FAQ's

Joint Replacement

Arthritic or damaged bones surfaces are removed and resurfaced with an artificial joint know as prosthesis. Knee and hip replacements are most common, but joint replacement can be performed on other joint such as the shoulder elbow, etc

When complete joint is damaged with degenerated cartilage all over then it becomes difficult for the patient to continue day to day activities of life. So total joint replacement to be considered if other options like medication physiotherapy etc will not relieve pain and disability in such condition. The goal is to relieve the pain in the joint caused by the damage done to the cartilage. Total joint replacement which is also called as Arthroplasty is one of the most successful and innovative surgery of 19th Century

Under the effect of spinal or epidural or general anesthesia the damaged ends of the bones and cartilage are replaced with an artificial joint made of metal and plastic surfaces. They are shaped to restore joint movements and function.

The materials used in a total joint replacement are designed to enable the joint to move just like your normal joint and hence resemble the normal joint closely. The prosthesis is generally composed of two parts: a metal piece that fits closely into a matching sturdy plastic piece. Alloys of cobalt, chrome and titanium are main metal used. The plastic used is ultra-high-molecular-weight-polyethylene. Using these advanced bio-materials and well executed surgical technique one can expect excellent results of long term durability

Total Hip Replacement Surgery

This surgery is the most successful innovation of 19th Century. This remains gold standard procedure. In this operation socket and ball (head) of the femur bone is removed. Depending up on the bone quality new socket and stem-head made of different materials is used in. This articular surface material could be combination of plastic (ultra high molecular weight polyethylene) on Metal (cobalt chrome molibdinum), plastic on ceramic ball and ceramic on ceramic ball. Again depending up on the age and quality of bone these joints have been put in with bone cement or without bone cement. Results of this conventional hip replacement surgery are excellent only difference from hip resurfacing is that original ball is not conserved and patients are not allowed to squat

Total Knee Replacement

When whole knee joint (all compartments) is affected then only solution to relieve pain and get back to normal routine activities is total knee replacement surgery. In this procedure thigh bone side of joint(femur) is replaced with metal prosthesis,leg side(tibia)is replaced with metal and plastic and knee cap(patella) is replaced with plastic prosthesis Results and durability of this surgery is excellent

There is a breakthrough technology with high flexion –Knee designs where patient can get complete knee bending and can sit cross legged after surgery. This has been done regularly in Sudha hospital. Knee replacement surgery in our hospital regularly done using computer navigation system

Unicondylar Knee Replacement

When one compartment of knee joint is arthritic then replacing this part with metal and plastic joint through a small incision(skin cut) provides excellent quick recovery.Benefit of this operation is that patient can bend the knee fully and can perform most of the activities. Hospitalization for this surgery is just two days

A very special technique patient control analgesia (PCA) is used where a catheter is kept in epidural space and through PCA pump pain relieving medicines are delivered in controlled fashion to relieve pain. If patient need more dose of medication as per pain, (extra medicine) a bolus can be adjusted by patient himself/herself through hand press button given to them in post-operative period for 2 to 3 days. There is no post-operative pain; hence this is painless joint replacement surgery

In case of knee, hip, shoulder and elbow replacements patients have to be in the hospital for about 3 to 5 days. After unicompartmental knee replacement patient goes back home in 2 days time

In general physiotherapy program is neither strenuous nor painful. Few simple actions of exercises are taught to the patients by physiotherapist. They have been also taught proper gait training with the use of walker and crutches or canes

Yes. Both knee/bilateral knee replacement can be done same day & same time. Safety of the patient is the most important criteria for this surgery. Medically fit patient having pain in both knees and willing to undergo surgery on both sides is the indication for bilateral total knee replacement Advantages of joint replacement surgery

  • Complete relieve from pain
  • Correction of deformities
  • Increase range of movements of the joint & stability
  • Improvement in walking ability
  • Better quality of life

Infection: This is avoided by performing surgery in special joint replacement operation theatre having laminar air flow, use of body exhaust gown and appropriate antibiotics Loosening and Dislocation: This is avoided by proper instruction to patients, proper surgical technique and use of appropriate designs of implants

Risk of clot formation: This clot formation in leg blood vessels can be avoided by proper precautions in high risk patients

Infertility

Infertility is a condition where the couple is unable to conceive after 12 months of regular sexual relationship without birth control.

There are two kinds of infertility - primary and secondary:

  • Primary infertility means that the couple has never conceived.
  • Secondary infertility means that the couple has experienced a pregnancy before and failed to conceive later.

To understand infertility, we need to understand the process of fertilization.

To conceive, an egg (ovum) from the woman has to combine with a sperm from the man. An ovum is released from an ovary when a woman ovulates. This usually occurs once a month between 12 and 16 days from the start of her last period if she has a regular monthly cycle of 28-30 days. The ovum travels down a Fallopian tube to the middle of the womb (uterus) over 12-24 hours.

Sperms are placed near the neck of the womb (cervix) when a man ejaculates during sex. The sperms travel up past the cervix to get into the main part of the uterus, and into the Fallopian tubes. If there are sperm in the Fallopian tubes then one may combine with (fertilize) the ovum to make an embryo. The tiny embryo travels down into the uterus and attaches to the lining of the uterus. The embryo then grows and matures into a baby.

If you've had more than a year of regular sexual relationship without birth control and you haven't achieved pregnancy, it's best to seek help. One can also try to plan to have sexual relationship during the days the woman is ovulating which is known as her fertile period. If a woman has regular menstrual cycles, sexual relationship between the 8th & the 20th day will help.

It's a myth that infertility is always a "woman's problem". Half of all cases of infertility result from problems with the man's reproductive system. Of couples that seek medical treatment for infertility, 20% conceive before the treatment actually begins. One reason may be that anxiety about infertility may have contributed to the fertility problem, so contacting a doctor and counseling helps. 50% conceive within two years from starting treatment. Most infertility results from physical problems in a man or woman's reproductive system.

It is usually worth seeing a GP if you have not conceived after one year of trying. A GP can check for some common causes, talk things over, and discuss possible options. You may want to see your GP earlier, if the woman in the couple is over the age of 36 or if either partner has a history of fertility problems.

Causes in Women

Ovulation problems
Not producing eggs (ovulating) is a reason for infertility in about 3 in 10 couples.

There are various causes of ovulation problems including:

  • Early (premature) menopause.
  • Polycystic ovary syndrome (PCOS). This also leads to excessive hair growth, acne, and menstrual problems, and is associated with being overweight.
  • Hormone problems - Excess prolactin hormone is a cause. This hormone is produced by the pituitary gland that lies just beneath the brain and helps with milk production. Too little or too much thyroxine hormone also affects fertility.
  • Being very underweight or overweight. Women with anorexia nervosa often do not ovulate.
  • Excessive exercise can affect your hormone balance which can affect ovulation.
  • Long-term illnesses. Some women with severe chronic illnesses, such as uncontrolled diabetes, cancers and kidney failure, may not ovulate.
  • Fallopian tube, cervix or womb problems

Problems include:

  • Endometriosis, which causes about 1 in 20 cases of infertility. Tissue that normally lines the womb is found outside the uterus. It is trapped in the pelvic area and can affect the ovaries, uterus, and nearby structures. It often causes pain and/or painful periods.
  • Pelvic inflammatory disease (PID) is another common cause. Chlamydial infection can be a cause of PID. PID can cause scarring and damage which can affect fertility.
  • Previous surgery to the Fallopian tubes, cervix or uterus.
  • Large fibroids may also cause problems

Causes in Men

Some men are born with testicles that do not make any sperm or they make very few sperm. Some are born without testes or without a vas deferens. The most common reason for male infertility is a problem with sperm, due to an unknown cause. The sperm may be reduced in number, less mobile (less able to swim forwards), and/or be abnormal in their form.

There are a variety of factors that may affect sperm production and male infertility. These include:

  • Current or past infection of the testes (eg, mumps).
  • Tumors of the testes.
  • Testes that have failed to descend properly.
  • Side-effects of some medicines like sulfasalazine, nitrofurantoin, tetracyclines, cimetidine, colchicine, allopurinol, some chemotherapy drugs, cannabis, cocaine and anabolic steroids.
  • There may be an association between an increased scrotal temperature and reduced semen quality, however it is still uncertain whether wearing loose-fitting underwear actually improves fertility.
  • A varicocele is like a varicose vein in the scrotum (the skin that covers the testes). Varicoceles are found in just over 1 in 10 men with normal sperm and 1 in 4 men with abnormal sperm.
  • Certain hormone problems (eg, problems with the pituitary gland in the brain leading to Cushing's disease or hyperprolactinaemia.

No cause can be found in about 3 in 10 couples with infertility.

Older women tend to be less fertile than younger women. The fall off of fertility seems to be greatest once women are past the mid 30s. If the male or the female partner is stressed, this can affect libido and how often the couple has sex.

Sudha Hospital offers several specialized investigative procedures for infertility for men and women. Both the partners are expected to come for the first visit wherein a detailed history and previous reports are reviewed.

Investigations for the male

Apart from necessary basic blood and urine examination, semen analysis will be done.

Investigations for the female

Routine investigations such as CBC, FBS, urine routine, TSH,/ FSH / LH / Prolactin (Day 2 of the cycle) VDRL, Hepatitis B, HIV and Blood grouping and Rubella IgG levels will be done.

The following tests could be done as per the doctor's requisition:

  • Serum FSH
  • Serum LH
  • Serum PRL
  • Serum TSH

The above tests are to be done on day 2 or 3 of the menstrual cycle (First day of the period is counted as Day

Other procedures that may be done include:

HSG (Hysterosalpingogram)
This is a procedure where X-ray pictures of the uterus (Hystero) and fallopian tubes (Salpingo) are taken. A dye is injected into the uterus and pictures are taken to identify abnormalities in the uterine cavity and the tubes. An alternative method is Sonohysterosalpingogram where ultrasound is used instead of X-ray.

Trans-vaginal Ultra Sonogram
This is done to check for abnormalities in the uterus, tubes and ovaries. This is best done around the 13th day of the cycle. Follicular tracking and monitoring of follicle development in patients who are undergoing treatment with ovulation induction drugs is also done through a trans-vaginal scan.

Laproscopic Hysteroscopy
This is visualization of the interior aspects of the uterus with an endoscope. This helps in:

Laproscopic Hysteroscopy
This is visualization of the interior aspects of the uterus with an endoscope. This helps in:

  • Identification of pathology in the uterine cavity
  • Release of adhesions inside the uterus
  • Resection of fibroid/ polyp which protrudes into the uterine cavity
  • Cannulation of uterine end of tube if blocked
  • Resection of uterine septum

Laparoscopy
This is direct visualization of the peritoneal cavity with an endoscope. This is useful for:

  • Visualization of the uterus, tubes, ovaries and structures adjacent to it.
  • Performing the dye test to check tubal patency
  • Operative interventions if necessary

All these investigations will be individualized as per the doctor's decision.

The doctor would review the results of the investigations and depending upon the cause of infertility, treatment will be initiated.

Infertility treatment can range from practical lifestyle changes to extended medical procedures - depending on the nature of the problem. As a first step, it may just be a few simple measures, like awareness of fertile period and psycho social interventions (Quit Smoking / Alcohol, Relaxation Therapy).

Fertility treatments can be grouped into three categories:

Medicines to improve fertility

Used alone or along with other methods

Surgical treatments

Used when a cause of the infertility can be treated by a surgical intervention

Assisted conception

Includes procedures such as intrauterine insemination (IUI), in vitro fertilisation (IVF), gamete intrafallopian transfer (GIFT), and intracytoplasmic sperm injection (ICSI).

Each of these is discussed briefly below.

Medicines that may improve fertility

Medicines are mainly given to stimulate ovulation. Hormones called gonadotropins control ovulation. These are made in the pituitary gland. A gonadotropin is a hormone that stimulates the activity of the gonads (the ovaries in women and the testes in men). The main gonadotropins made by the pituitary gland are called follicle-stimulating hormone (FSH) and luteinising hormone (LH).

Clomifene is a medication used to help with fertility It is taken as a tablet. It works by blocking a feedback mechanism to the pituitary gland. This results in the pituitary making and releasing more gonadotropin hormones than normal. The extra amount of gonadotropin hormones may stimulate the ovaries to ovulate.

Injectable medications that contain gonadotrophins are another type of treatment. They are used when clomifene does not work, or prior to IUI and IVF, to cause ovulation.

Surgical treatments

  • Fallopian tube problems - surgery may help some women with infertility caused by Fallopian tube problems. Some women who have had a tubal tie (sterilisation) in the past for contraception may be able to have their fertility restored by tubal surgery.
  • Endometriosis - laparascopic surgery may help to improve fertility in women with endometriosis.
  • Polycystic ovary syndrome - an operation on the ovaries may be suitable for some women with PCOS. The procedure is sometimes called ovarian drilling or ovarian diathermy. Using keyhole surgery, a heat source (diathermy) is usually used to destroy some of the tiny cysts (follicles) that develop in the ovaries. It is usually done if other treatments for PCOS haven't worked.
  • Fibroids - for women with fibroids, surgery (to remove the fibroid) may be considered if there is no other explanation for the infertility.
  • Male infertility - when sperm are blocked by an abnormality in the epididymis (a coiled tube inside the scrotum that is used to store sperm) in the testis, surgery may help. Varicoceles (like varicose veins of the testes) that occur in men who have an abnormal sperm count may be repaired.
  • Assisted Conception

  • IUI (Intra Uterine Insemination): This is the method by which processed semen is placed directly in the uterus with the help of a catheter.
  • IVF (Invitro Fertilization): IVF means fertilization of an ovum outside the body and consequently, the transfer of the fertilized ovum (embryo) into the uterus of the woman.
  • ICSI (Intra Cytoplasmic Sperm Injection): ICSI is the technological breakthrough in the field of IVF which is used to overcome the inability of sperm to fertilize an egg (which may be either due to sub-optimal sperm parameters, oocyte defects or other reasons). In this technique, a single sperm is directly injected into the cytoplasm of an egg in order to achieve fertilization.
  • TESA (Testicular Sperm Aspiration): Sudha Hospitals carries out on an average 8-10 TESA every month.
  • Embryo Freezing Excess (Surplus): Embryos can be Cryo-preserved at ultra low temperatures for many years. These frozen embryos can be used subsequently, without the need for ovarian stimulation and egg retrieval.
  • Assisted Hatching: The procedure is based on the fact that an alteration in zona pellucida (outer covering of egg) either by drilling a hole through it or by thinning it, will promote hatching or implantation of embryos that are otherwise unable to escape intact from the zona pellucida.
  • Semen/Sperm freezing: Semen/Sperm can be stored frozen at ultra low temperatures for a longer duration which could be helpful in a variety of circumstances - semen freezing prior to chemotherapy, inability of the male partner to be present or to deliver the semen on the day of procedure, testicular biopsy/sperm freezing to avoid repeated biopsies, donor semen, etc.

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Hip Replacement

In the hip joint there is a layer of smooth cartilage on the ball of the upper end of the thigh bone (femur) and another layer within the hip socket. This cartilage serves as a cushion and allows for smooth motion of the hip. Arthritis is a wearing away of this cartilage. Eventually it wears down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.

A total hip replacement is an operation that removes the arthritic ball of the upper thigh bone (femur) as well as damaged cartilage from the hip socket. The ball is replaced with a metal ball that is fixed solidly inside the femur. The socket is replaced with a plastic liner that is usually fixed inside a metal shell. This creates a smoothly functioning joint that does not hurt.

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Your orthopaedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, an examination and X-rays. Your orthopaedic surgeon will ask you to decide if your discomfort, stiffness and disability justify undergoing surgery. There is no harm in waiting if conservative, non-operative methods are controlling your discomfort.

Age is not a problem if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for an opinion about your general health and readiness for surgery.

We expect most hips to last more than 10–15 years. However, there is no guarantee, and 5–10 percent may not last that long. A second replacement may be necessary.

The most common reason for failure is loosening of the artificial ball where it is secured in the femur, or loosening of the socket. Wearing of the plastic spacer may also result in the need for revision.

Most surgeries go well without any complications. Infection and blood clots are two serious complications that concern us the most. To avoid these complications, we use antibiotics and blood thinners. We also take special precautions in the operating room to reduce risk of infections. The chances of this happening in your lifetime are 1 percent or less. Dislocation of the hip after surgery is a risk. Your surgeon and physical therapist will discuss ways to reduce that risk.

Yes. You should discuss preoperative physical therapy and exercise with your surgeon. Exercises should begin as soon as possible.

You may need blood after the surgery. You may donate your own blood, if able, or use the community-blood-bank supply.

Your surgeon may request that you get out of bed the day of your surgery. The next morning you will get up, sit in a chair or recliner and walk with a walker with help from the staff.

Most hip-replacement patients are hospitalized for three to four days after surgery. If you need more time for rehabilitation, other options might be available to you. Make arrangements before your surgery to have someone stay with you after you are discharged.

After your surgeon has scheduled your surgery, the Center for Advanced Joint Replacement case manager will contact you.

We reserve approximately two to two-and-a-half hours for surgery. Some of this time is taken by the operating-room staff to prepare for the surgery.

You may have a general anesthetic, which most people call "being put to sleep," or a spinal anesthetic. The choice is between you and the anesthesiologist.

Yes, but we will keep you comfortable with appropriate medication. Generally most patients are able to stop very strong medication within one day. The day of surgery, most patients control their own medicine with a special pump that delivers the drug directly into their IV. Your surgeon will discuss with you what pain control option is best for you.

Your orthopaedic surgeon will do the surgery. A physician's assistant often helps during the procedure.

The answer to this question is different for different people. Because each person’s condition is unique, the doctor and you must weigh the advantages and disadvantages.

Cemented replacements are more frequently used for older, less active people and people with weak bones, such as those who have osteoporosis, while uncemented replacements are more frequently used for younger, more active people.

Studies show that cemented and uncemented prostheses have comparable rates of success. Studies also indicate that if you need an additional hip replacement, or revision, the rates of success for cemented and uncemented prostheses are comparable. However, more long-term data are available in the India for hip replacements with cemented prostheses, because doctors have been using them here since the late 1960s, whereas uncemented prostheses were not introduced until the late 1970s.

The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, a person with uncemented replacements must limit activities for up to 3 months to protect the hip joint. Also, it is more common for someone with an uncemented prosthesis to experience thigh pain in the months following the surgery, while the bone is growing into the prosthesis.

The scar will be approximately 6–8 inches long. It will be along the side of your hip.

Yes. Until your muscle strength returns after surgery, you will need a walker, a cane or crutches. Your equipment needs will be determined by the physical therapist and ordered for you by the Center for Advanced Joint Replacement case manager and delivered to you before you leave the hospital.

After hip-replacement surgery, you will need a high toilet seat for about three months. If needed, you will also be taught by the occupational therapist to use adaptive equipment to help you with lower body dressing and bathing. You might also benefit from a bath seat or grab bars in the bathroom. Your home equipment needs will be arranged while you are in the hospital.

Many patients go directly home when discharged. The physical therapist will be scheduled to come to your home three times a week. You should check with your insurance company to see what rehabilitation benefits you are eligible for.

Yes. In the first several days or weeks after surgery, depending on your progress, you will need someone to assist you with meal preparation, housekeeping, etc. Family members or friends must be available to help. Preparing ahead of time, before your surgery, can minimize the amount of help required. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and single-portion frozen meals will reduce the need for extra help.

Yes. Physical therapy will continue after you go home with a therapist in your home or at an outpatient physical-therapy facility. The length of time required for this type of therapy varies with each patient. We will help you with these arrangements before you go home.

The ability to drive depends on whether surgery was on your right hip or your left hip and the type of car you have. If the surgery was on your left hip and you have an automatic transmission, you could be driving within two weeks. If the surgery was on your right hip, your driving could be restricted as long as six weeks. Consult with your surgeon for advice on your activity. You should not drive if you are taking narcotic pain medicine.

We recommend that most people take at least one month off from work, even if your job allows you to sit frequently. More strenuous jobs will require a longer absence from work.

The time to resume sexual intercourse should be discussed with your surgeon. The Center for Advanced Joint Replacement has a guide on resuming sexual intercourse and will give you a copy at your discharge instruction class.

Two to four weeks after discharge, you will be seen for your first post-operative office visit. The frequency of follow-up visits will depend on your progress.

High-impact activities such as contact sports, running, singles tennis and basketball are not recommended. Injury-prone sports such as downhill skiing are also dangerous for your new joint. You will be restricted from crossing your legs. Your surgeon and therapist will discuss further limitations with you following surgery. You are encouraged to participate in low-impact activities such as walking, dancing, golfing, hiking, swimming, bowling and gardening.

In many cases, patients with hip replacements think that the new joint feels completely natural. However, we recommend always avoiding extreme positions or high-impact physical activity. The leg with the new hip may be longer than it was before, either because of previous shortening due to the hip disease, or because of a need to lengthen the hip to avoid dislocation. Most patients get used to this feeling in time or can use a small lift in the other shoe. Some patients have aching in the thigh when bearing weight for a few months after surgery.

How to Prepare for Surgery and Recovery

People can do many things before and after they have surgery to make everyday tasks easier and help speed their recovery.

    Before Surgery

  • Learn what to expect. Request information written for patients from the doctor, or contact one of the organizations listed near the end of this publication.
  • Arrange for someone to help you around the house for a week or two after coming home from the hospital.
  • Arrange for transportation to and from the hospital.
  • Set up a “recovery station” at home. Place the television remote control, radio, telephone, medicine, tissues, wastebasket, and pitcher and glass next to the spot where you will spend the most time while you recover.
  • Place items you use every day at arm’s level to avoid reaching up or bending down.
  • Stock up on kitchen supplies and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily.
  • After Surgery

  • Follow the doctor’s instructions.
  • Work with a physical therapist or other health care professional to rehabilitate your hip.
  • Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.
  • Use a long-handled “reacher” to turn on lights or grab things that are beyond arm’s length. Hospital personnel may provide one of these or suggest where to buy one.
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