FAQ's for Hip Replacement, Knee Replacement & BMHR

FAQ's

	Who can undergo Hip Resurfacing?
	Anyone in the age group of 18 to 65 years can undergo hip resurfacing. All that is required is that there must be enough femoral head left to resurface and the bone must be of fair quality. Even moderately osteoporotic bone can be resurfaced, provided patients take bone strengthening agents (Calcium, Vitamin D, Fosamax/Actonel) thereafter The message is clear - patients must not wait forever to have surgery on their hips. The best results are obtained when surgery is done in good time!
	Who should not undergo Hip Resurfacing?
	Patients with very severe osteoporosis, patient who have been bed-bound for long, patients with renal failure, people who are above 65 years old will do well with a Extra Large Head Metal on Metal THR (also called Stemmed Resurfacing) or a Conventional Total Hip Replacement rather than resurfacing.
	What are the advantages of Hip Resurfacing and BMHR?
	The advantages are restoration of normal function, no activity restriction, bone conserving surgery (removes only unhealthy bone), minimally invasive bone surgery, it helps improve the bone strength thus minimising osteoporosis, encourages normal load distribution, makes leg lengths equal, no bone loss, is long lasting (based on more than 35 years history of metal on metal joints in Europe & UK), can be converted to an Extra Large Head Metal on Metal THR (Stemmed Resurfacing) if required later on, patients can play sport, squat, sit cross legged, & use Indian toilet.
	What is Stemmed Resurfacing?
	Stemmed Resurfacing (Modular Hip or Extra Large Head Metal on Metal Replacement) can be done when Resurfacing is not possible. This has a resurfacing metal acetabular component, a resurfacing metal head and is connected to a femoral stem. This does not preserve the femoral head but is far superior to a conventional total hip replacement in that it has a metal on metal bearing that does not wear out, the hip feels normal to the patient and patients can do the same activities as Resurfacing patients such as walking long distances comfortably, using an Indian toilet, squatting and sitting cross legged. The only thing that Stemmed Resurfacing patients should not do that Resurfacing patients can, is play high impact sport or run. The x ray appearance of a Stemmed Resurfacing is shown on the left.
	For which conditions can Hip Resurfacing be done?
	Basically, any kind of hip arthritis is suitable for hip resurfacing. The common types of hip arthritis that are usually resurfaced are Primary Osteoarthritis, Avascular Necrosis (AVN), Ankylosing Spondylitis, Rheumatoid Arthritis, arthritis following fractures, old Perthes disease, Congenital dislocation of the hip (CDH/DDH) or Dysplastic hip. Hip Resurfacing can be performed in AVN only if the AVN is of a small area and is non progressive. For progressive AVN or AVN with a large area of damage, the BMHR is the best treatment.
	I have Avascular Necrosis in my hip/s. What treatment do I need?
	Early AVN (Stage I) needs medications, observation, physical therapy or core decompression surgery. Stage II B AVN is treated with the BMHR/Silent Hip surgery that SAVES BONE and allows you full mobility and activity levels, including the ability to kneel, squat and sit cross legged. Stage III or IV AVN that is 'Progressive' or has a large area of damage is best treated with a BMHR/Silent Hip surgery. Stage IV AVN that is 'Non-progressive' and has a smaller area of damage is best treated with Hip Resurfacing. Stage IV AVN that has damaged the whole femoral head is treated with a THR. Clearly, the BMHR is the safest and best surgery for most AVN patients. Dr. Pispati is one of the very few surgeons in the world who has been trained in and is allowed to do the BMHR surgeons.
	I have Osteoporosis. Can I undergo Hip Resurfacing?
	If you are under 65 years old with osteoporosis, then it is likely that the osteoporosis in the hip is simply due to lack of normal weight bearing due to pain and arthritis. In fact this osteoporosis gets corrected after Hip Resurfacing, so you can indeed have a hip resurfacing.
	I was to undergo hip resurfacing, but during surgery the surgeon found more damage in the femoral head than expected, and hence did a Big Ball Metal on Metal THR. I am depressed now. What shall I do???
	You should be thrilled because a Big ball metal on metal THR is a WINNER ! This system is NOT the same as a conventional THR. A conventional THR uses a small ball and hence may dislocate (whereas this uses a large ball of your body's own size, and so feels natural and does not dislocate); a conventional THR uses metal on plastic and hence wears away (whereas this is metal on metal which hardly wears!). The problems of conventional THR are NOT due to the use of a stem; the problems are due to a small ball and the use of metal on plastic. Effectively, a big ball metal on metal THR is a resurfacing device to which one attaches a stem. The x rays picture of a Stemmed Resurfacing (Big Ball Metal on Metal THR) is shown on this page on the left hand side. Click to see Picture
	What prosthesis do you use for Resurfacing Hip and Knee Replacement?
	For Hip Resurfacing, Dr Pispati uses the BHR (Smith & Nephew) or ASR DePuy). For THR, he uses Smith & Nephew, DePuy or Zimmer. For TKR, he uses Smith & Nephew, Zimmer, DePuy, Exactech (Hospital for Special Surgery, New York) or Aesculap. Dr Pispati is happy to make the choice for the patient or the patient may choose the prosthesis/implants himself/herself.
	I have just undergone a Hip Replacement (or a Knee Replacement) and will be going home soon. What adjustments do I need to make inside my house?
	A Physiotherapist needs to attend to you daily for about 2 to 3 weeks after surgery. Please sit on chairs or sofas or use beds that have a minimum height of atleast 18 inches {ideally 20 inches) from the ground. If you are overweight, please use an adjustable height chair commode for 2 months to sit on for toilet purposes (minimum 18-20 inches height). If you are not overweight, you may use a "toilet seat raise" to raise the height of your toilet to atleast 18 inches (this is available at all leading Chemist / Pharmacy shops). Do not bend forward to lift things up from the floor – use a special device called “Helping Hand” for this.
	Can I know more about your Hospital & Team?
	Jaslok Hospital in Mumbai is a leading International centre of Excellence for Hip Resurfacing surgery, Total Hip and Knee Replacement, and Arthroscopy (see picture on Left). It is viewed as one of the best hospitals in Asia and is recognised by BUPA International, a leading international insurance company. A Consultant-led service exists for patients, so that all their doubts, worries and problems are dealt with directly. They have State-of-the-art Operation Theatres with modern equipment from USA, Germany & UK. Our Ward and Theatre nurses are extremely well trained to the best of International standards. A Team of Resident doctors is available 24 hours to look after patients. We are kind, caring and sympathetic. We have been regularly treating and operating on patients from Western and Eastern countries - patients come to our hospital from all over the world for world-class treatment. Our hospital has Intensive Care Units, Blood Bank, 24 hour Emergency services, Top class Imaging (X ray, MRI, CT scan, Bone scan, Ultrasound) and Laboratory facilities. Jaslok Hospital provides computer access to patients and also provides special meals/diet for foreign patients to suit their palettes You can visit their website: http://www.jaslokhospital.net Dr. Pispati also performs surgery at the Bhatia Hospital in Mumbai. This is a smaller, state-of-the-art, well managed private hospital with excellent operating equipment, diagnostic and treatment facilities. This hospital provides vegetarian food, while non-vegetarian food can be ordered by you from the dozens of restaurants and take-aways in the nearby area. Both the Jaslok and Bhatia hospitals are located in South Mumbai, which is the heart of Mumbai, close to the city centre.
	How can I stay in touch with my friends/relatives whilst I am admitted into hospital?
	If you are at the Jaslok Hospital, computer access is available for your use in the library (high speed broadband). Alternatively, you can purchase a hi speed wifi usb datacard/modem from shops nearby (Reliance datacard or Tata Photon usb modem). If you are at the Bhatia Hospital, you should purchase a Reliance datacard or Tata Photon wifi modem.