Hip
Total Hip Replacement
A hip replacement swaps a worn ball-and-socket joint for an artificial one. The damaged head of the thigh bone is removed and replaced with a stem and a new ball, and the socket in the pelvis is resurfaced with a cup, restoring smooth, weight-bearing movement.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
When it is worth considering
Hip arthritis is often mistaken for a back problem, because the pain typically sits in the groin and can travel down the front of the thigh towards the knee rather than over the hip itself. The other classic sign is difficulty with socks, shoes and nail-cutting on that side, because the joint no longer rotates.
Replacement usually enters the conversation when:
- Groin or thigh pain persists at rest and disturbs sleep
- Walking distance has dropped markedly and a stick has become necessary
- Putting on socks or shoes on that side has become difficult or impossible
- Painkillers, physiotherapy and activity changes are no longer holding it
- The hip has collapsed following avascular necrosis, or has been damaged by a fracture
What the operation involves
The procedure usually takes one to two hours, most often under spinal anaesthesia. The worn ball is removed, the socket is prepared and a cup is fixed into the pelvis, and a stem is seated in the thigh bone to carry the new ball.
Leg length and the position of the components are checked during the operation, because both determine how stable the hip feels afterwards and whether the two legs end up the same length.
Hip replacement, along with knee replacement, was the subject of Dr. Khanna's arthroplasty fellowships in Mumbai and at Max Superspeciality Hospital, Mohali.
Recovery, week by week
Hip replacement recovery is usually faster and less painful than knee replacement, which surprises people who expect the opposite.
- Day 0 to 1. Standing and walking with a walker, generally the same day or the next.
- Week 1 to 2. Two to four days in hospital. Walking indoors with support and practising the movement precautions below.
- Week 3 to 6. Stick rather than walker, stairs, and back to desk work for most people.
- Week 6 to 12. Walking unaided, driving once safe, and most daily activity back to normal.
- 3 to 6 months. Strength and endurance continue to build; most people describe the hip as feeling like their own by this point.
The movement precautions
For the first six to twelve weeks the new hip can dislocate if it is pushed into certain positions before the soft tissues around it have healed. Which positions depends on the surgical approach used, so you will be given instructions specific to your operation. Commonly they include:
- Not bending the hip past 90 degrees, so no low chairs, low toilets or deep sofas
- Not crossing the operated leg over the other one
- Not twisting the body over a planted foot
- Sleeping on your back, often with a pillow between the knees, for the first few weeks
Getting a raised toilet seat and a firm high chair organised before the operation makes the first fortnight considerably easier.
Risks worth knowing about
Dislocation, infection, blood clots, a difference in leg length, loosening or wear of the implant over the years, and injury to nearby nerves are the main ones. Fracture of the thigh bone around the stem is uncommon but possible, particularly in thin or osteoporotic bone.
Modern hip implants commonly last twenty years or more, and often longer in an older, less active patient. As with the knee, that lifespan is part of deciding when to operate rather than an afterthought.
Common questions
Will my legs end up the same length?
That is the aim, and it is measured during the operation. Small differences of a few millimetres are common, usually unnoticeable, and easily managed with a shoe insert if they are felt at all.
Can I sit cross-legged or squat afterwards?
Both push the hip into the positions that risk dislocation, so they are generally advised against, squatting toilets included. This matters more in Indian households than the standard advice usually acknowledges, so plan for it before the operation.
How soon can I climb stairs?
Usually within the first few days, leading with the unoperated leg going up and the operated leg going down. Your physiotherapist will take you through it before you are discharged.
Is hip replacement more painful than knee replacement?
Generally less. Most patients find the early recovery easier than they expected, and easier than a knee replacement on the same timeline.
Not sure whether you need this?
That is the right question to bring to a consultation. Second opinions on surgery already advised elsewhere are a routine part of the practice. Bring your imaging and any plan you have been given.
Not sure this is your problem?
These start from the symptom rather than the operation, and cover what else can cause it and what gets tried first.