sitting in a chair and standing up again requires a 90-to-130-degree range of motion. Other activities, like gardening, playing golf, or kneeling for prayer involve motions that require up to 130 to 150 degrees of flex-ion to perform.
Getting a full range of motion, strength and flexibility back after surgery usually takes time. That’s where pre-operative exercise and education and post-operative physical therapy programs come in to ensure you’re physically and emotionally prepared for surgery, and to maximize your recovery after surgery.
Knee replacement surgery is recommended when the cartilage layer in your knee has completely worn off. This usually manifest as pain while walking and development of deformities in the knee. The Orthopedician will get x-rays of your knee joint done to conform the diagnosis.
Although performed commonly now, Knee replacement surgery needs to be done by a specialist joint replacement surgeon at specialized hospital. Choosing your hospital and surgeon correctly is of vital importance for a successful surgery. Even though your surgeon will cross check and investigate you for any other issues like throat, ear and urinary tract infections, it is important to bring any such infection to attention. It is also imperative to mention any other long term illness and medical history to your surgeon before the surgery. You need to plan to take a break of at least three weeks from your regular activities. It is better to request that a relative be present or arrange for an attendant for the first two weeks after the surgery. Hospital with specialized or a separate joint replacement OT should be proffered. Overall cleanliness of the hospital will give you a rough idea about the hygiene and anti-infection protocols being practiced in the hospital.
It usually depends on whether one knee or both knees need surgery. A single knee replacement usually means about 3 to 5 days of hospital stay where as both knees being replaced would means 7 to 9 days of hospital stay.
A day after the surgery, you will be made to stand and walk a few steps and you will feel completely normal in a few weeks. The belief of being bedridden after surgery is a total myth.
The average expenditure of a TKR in a specialty hospital using standardized US FDA approved implants would range between INR 1.6 to 1.8 lacs per joint. The cost of the implant itself is about 40-60% of the total expenditure. Specialized joint replacement operation theaters use strictly controlled air pressure and temperature control settings. Besides this, a modern OT set-up at Columbia Asia Hospital, disposable or single use equipment is used to reduce the chance of infection. Hence the cost at specialized centers will be higher than the average hospitals.
Common Myths and Facts of Knee Replacement
Selection of a cases for a knee replacement is not based on age but on the person’s level of pain and immobility. The usual age for arthritis to cause disabling pain affecting the quality of life in patients is after the age of sixty. However, it may be needed by some in their 40s depending on tolerance to pain and limitation of mobility. Similarly, patients above the age of 75 years should not be denied this surgery solely because of their age. Their fitness level should be assessed and they can safely undergo the procedure if they do not have other uncontrolled or untreated illness.
The name ‘total knee replacement’ is a misnomer as the joint is never totally replaced. Just about 8 to 10 mm of bone at the damaged ends of the joints are cut and capped by metallic implants. It would be more apt to call it ‘joint resurfacing’.
Top orthopaedic surgeons say “don’t wait”. If everyday activities are causing pain and interfering with your daily life, and you have already tried non-surgical options such as medication and physiotherapy, it is time to discuss the option of joint replacement surgery with your orthopaedic surgeon. If you need to take a pain killer tablet every time you have to travel, it is an indication that a joint replacement would be helpful. Painkiller for prolonged period could damage the liver and kidneys.
Body mass as well as the appropriate surgical technique plays an important role in achieving good knee bending. A patient who has undergone knee replacement can occasionally sit cross legged but definitely not for long periods as this position can wear out the implant earlier and reduce the life of the replaced joint.
The whole purpose of undergoing a Total Knee Replacement is to increased one’s mobility. In fact, patients are encouraged to stand with assistance on the evening of the procedure itself and start walking with the help of a walking aid from the next day. Most patients experienced a dramatic increase in their mobility levels. Knee replacement surgery is found to be one of the procedures with a success rate of almost 98 percent.
The surgery cost anywhere between Rs 1.7 lakh to Rs 2 lakh when done in standardized centers using US FDA approved implants. A significant amount of the expense is because of the implants which are an imported. While indigenous implants are a promising option its long term performance is yet to be assessed.
If you have severe arthritis in both your knees it is definitely prudent to get them operated together provided your medical fitness has been approved by a physician. Operating on both knees together does improve your post-operative mobility much faster than doing them in two separate operations, besides the financial and logistical advantages.
Most of the implants are made of metallic alloys which are highly biocompatible hence they do not cause any reactions. A few patients have nickel allergy (which is rare) and in such cases, studies have recommended the use of Oxinium or at times Gold plated components.
The infection prevention strategies are standardized in Columbia Asia Hospital where strict adherence to protocol is followed. These guidelines specify the operating room environment and infection control practices which help in eliminating infection. There are also surveillance mechanisms in place for infection control across the hospital.