On July 31, 2021. Seniors Today hosted its weekly Health Live webinar with Dr Dilip Shah, leading Orthopaedic Surgeon. Dr Noor Gill captures the takeaways from the session.
Dr Dilip Shah is a leading Orthopaedic Surgeon based in Mumbai. With over four decades of experience, Dr Shah completed his MBBS from the KEM Hospital and Seth GS Medical College in 1978 and MS – Orthopaedics from KEM & GSMC in 1980. He has done his D Ortho from Mumbai at the College of Physicians and Surgeons. He is a member of the World Orthopaedic Surgeon’s Association (SICOT) and the Bombay Orthopaedic Society. Dr Shah is a recipient of the highest fellowship of SICOT, Italy, in 1985 and an also an an awardee of AO International Fellowship, German, in 1995. He received the national fellowship (BOS) in 1989. In this Health Live @ Seniors Today session, he spoke about and answered questions about total hip replacement.
- D.ORTHO IN 1980 from b’bay, college of physicians & surgeons
- Winner of the highest fellowship of SICOT, Italy in 1985
- Instructor for AO courses since 1985
- Awardee of AO international fellowship, Germany in 1995
- Winner of national fellowship BOS in 1989
Some of the cases/ conditions where you may require total hip replacement include:
- Rheumatoid arthritis- the patient has crooked fingers and the disease involves many other joints as well.
- Juvenile rheumatoid arthritis
- Ankylosing spondylitis- these patients have a bamboo spine and most of the movable joints tend to have restricted range of movement or no movement at all.
- Avascular necrosis
- Slipped capital femoral epiphysis- is a condition where the head of the femur slips with respect to the rest of the femur.
Congenital hip dislocation
Dysplasia of hip- the growing end of the femur gets affected during the childhood itself
Paget’s disease where the hip gets eroded.
Fracture of the femur
Hemophilias can also lead to requirement of hip replacement
Tumours in the hip where we might have to remove a part of the femur and perform a hip replacement
Achondroplasia
Dr Shah says that he does not recommend total hip replacement unless the patient wants it. If it is done in cases where it is not indicated, it is unethical.
- Exercises immediately after a total hip replacement surgery are very important. These include-
- Moving your foot up and down
- Rotating your toes and ankle
- Move your hip and knee joint
These exercises are important because if you fail to do them, there is something that is called the embolic phenomenon in which a clot that is formed elsewhere in the body travels to another site such as the heart or the brain via the bloodstream, which can be taxing to your life as well.
Exercise prescription after the operation, in the later stages includes:
Standing behind a chair
Moving one hip after the other with a firm and stable support
Some complications of the surgery include:
Blood collection
New bone formation
Air bubble or fat embolism that can travel to your lung
Nerve and blood vessel damage
Subluxation fractures of the acetabulum
Loss of bone
– A few takehome message from Dr Shah for prevention are:
- Don’t lock the doors from inside when you’re in the bathroom.
- While taking a bath or a shower, make it a point to sit down on a stool and then do so.
- Keep a hand hold/ support attached firmly to a wall near your WC and use it while sitting down and while standing up from the commode
- If you have difficulty maintaining balance or trying to wear your trousers, sit on the bed or a chair and then wear it.
- When you’re getting out of bed, get up from the bed to sitting position, stay there for 30-40 seconds and then go on to standing up. After you’ve stood up, stand near the bed for 30-40 seconds before you start walking or attending calls, especially at night.
- Avoid climbing stools. If you want to reach for something in the cabinets, ask someone else to do it for you.
- It is always better to have a call bell in your room in case of an emergency.
- Always have a dim light on in your room and in the bathroom at night.
Hip replacement includes replacing 2 components- the cup and the saucer. In no way should that be confused with the replacement of pelvis, which is done in only extreme cases and tumours.
If you have pain in the hip that radiates to the thigh, the follow up question should be, does it go to the front of your thigh or the back?
If it is radiating to the front of the thigh and is aggravated on moving the hip, the most probably cause is hip arthritis.
If it is radiating to the back of the thigh and goes down to your knee, ankle, foot, it is sciatica pain which can be caused due to a mild slip disc.
So this required thorough clinical examination to determine whether your problem is one due to the hip or the nerve.
For this you can also get radio imaging X-ray, both hip, lateral view and lumbosacral spine X-ray- AP and lateral view.
AVN (avascular necrosis) has been staged into stages 1 through 4. Stages 1 and 2 can be treated with complete bed rest and medical intervention but once it progresses to stages 3 and 4, it inevitably requires total hip replacement because the pain can be unbearable.
You can get a bilateral hip replacement surgery, but it also depends on the patient, the anaesthetist, the insurance company and coverage.
A well-done, uncemented hip replacement can last 20-25 years. But after 25 years the components start becoming loose.
Dr Shah prefers spinal epidural anesthesia for hip replacement surgery in the senior citizens.
