Revision Hip Replacement in India

India is a popular destination abroad for revision hip replacement (or arthroplasty) surgery. Revision hip replacement is an orthopedic surgery to replace an earlier hip prosthesis that has worn out. Though first-time hip joint replacements are common and successful nowadays, they tend to wear out with time. When a patient’s hip replacement has worn out, he/she may need a revision hip surgery.

Revision hip replacement surgery is more complicated and time-consuming than first-time total hip replacement surgery. As a result, cost of revision hip surgery is very high in USA, Canada and UK. It would be much more affordable to get your revision hip replacement surgery in India at world class hospitals by board certified orthopedic surgeons.

Why does Revision Hip Replacement become Necessary?

Hip joints are replaced for the first time in patients suffering from severe hip arthritis or trauma. These hip prostheses work very well in the first 15 years for most people. However, by 15 to 20 years, a good number of people will have worn out their prosthesis and will need hip revision surgery.

• Hip replacements can wear out for reasons like infections, damage to the prosthesis, bone breakage around the replacement, etc.
• Obesity can contribute to faster wearing of the hip implant.
• People who undergo hip replacement at a relatively younger age will probably outlive their hip prosthesis. People who are very active are at higher risk. Ceramic hip replacement which has less wear than MoM prosthesis may be of help to this category.
• Another common reason is aseptic loosening which is the loosening of the hip implant inside the bone. This is a painful condition. If there are causes like infections for needing revision surgery, these will have to be taken care of separately before revision surgery is done.
• A US study of 51,000 hip revision surgeries found that dislocation of the initial prosthesis was the reason in 23% of hip revisions while 20% was accounted for by mechanical loosening of the device and another 15% of revisions were needed due to infections.

It must be noted that all individuals who need a revision surgery do not experience symptoms. Conversely every person who experiences some of the symptoms cannot undergo the rigors of revision surgery. A decision in this regard can be made only after a thorough medical examination of the candidate to see if the benefits outweigh the risks.

Advantages and Risks of Revision Hip Replacement

Benefits:

• Pain relief.
• Improved ease in movement.
• Treatment of infection and avoiding further complications.

Disadvantages:

• By the time revision surgery is needed, the person has advanced in age. Quality of the bone becomes an issue due to this.
• With total hip replacement the first time, your orthopedic surgeon would have removed some bone in order to fix the prosthesis. Availability of sufficient bone to secure the revision prosthesis can be a problem.
• In several cases, bone grafts are needed. This involves addition of bone material to reconstruct the acetabulum (hip socket) from where bone was removed to fix the prosthesis. It can be an auto-graft (bone taken from other parts of one’s own body- e.g. pelvis) if the requirement is very small. If more bone is needed, the hip surgeon will use an allograft (donor bone). Due to concerns like contracting HIV or hepatitis, the bone tissue needs to be screened thoroughly for infectious agents and proper processing.
•  After grafting, you are advised to avoid putting weight on the operated hip for three months or so. This time is needed for the graft to grow into solid bone. This can be a lot of hard work and you will need crutches for some time. Patients for revision surgery are typically older and less able to cope with long procedures and blood loss.
• The old, worn out prosthesis has to be removed. This adds to the time and complicated nature of revision hip replacement surgery.

Risks:

• There is a chance of the femur bone fracturing during surgery. If this happens, extra repair measures will be needed.
• The operated leg may end up being shorter or longer than before surgery.
• Mobility and range of motion may be more restricted compared to after first-time replacements.
• You may be unable to regain your normal gait again.
• Dislocation and loosening risk is to be expected in the first three months after operation. Greater pre-operative bone loss and poor quality of bone increase this risk.
• Infection, bleeding, trauma to nerves in the region etc are likely, just like in all surgical procedures.
• Blood clots in legs or lungs can occur due to twisting and trauma of blood vessels.
• Patients with existing heart and lung problems may experience problems related to these.

For all these reasons, a revision hip arthroplasty has to be carefully considered and planned.

Why consider India for Hip Revision Surgeries?

The reasons for India’s popularity as a center for hip revision surgery are:

• The number of revision surgeries performed by the specialist orthopedic surgeons in India is very high compared to that done by their counterparts in the West. This is good news as revision surgeries usually require higher level of expertise and experience for good results.
• The cost is way lower. This, again, is very advantageous as revision surgery is usually performed on older people, whose income may have been reduced or who may be dipping into their savings for this surgery.
• Most insurance plans do not cover revision surgeries.
• Most surgeons have been dealing with Western patients for a long time now. So, there is ease and comfort on both sides.

Cost of Revision Hip Replacement in India

Revision hip surgery is technically more demanding of the surgeon. Only highly experienced hip surgeons undertake to perform this surgery due to increased risk factors. Consequently, revision hip surgery is even more expensive than primary THR. Orthopedic surgeries are highly costly in USA, Canada and UK.

For the medically uninsured population, revision hip surgery in world-class orthopedic hospitals in India can work out much more affordable. Orthopedic surgeons in India have high level of expertise and specialization in surgeries such as hip resurfacing, revision hip surgery and knee arthroplasty.