According to World Health Organization, total hip replacement [THR] is one of the most successful and cost effective procedure in modern medicine which was introduced in early 1960s by Sir John Charley. THR can relieve pain, restore function and improve quality
of life.

There are about 100 different types of arthritis which could affect joints however common types are osteoarthritis, rheumatoid arthritis, secondary arthritis due to trauma or infection.
Osteoarthritis is degenerative condition seen with advancing age where the cartilage is gradually worn away and leads to pain. One can slow the progression of arthritis by maintaining ideal weight and strength in the muscles. Specific conditions like gouty arthritis or rheumatoid arthritis should be treated with appropriate medication. In advanced conditions with loss of cartilage total hip replacement is choice of treatment. In avascular necrosis of head of femur with collapse hip replacement is indicated direct anterior approach is considered the most preferred choice in hip surgery now.
Conventional approaches involve cutting muscle that support and stabilize hip joint while in direct anterior approach muscles are separated to reach and expose the hip joint. Pain and bleeding is relatively less in this approach and rehabilitation is quicker.

Dr Sharat Kumar said that due to improvements in anaesthesia, pain management, surgical techniques and implant design it is safe to do both hip replacements simultaneously. Approximately 10 percent of total knee replacements are bilateral however less than 1 percent are bilateral total hip replacements.

He also added there is convincing clinical evidence showing simultaneous both hip replacements to be as safe as sequential hip replacements. He felt that there are multiple benefits and many patients would prefer to undergo same day and avoid another surgery and rehabilitation there by saving significant time as well as overall cost of surgery.

He did caution that patient selection is crucial as all patients are not suitable candidates and every case has to be considered on an individual basis in order to avoid complications particularly in the elderly with multiple medical conditions. He added that performing bilateral total hip replacements can be demanding and it is essential to have experience and familiarity in different types including cemented, uncemented and hybrid type of hip replacements.

Fitness is Crucial

Precision joint replacement technique and advances in technology brought in many changes in implant designs giving more joint stability as well as longevity. Regular low impact exercise has multiple health benefits. It improves muscle strength, flexibility and improves the range of movements and joint stability. It is paramount that while performing some exercises utmost caution and discretion is needed as over stretching could result in joint dislocation.

Fitness is an integral part of successful surgical outcome and excellent surgery can be marred by lack of fitness. Dr P Sharat Kumar feels fitness improves not only the quality of life but also the life of the joint replacement and could delay the need for revision joint replacement surgery.