Hip Replacement and Knee Replacement Surgery

Hip Joint and Knee Joint pain is one of the serious problems that usually affect aged and adult people. We witness this problem in just less number of children and young folks. However, if the knee and hit joint pain are too severe, there are few medications and other treatment options that help relieving the pain.

If this problem in a patient reaches a critical stage then, the doctors advise replacement surgery. Hip replacement and knee replacement surgeries are surgical procedures in which a doctor removes a painful hip joint or knee joint damaged by arthritis. Later, it is replaced with an artificial joint made up of metal and plastic components.

Here is an excerpt from a video interview with Dr. B V R N Varma, Chief Orthopaedic Surgeon & Joint Replacement Surgeon, OMNI Hospitals, Visakhapatnam on Hip Replacement & Knee Replacement Surgery, causes of Knee Joint and Hip Joint Pain, surgery procedure and more.

Q. What is Hip Replacement and Knee Joint Replacement?

A. Replacing the head of the hip joint through artificial implantation made of metal or some plastic components. If all the treatment options are failed, they go for hip replacement surgery. This procedure relieves pain in the hip joint of the patient and helps them walk easily without much struggle.
The replacement of cartilage alongside the part of a bone is called Knee Replacement. A tiny part of the bone is cut for this replacement procedure. It is further implanted with titanium.

Q. What Causes Pain in Knee Joint and Hip Joint?

A. The causes of knee joint and hip joint and quite different. People usually get knee joint pain due to arthritis and degenerative changes. When a person becomes older, they undergo a few degenerative changes.
Some of them feel pain in the knee joint in their old age. Just the way skin turns wrinkled as age increases, people feel pain in their knees as they become older. Most commonly, old people get arthritis in the knee joint.
On the other hand, the most common causes of hip joint include injuries to the hip joint, Rheumatoid Arthritis, fractures secondary arthritis. All of these can cause pain in the hip joint.

Q. What is double or bilateral joint replacement surgery?

A. Bilateral replacement can be done for both hips or both knees. Single Knee replacement can be done for one knee joint either right one or left one. For instance, a young person having pain in both the knee joints then, the replacement will be done in a single sitting, one after the other. For one knee joint replacement, it takes an hour or more.
If the patient is more than 60 years and the cardiac status is not good then, the replacement will be done only for a single knee joint replacement. After a period of 3 months, 6 months or 1 year, the replacement will be done for the second knee joint.

Q. What are the risks of delaying a joint replacement surgery?

A. The joint replacement surgery is actually done for two main reasons. One is to relieve the pain and improve the functioning of the knee joint. If the cartilage is eroded, it is very much difficult to regrow the cartilage using medications. There is no medicine that helps in the growth of cartilage.
If it is the 1st or 2nd stage then, it is possible to reduce the joint pain through medication. But, if it is stage 3 and beyond then, it is not possible to regrow the cartilage. In general, the replacement surgery for a knee joint is performed for those whose age is above 55 or 60 years. Once the surgery is done, it enhances the functioning of the knee joint. The patient becomes pretty active and capable of walking without any support.
The hip replacement surgery is usually done for young patients. This particular surgery is done in a very rare case in old age patients. People suffering from hit joint pain cannot sit, climb stairs, squat, and cannot walk straight. If such patients don’t undergo hip replacement surgery, they can’t perform their daily activities as mentioned earlier. The more you delay the surgery, the more deformities happen in the hip joint or in the knee joint.
The doctor will suggest surgery only if you are fit for it. If the pain is affecting the functioning of the knee joint or hip joint then, the patient must and should go for a hip joint or knee joint replacement surgery. Otherwise, the patient in stage 3 has to undergo hip or knee replacement surgery.

Q. What is the difference between full and partial knee replacement?

A. Knee replacement has two compartments. Medial compartment [inside] and lateral compartment [outside]. If the young patient suffering from a knee replacement inside the knee joint or injuries or fractures then, partial replacement surgery is done. In partial knee replacement surgery, only half of the knee joint is replaced. If it is stage 3 then, a full knee replacement is suggested.

Q. How long does the surgery take place?

A. In general, the doctors ask the patient to come a day before the surgery. They perform all sorts of checkups such as blood tests, anesthesia checkups, cardiac checkups, physical fitness and other tests. Some of the cardiac patients use blood thinners. Such patients must tell the surgeon that they use blood thinners. In such a case, they must stop using blood thinners 5 days before the surgery.
They must admit to the hospital 1 day before surgery. At the time of the surgery, you require blood packets for the replacement. Based on the count of hemoglobin, you must arrange the number of blood packets that are essential during the surgery. The time for surgery is precisely 1 hour and 10 minutes that include giving anesthesia, and for stabilizing the patient.

Q. Should the patient reduce weight before surgery?

A. Mostly, patients visit the doctor only when they get severe pain i.e., at their stage 3 or stage 4. Such patients actually can’t reduce their weight to a maximum extent. However, they might reduce the consumption of foods that increase weight. But, it is not enough. Once the replacement surgery is done, they can start doing gradual walking in a park or around the house after 6 weeks or 2 months. As soon as the pain decreases and the functioning of the joints are proper then, they can go for walking on a frequent basis. As a result, they can reduce weight.

Q. Can excess weight cause Knee Arthritis?

A. Excess weight is one of the major causes of knee arthritis. Even patients with normal weight can also get arthritis. In fact, arthritis is a universal degenerative condition. Irrespective of the weight of the person, people might get arthritis. If the weight of a person is more then, they get severe pain while climbing the steps and the functioning is limited.

Q. Will the patient have In-Patient or Out-Patient Knee Replacement Surgery?

A. Generally, replacement surgery takes only an hour or more. They admit to the hospital a day before the surgery. As it is major surgery, the patient must be careful even after the surgery. The patients must stay at least 4 to 5 days in the hospital after the surgery process.

Q. Are there any complications associated with this replacement surgery?

A. Obviously, there will be minimal complications i.e., 1 percent. In the case of hip replacement surgery, the major complication is a fat embolism. DVT [Deep Vein Thrombosis] is another complication in a patient who undergoes this replacement surgery. If the patient is not active even after the surgery, the doctors will mobilize the patient.
They mobilize the patient a few hours following the surgery or the next day. The doctors must be very careful about the infection part, post-surgery complications and others. Early complications include DVT, fat embolism and others. Some of the aged patients must go for Physiotherapy and practice some exercises to strengthen their bone quality.

Q. What is the success rate of Knee or Hip replacement surgeries?

A. The success rate of these types of surgeries is very high. Knee replacement surgery is one of the most successful surgeries across the world. The rate is about 95 percent. With the latest equipment and greater advancements in the operation theatres, surgical techniques, and anesthesia techniques, the success rate has gone to almost 99 percent.

Q. What is done post knee replacement or hip replacement surgery?

A. After the knee replacement or hip replacement surgery, the patient is taken to the intensive care unit. They need to stay in ICU for about 12 hours to 24 hours based on the recovery of the patient. Once the patient is recovered in the ICU, the patient will be mobilized. A physiotherapist will meet the patient immediately after the surgery. They help the patient in planning an exercise program.
To reduce the pain, the doctors place an epidural catheter where the anesthesia drug is given. It reduces knee pain in the patient. For instance, once the incision is done, the pain will be very high. By increasing the epidural anesthesia, the pain reduces to around 80 percent. After the surgery, the patients can go home and start walking around the house. The pain in the patient’s knee or hip will be reduced in less than a week post-surgery.

Q. How long does the New Artificial Joint Last?

A. In general, the new joint will last long for about 10 to 15 years. As there are advancements in the metallurgy and improvements in surgical techniques, they last long for more than 20 years. The artificial joint materials are paired with ceramic or cobalt-chromium balls to enhance the quality of the artificial joint.
In the case of hip replacement patients, the number of revisions might be more. However, with recent advancements, the quality of new artificial hip joints last for several years. Moreover, it also depends on the patient’s work condition, type of function or the type of work the patient does.

Q. Will the patient get allergy with the type of joint replacement implants?

A. Most of the time, the patients don’t get allergy due to the metal used for the joint replacement. If the metal doesn’t suit the bone then, it becomes loose. In such a case, the patient must go for a revision to the doctor.

Q. What is the difference between Cemented and Uncemented Joint Replacement?

A. This terminology is actually used in case of hip replacement. Uncemented hip joint replacements are usually done to the young patients. In such folks, the bone quality is good. Cemented Hip Joint Replacement is done for old or aged patients. If the bone quality is poor, they prefer cemented joint replacement. Uncemented Hip Joint Replacement is confined to young patients.

Q. What is the pain management therapy post-surgery?

A. During the surgery, they place a small catheter or epidural catheter inside the spinal canal for giving anesthesia to the patient. The power of anesthesia works for about 36 hours to 48 hours. The pain in the patient will be low compared to the spinal anesthesia.

Q. Is there any difference between the recovery time for Hip and Knee Replacement Surgery?

A. No, there is no difference. The recovery time for Knee replacement surgery and hip joint replacement surgery is almost the same.

Q. Should the Patient Require a Guardian During or Pre-Surgery?

A. Mostly, the aged or old people will go for Knee replacement surgeries. Such patients definitely need a guardian to stay with them in the hospital for about 4 to 5 days. The hip replacement patients must stay for about 2 or 3 days.

Q. Do the patient require revision post surgery?

A. Revision is necessary for patients if they get any sort of infection post-surgery. Another main common cause for a revision might be delayed phase i.e., 3 years or 5 years or 10 years. If the bone quality worsens, the implant becomes loose. In such a case, the patients must definitely go for revision. The same thing is done for hip replacement and knee replacement patients.

Q. Do patients require Rehabilitation after surgery?

A. At the time of surgery, the surgeons make an incision which is around 4 to 5 cms. On the same day of the surgery, the patient is mobilized and performs physiotherapy treatment on them. This will be carried out on the 2nd and 3rd days during their stay in the hospital. As a result, they can go home confidently and walk properly through some supports. Finally, they can walk properly even without any support.

Q. How rehabilitation is done in young and old patients?

A. The rehabilitation in young patients is very fast while it is very slow in old age patients. The aged patients are not physically as strong as young patients. It usually depends on the muscle condition of the patient for rehabilitation. The older patients might take around 4 to 8 weeks to come back to their normal condition. The patients who undergo these two surgeries are not allowed to sit on the floor. However, they can sit on a stool which is 10 cm height from the floor if required.

Q. What type of exercises are suitable for a hip replacement surgery patient?

A. Once the patient starts mobilizing after the removal of sutures, they need to go for a good physiotherapist. They need to do essential knee exercises, walking, and other exercises. As a result, the muscles will be strengthened and improves the functioning of the knee joint or hip joint. Walking will definitely bring change in the patient for fast recovery.

Q. What activities can someone perform after surgery?

A. The patient can perform any activity in less than a period of 2 weeks or 3 weeks whether it is a hip replacement or knee replacement surgery. If the patient is very positive and confident, they can do normal activities without any difficulty. The knee replacement patients must take at least 2 to 3 months’ time to carry out their own activities. In the case of a hip replacement patient, they can get back to their routine in a span of 10 days.

Q. Cemented or Uncemented – What type of Hip Joint Replacement is required?

A. It actually depends on the condition of the bone. If the bone is weak, they can go for a Cemented joint replacement. If the bone is strong and the patient is young, they can go for Uncemented joint replacement. If the young patients whose age is between 20 and 24 years, the implant lasts long for about 15 to 20 years. Such patients might require a hip replacement once again sometime later.
It is quite easy to remove an uncemented hip replacement compared to the cemented hip replacement. Some of the female old age patients at the age of 50 or 60 go for the cemented hip. On the other hand, for male people, they can go for cemented or uncemented hip replacement.

Q. What are the preventive measures to be taken after a joint replacement surgery?

A. Physiotherapy: The most important thing a patient must do after joint replacement surgery is Physiotherapy. Wherever the patient does physiotherapy, whether it is their home or hospital or a physiotherapy center, the patient must be highly self-motivated. Spending a lot of money and performing the surgery is not just enough for a fast recovery. The patient must put maximum effort in the form of doing physiotherapy two times a day for a rapid recovery. This way, the patients can do their own activities without other’s help or support.

Q. Is traveling advisable for the patients after joint replacement surgery?

A. The young patients can travel 10 days or 2 weeks after the surgery. But, the old age patients can travel only after 2 months.

Q. Other Inputs regarding Knee or Hip Joint Replacement Surgery

A. Knee replacement has become the most common surgery in the current epoch. Some of the people still get afraid of these surgeries because of their ignorance. Few people may not be aware or don’t have enough knowledge about joint replacement surgery. People having severe knee or hip pain are advised to consult a good surgeon and get adequate knowledge on the surgery and then take a proper decision whether to go for a surgery or just cure it with medication.