Restore Mobility with Joint Replacement Surgery

Understanding Joint Replacement in the Indian Context

Osteoarthritis affects 1 in 5 Indians over age 60, with knee arthritis particularly prevalent due to floor-sitting, squatting lifestyles, and genetic predisposition. At Ajuda Hospitals, our joint replacement program combines international best practices with culturally adapted rehabilitation—helping patients return to temple visits, floor-sitting, and Indian toilet use.

Joint replacement (arthroplasty) involves removing damaged cartilage and bone, then inserting metal, ceramic, or polyethylene components that glide smoothly, eliminating pain and restoring function. Advances in computer navigation, minimally invasive surgery, and rapid recovery protocols now allow same-day mobilization and 3-4 day hospital stays.

Hyderabad's aging population and rising obesity rates drive increasing demand for knee and hip replacements. Our multidisciplinary team—orthopaedic surgeons trained at top fellowship centers, anesthetists specializing in regional blocks, physiotherapists, and pain management experts—delivers outcomes matching Apollo, CARE, and international standards.

When to Consult Our Joint Replacement Specialists

Schedule a consultation if you're over 60 with progressive joint pain, or younger with post-traumatic or inflammatory arthritis. Early evaluation allows pre-operative optimization (weight loss, diabetes control, dental clearance) for better outcomes.

Our Diagnostic Approach

Comprehensive Joint Assessment

History: Pain location, duration, night pain, functional limitations (Oxford Knee/Hip Score questionnaire). Previous treatments: NSAIDs, physiotherapy, steroid injections, viscosupplementation.

Physical Examination:

• Range of motion: Knee flexion (normal 135°), hip internal rotation (normal 45°)
• Alignment: Varus (bow-legs), valgus (knock-knees), fixed flexion deformity
• Stability: Ligament laxity (ACL, PCL, collaterals) affects implant choice
• Leg-length discrepancy: Hip arthritis causes shortening; corrected during THR
• Gait analysis: Antalgic limp, Trendelenburg gait (abductor weakness)

Imaging & Severity Grading

Standing X-rays (weight-bearing essential to assess true joint space):

• Kellgren-Lawrence Grade 0-4: Grade 3-4 (severe space narrowing/bone-on-bone) qualify for surgery
• AP, lateral, skyline views: Document patellofemoral arthritis, osteophytes, subchondral cysts
• Full-leg alignment films: Measure mechanical axis for computer navigation planning

MRI (ordered if):

• Isolated cartilage defect vs diffuse arthritis unclear (partial vs total replacement decision)
• Meniscal tear or ACL deficiency confounding symptoms
• Avascular necrosis or bone marrow edema suspected

CT scan: 3D reconstruction for complex deformities (post-traumatic arthritis, prior osteotomies, hardware in situ).

Medical Clearance & Optimization

Mandatory Pre-operative Workup:

• Blood tests: CBC (Hb >10 g/dL to avoid transfusion), HbA1c (<7.5% reduces infection 3x), renal/liver function
• ECG, chest X-ray, cardiology clearance if age >60 or cardiac history
• Dental evaluation: Untreated caries/periodontitis seed prosthetic infections months later
• Urine culture: Treat UTI pre-operatively; post-op bacteremia can infect implant

Weight Optimization: BMI >35 doubles infection and dislocation risk. We offer bariatric consultation and 3-month weight loss program before surgery.

Digital Templating & Implant Selection

Pre-operative Planning:

• Digital X-ray templates estimate implant sizes (femoral/tibial components, polyethylene thickness)
• Correct leg-length discrepancy in hip replacements (avoid nerve stretch palsy)
• Choose cemented (elderly with osteoporosis) vs uncemented (younger with good bone stock) fixation
• Select bearing surface: ceramic-on-polyethylene (lowest wear), metal-on-polyethylene, or highly cross-linked polyethylene

Treatment Pathways

Our joint replacement protocols follow Indian Orthopaedic Association and American Academy of Orthopaedic Surgeons (AAOS) guidelines:

Total Knee Replacement (TKR)

Indications: Grade 3-4 osteoarthritis, rheumatoid arthritis, post-traumatic arthritis with tri-compartmental involvement.

Procedure (Computer-Assisted):

1. Infrared trackers attached to femur and tibia
2. Computer maps bone anatomy in 3D space
3. Saw cuts made within 0.5° of planned alignment (manual surgery: ±3° accuracy)
4. Remove damaged cartilage/bone from femoral condyles, tibial plateau, patella
5. Trial implants test stability and range of motion
6. Cement final metal/polyethylene components
7. Tourniquet deflation, hemostasis, drain insertion, closure

Mobilization: Sit at bedside 4 hours post-op. Walk with walker by evening. Continuous passive motion (CPM) machine overnight.

Hospital Stay: 3-4 days. Discharge when independent walking, stair climbing, and flexion >90° achieved.

Partial Knee Replacement (Unicompartmental)

Indications: Isolated medial or lateral compartment arthritis. Intact ACL/PCL. Age >60 (younger patients risk progression to total replacement).

Advantages:

• Smaller incision (8 cm vs 15 cm for TKR)
• Preserves cruciate ligaments—more natural knee feel
• Faster recovery: Return to activities at 6 weeks vs 12 weeks for TKR
• Bone preservation: Easier revision to TKR if needed later

Outcomes: 85% 10-year survival. 10-15% require conversion to TKR due to opposite compartment degeneration.

Total Hip Replacement (THR)

Indications: Grade 3-4 hip osteoarthritis, avascular necrosis, rheumatoid arthritis, femoral neck fractures in elderly.

Approaches:

• Posterior: Larger surgical exposure; higher dislocation risk (3-5%) requiring 6-week hip precautions
• Anterior (minimally invasive): Muscle-sparing, faster recovery, lower dislocation risk (<1%), difficult in obese patients
• Lateral: Trendelenburg gait risk due to abductor damage; rarely used now

Procedure:

1. Dislocate hip; remove femoral head with oscillating saw
2. Ream acetabulum; press-fit metal shell with screw fixation
3. Insert polyethylene liner (locking mechanism prevents dissociation)
4. Broach femoral canal; insert stem (cemented or press-fit)
5. Trial heads test leg length and stability
6. Insert final ceramic or metal head; reduce hip
7. Check stability in flexion, extension, internal rotation

Mobilization: Full weight-bearing same day if uncemented stem. Walk with walker by evening.

Hospital Stay: 3-4 days. Discharge with hip precautions (no crossing legs, no bending >90°) for 6 weeks.

Revision Joint Replacement

Indications: Aseptic loosening (wear debris causes bone loss), infection (2-stage revision with antibiotic spacer), instability/dislocation, implant fracture.

Challenges:

• Bone defects require grafts (morselized cancellous auto/allograft) or metal augments (wedges, cones)
• Soft tissue scarring, ligament insufficiency need constrained implants (hinged knee, dual-mobility hip)
• Higher complication rate: infection (5-10%), re-revision (15% at 10 years)

Outcomes: 80-85% good results at 10 years. Early detection of loosening (X-ray surveillance) improves revision success.

Technology & Innovation

Computer-Assisted Navigation

How It Works:

• Infrared cameras track bone-mounted trackers and surgical instruments in 3D space
• Surgeon registers anatomical landmarks (hip center, knee epicondyles, ankle center)
• Computer calculates mechanical axis and guides bone cuts to achieve neutral alignment (0° ± 3°)

Benefits:

• Reduces outliers (>3° malalignment) from 20% to <5%
• Each 1° varus/valgus error increases polyethylene wear by 15% annually
• Improved implant longevity: 92% 15-year survival vs 87% with manual technique

Robotic-Assisted Joint Replacement

Mako/Rosa Robotics: Surgeon plans bone cuts on pre-operative CT scan. Robotic arm executes plan with submillimeter accuracy. Haptic feedback prevents saw deviation beyond virtual boundaries.

Outcomes: Even more precise than navigation. Enables partial knee replacements in challenging anatomy.

Rapid Recovery Protocols

Multimodal Analgesia: Spinal anesthesia + adductor canal block + periarticular infiltration (cocktail of local anesthetic, epinephrine, steroid) eliminates opioid need, enabling same-day mobilization.

Tranexamic Acid: Antifibrinolytic given pre-operatively reduces blood loss by 50%. Eliminates transfusion need in 95% of cases.

Early Mobilization: Out of bed 4-6 hours post-op. Prevents DVT, pneumonia, delirium. Reduces hospital stay from 7 days to 3-4 days.

What to Expect: Your Care Journey

Pre-Operative Phase (2-6 Weeks Before Surgery)

• Joint replacement education class (surgery details, expectations, home preparation)
• Physiotherapy sessions: Strengthen quadriceps, hamstrings, core—speeds post-op recovery
• Dental clearance, medical optimization (HbA1c, weight, anemia correction)
• Arrange home help: Walker, raised toilet seat, shower chair, someone to assist first 2 weeks

Day of Surgery

• Admission 2 hours before surgery
• Spinal/epidural anesthesia (awake but numb below waist) or general anesthesia
• 1-1.5 hour surgery
• Recovery room 1-2 hours; pain control with nerve blocks
• Transfer to ward; physiotherapist assists sitting at bedside by evening

Post-Operative Days 1-3

• Day 1: Walk with walker; perform ankle pumps, quadriceps sets; oral diet resumed
• Day 2: Walk 50-100 meters; practice stairs with rail; X-ray confirms implant position
• Day 3: Drain removal; independent walking; wound inspection; discharge planning
• Day 4: Discharge home with physiotherapy prescription, pain medications, anticoagulation (enoxaparin/rivaroxaban for 2 weeks), infection prevention instructions

Outpatient Follow-Up

• Week 2: Suture removal, wound check, confirm no signs of infection
• Week 6: X-rays assess alignment, early signs of loosening; advance to full weight-bearing; wean off walker
• Month 3: Return to most activities; driving cleared; swimming encouraged (low-impact lifelong exercise)
• Year 1 & Beyond: Annual X-rays monitor for wear/loosening; report any persistent pain or instability

Preventing Complications

Joint replacement complications are rare (<5%) but serious:

Infection (1-2%)

Risk Factors: Diabetes, obesity, steroid use, rheumatoid arthritis, poor dental hygiene.

Prevention:

• Pre-operative chlorhexidine baths; nasal mupirocin if MRSA carrier
• IV antibiotics (cefazolin) 30 minutes before incision
• Laminar flow OT; surgeon double-gloving; antibiotic-loaded cement

Management: Early infection (<6 weeks): Washout + implant retention. Late infection: 2-stage revision with antibiotic spacer.

Dislocation (2-5% Hip, <1% Knee)

Risk Factors: Posterior approach THR, weak abductors, prior hip surgery, neuromuscular disorders.

Prevention: Anterior approach THR (lower risk), larger femoral head (36mm vs 28mm), hip precautions for 6 weeks.

Management: Closed reduction under sedation. Recurrent dislocation requires revision to constrained liner or dual-mobility cup.

DVT/Pulmonary Embolism (1-3%)

Prevention: Mechanical (calf pump devices, TED stockings) + chemical prophylaxis (enoxaparin, rivaroxaban, aspirin) for 2 weeks. Early mobilization paramount.

Screening: Report unilateral calf swelling, shortness of breath, chest pain immediately. Doppler ultrasound confirms DVT; CT angiogram for PE.

Aseptic Loosening (5-10% at 15 years)

Cause: Polyethylene wear debris triggers macrophage-mediated bone resorption (osteolysis).

Prevention: Highly cross-linked polyethylene (wear rate 0.05 mm/year vs 0.1 mm/year with conventional), ceramic bearings (even less wear).

Detection: Annual X-rays after 5 years look for radiolucent lines (>2 mm progressive lines indicate loosening).

Why Ajuda for Joint Replacement?

Take the First Step

If joint pain is limiting your life—preventing temple visits, gardening, or playing with grandchildren—joint replacement can restore your independence. Our team will guide you through every step, from pre-operative optimization to lifelong follow-up.

Schedule Your Evaluation: Call 9010550550 or WhatsApp to book a consultation. Bring recent X-rays and medication list. Most patients qualify for cashless insurance authorization.

Reclaim your mobility and pain-free living with Ajuda's world-class joint replacement program.