HIP REPLACEMENT SURGEON IN INDORE WHAT IS HIP REPLACEMENT SURGERY? Hip replacement surgery, also known as hip arthroplasty, is a surgical procedure in which a damaged or worn-out hip joint is removed and replaced with an artificial joint (prosthesis) made of metal, ceramic, or plastic. This is usually done to relieve severe pain, stiffness, and loss of mobility caused by conditions like osteoarthritis, rheumatoid arthritis, fractures, or avascular necrosis. The surgeon replaces the ball-and-socket parts of the hip joint: the head of the femur (thigh bone) and the hip socket (acetabulum). Hip replacement helps restore normal movement, reduce or eliminate pain, and significantly improve quality of life when other treatments like medication, physiotherapy, or lifestyle changes no longer work. MAIN CAUSES OF HIP REPLACEMENT 1. Osteoarthritis The most common reason. Caused by age-related wear and tear of the hip joint cartilage.Leads to pain, stiffness, and reduced mobility. 2. Rheumatoid Arthritis An autoimmune disease that causes chronic inflammation of the joints. It Destroys cartilage and bone, leading to severe joint damage and deformity. 3. Hip Fractures This is Especially common in older adults after falls. If the bone can't be repaired properly, hip replacement is often needed. 4. Avascular Necrosis (AVN) It Occurs when the blood supply to the hip bone is reduced, causing the bone to die and collapse. It Can be due to steroid use, alcohol abuse, trauma, or certain medical conditions. 5. Childhood Hip Diseases (e.g., Developmental Dysplasia, Perthes' disease) Improper hip development can cause long-term joint problems. These conditions may eventually lead to early joint damage and arthritis, requiring replacement in adulthood. TYPES OF HIP REPLACEMENT SURGERY 1. Total Hip Replacement (THR) – Most Common Both the ball (femoral head) and the socket (acetabulum) are replaced with artificial components. 2. Partial Hip Replacement (Hemiarthroplasty) In this surgery Only the femoral head (ball) is replaced and the socket is left as it is. 3. Hip Resurfacing In this surgery The femoral head is not removed, but instead it is reshaped and capped with a metal cover. The socket may still be replaced. 4. Revision Hip Replacement A repeat surgery is done when a previous hip replacement has failed or worn out. This is More complex and may involve replacing only part or maybe all components. It is Needed due to implant loosening, infection, fracture, or wear. WHO NEEDS HIP REPLACEMENT Hip replacement surgery is recommended for people who have severe hip joint damage that causes chronic pain, stiffness, and difficulty in movement, and does not improve with medicines. Who needs it : 1.People with Advanced Osteoarthritis 2.Patients with Rheumatoid Arthritis 3.Individuals with Avascular Necrosis (AVN) 4.People with Hip Fractures (Especially Elderly) 5.Those with Childhood Hip Disorders. Common signs that you may need hip replacement surgery : 1.Constant hip pain, even while resting 2.Stiffness and limited range of motion 3.Limping or difficulty standing/walking 4.No improvement with physiotherapy, medication, or injections. HOW IS HIP REPLACEMENT DONE? Hip replacement surgery is a procedure where a damaged hip joint is replaced with an artificial implant to relieve pain and restore movement. It usually takes 1.5 to 2 hours and is done under spinal or general anesthesia. How is it done? 1.Anesthesia The patient is given spinal anesthesia (numbs the body below the waist) or general anesthesia (makes you sleep during surgery). Sometimes a combination is used. 2. Incision A cut is made over the side, front, or back of the hip, depending on the approach used. Traditional approach: larger incision (20–30 cm) Minimally invasive: smaller incision (8–15 cm) 3. Removing the Damaged Bone The femoral head (ball part of the hip joint) is removed. The damaged cartilage and bone from the socket (acetabulum) are also cleaned out. 4. Inserting the Artificial Implants A metal or ceramic cup is placed into the hip socket. A metal stem is inserted into the thigh bone (femur), and a ball (metal or ceramic) is attached to the top. These parts together form the new artificial hip joint. 5. Fixing the Implants Implants may be cemented into place (common in older adults) or left uncemented, allowing bone to grow onto them Sometimes a combination of both methods is used. 6. Closing the Incision Muscles and tissues are repaired, and the skin is stitched or stapled. For more details on total hip replacement/ DAA total hip replacement, please visit our dedicated website for hip joint issues created by Dr Vikas jain- www.hipreplacementindia.in https://hipreplacementindia.in/treatment/bikini-hip-replacement/

Anterior Total hip replacement - A hip replacement surgery with Zero precautions. A hip replacement which can get you back to a completely pain-free life with normal walking. The biggest problem with old techniques of hip replacement are 1. 4 percent patients have high chances of hip dislocation (hip ball coming out & where resurgery is needed to fix). In order to prevent it, patients are adviced multiple precautions & restrictions sometimes for lifetime. 2. The other major problem is unequal length of legs after hip replacement. Leading to permanent abnormal walking & limp. With Anterior total hip replacement both the above issues can be easily managed. With Direct Anterior(surgery from front) Total Hip replacement, patients have the following advantages- 1. Both legs will be completely equal in length- since pt is positioned straight on table & comparison with computerized arm while operating making comparison to the opposite leg easier helping in getting completely equal legs. In other technique like posterior or anterolateral since patient is placed on side, legs end up being unequal since comparison is not possible with opposite leg at all. Even imaging is not possible. 2. Minimal muscle pain due to minimally invasive -mis technique. The entire surgery is performed with an incision of around 10 cms & zero muscle damage. 3. Zero precautions after surgery leading to stress free life. . Patients can sit on floor/use Indian Toilets without worrying about chances of hip dislocation. In older techniques patients are told to follow precautions for atleast 3 months & sometimes even lifetime. 4. No restriction in Sexual activities. 5. Patients have quick recovery due to less pain & can even walk without walker with full weight bearing within 1-2 days. With older techniques, patients still have to use walker or wait upto 1.5 months to put weight & walk. 6. A small 10 cm line incision which gets hidden in groin crease & becomes just like a thin pencil mark in 2-3 months. With Direct Anterior Total Hip replacement, pts can even get Both total hip replacements performed in a single sitting. Even the choice of implants cemented or uncemented & can be dual mobility, ceramic on ceramic , ceramic on poly or metal on poly as per patients preference. Anterolateral & Posterior hip replacement - Both are older techniques of total hip replacements where patients are adviced multiple precautions after surgery. Older techniques posterior/anterolateral (incision of surgery from back- posterior & surgery from side - anterolateral) total hip replacements have limitations such as patients are adviced not to sit on floor or do any activity on ground because of risk of hip ball dislocation & even where patients end up having unequal leg lengths after surgery. Multiple research papers have proven Direct Anterior Hip replacement has significant advantages. In The US, Hip replacement by Direct Anterior technique is preferred by most of the patients due to its significant advantages. Though Direct Anterior Hip replacement technique has excellent advantages, it can be performed in obese patients with weight more than 130 kgs only after proper assessment. We regularly have patients visiting from various parts of the country for Total Hip replacement with Direct Anterior Technique be it cases of hip avn, ankylosing spondylitis or post traumatic hip failure. We have numerous patients from all over the country visiting our centre in Indore & Mumbai who have been suffering from Hip issues & have undergone Total Hip Joint Replacement by Direct Anterior technique. For your benefit, please see the explanation & results regarding anterior hip replacement on our YouTube page- TheJointSurgeon https://youtube.com/@TJSJoints https://youtu.be/mC-Sd52dxsw https://youtu.be/jAKbalLIL4A https://youtu.be/Y3cyQRl5v_U If you are suffering from hip joint issues & need a hip replacement, Anterior Total Hip replacement is the best technique for you to be pain free & walk completely normally. We can help you. For more details or appointment please feel free to contact us. +91 7760547341

Hip Arthroscopy Arthroscopy, also referred to as keyhole or minimally invasive surgery, is a procedure in which an arthroscope is inserted into a joint to check for any damage and repair it simultaneously. An arthroscope is a small, fibre-optic instrument consisting of a lens, light source, and video camera. The camera projects an image of the inside of the joint onto a large screen monitor allowing the surgeon to look for any damage, assess the type of injury, and repair the problem. Hip arthroscopy is a surgical procedure performed through very small incisions to diagnose and treat various hip conditions including: Removal of torn cartilage or bone chips that cause hip pain and immobility. Repair a torn labrum: The labrum is a fibrous cartilage ring which lines the acetabular socket. Removal of bone spurs or extra bone growths caused by arthritis or an injury. Removal of part of the inflamed synovium (lining of the joint) in patients with inflammatory arthritis. This procedure is called a partial synovectomy. Repair of fractures or torn ligaments caused by trauma. Evaluation and diagnosis of conditions with unexplained pain, swelling, or stiffness in the hip that does not respond to conservative treatment. Hip arthroscopy is performed under regional or general anaesthesia depending on you and your surgeon’s preference. Your surgeon will make 2 or 3 small incisions about 1/4 inch in length around the hip joint. Through one of the incisions an arthroscope is inserted. Along with it, a sterile solution is pumped into the joint to expand the joint area and create room for the surgeon to work. Surgical instruments will be inserted through other tiny incisions to treat the problem. The larger image on the television monitor allows the surgeon to visualize the joint directly to determine the extent of damage so that it can be surgically treated. After the surgery, the incisions are closed and covered with a bandage. The advantages of hip arthroscopy over the traditional open hip surgery include: Smaller incisions Minimal trauma to surrounding ligaments, muscles, and tissues Less pain Faster recovery Lower infection rate Less scarring Earlier mobilization Shorter hospital stay

TOTAL SHOULDER REPLACEMENT/ PARTIAL SHOULDER REPLACEMENT The primary indication for a Total Shoulder Arthroplasty or Hemiarthroplasty is Inability to reconstruct the fracture. A repairable rotator cuff is a pre-requisite for this type of surgery. Replacement of the humeral head along with the glenoid surface constitutes Total Shoulder Arthroplasty whereas replacement of only the humeral head constitutes Hemiarthroplasty of the shoulder joint. Supporting indications • Poor bone quality • Humeral head ischemia in the elderly patient • Intraoperative failure of osteosynthesis • Osteoarthritis of the shoulder joint ( Though reverse shoulder replacement is a preferred procedure) Advantages • Provides a replacement for unreconstructable humeral head • If failure of fixation and/or avascular necrosis (AVN) are highly likely, primary arthroplasty may avoid a second surgery Introduction Arthroplasty is indicated in all cases where a stable fixation is not achievable especially in situations with poor bone quality like severe osteoporosis. In the elderly, the indication might be extended to head-splitting fractures and situations with a probably ischemic humeral head (e.g., a displaced anatomical neck fracture with no capsular attachment remaining). PRE-OPERATIVE STEPS Every effort is made to assess the patient prior to surgery in order to ensure safety of the patient for the elective procedure. 1. After admission, routine blood work-up will be done prior to surgery. Depending on the age of the patient and other premorbid conditions, other investigations such as Echocardiography may be performed in elderly patients. 2. All the investigations prior to surgery are performed in order to ensure that the surgical procedure can be safely tolerated by the patient, since shoulder arthroscopy is an elective procedure. If any risk is involved, the patient/ attendants will be informed so. 3. Blood transfusion though rarely required, may be done depending on the reports. 4. X-rays and MRI will be done ideally in order to guide the surgical plan and the prognosis. 5. Surgical consent will be explained to the patient detailing the procedure as well as the risks involved, if any. INTRA-OPERATIVE STEPS 1. This procedure is performed with the patient in a beach chair position. 2. For this procedure the deltopectoral approach is normally used. 3. It is crucial to evaluate the fracture. Identify the fracture lines, the long head of the biceps and the condition of the rotator cuff. 4. Sutures are inserted into the subscapularis tendon and the supraspinatus tendon just superficial to the tendon’s bony insertions. These provide anchors for reduction, and temporary fixation of the greater and lesser tuberosities. 5. The biceps tendon is temporarily attached to the superior border of the pectoralis muscle. A tenotomy of the long head of the bicipital tendon close to the rotator interval is performed. 6. Any remaining medial capsular attachment to the head should be carefully released with special attention not to damage the axillary nerve medial to the proximal humerus. 7. Insert a suture into the infraspinatus tendon. 8. The correct prosthesis head size can be measured on the retrieved humeral head. 9. In general, the reattachment of the tuberosities can be performed with sutures or cables. 10. Preparation of the humeral shaft is performed after opening the medullary canal and gently enlarging the humeral canal with rasps of increasing sizes. 11. Determine humeral head retroversion 12. Preparation of the Glenoid is performed and an appropriate sized trial is used to see the alignment. 13. Implantation of the prosthesis is performed, respecting the proper insertion height and the retroversion. 14. Depending on the prosthesis type and the remaining bony situation, bone cement may be necessary to fix the implant. Certainly it is wise to use cement if the prosthesis does not fit securely in the humerus. 15. Once the prosthesis is inserted, stability of the shoulder joint is assessed. After stability assessment, wound wash is given followed by wound closure and dressings. POST OPERATIVE PHASE Care after surgery: • Wear your sling or brace at all times for as long as directed. This helps to remind you not to use the arm. It also allows your shoulder to heal and decreases pain. • Apply ice on your shoulder for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain. • Place a small pillow or towel behind your elbow when you lie on your back. This keeps your shoulder in proper position. You may need to sleep in an upright position if you cannot sleep on your back. Place 2 to 3 pillows lengthwise behind your back when in bed. Make sure the pillows do not move your shoulder forward. Instead, you can sleep in a reclining chair. • Avoid moving your shoulder. Do not stretch or shrug your shoulder. Do not do exercises on your own until your healthcare provider says it is okay. • Do not lift with your hand on your surgery side. You put pressure on your shoulder muscles when you lift. • Do not lean on the hand of your surgery side. Pressure will cause pain and may cause damage to your shoulder. • Do not drive until your healthcare provider says it is okay. Shoulder bandage care: Keep your dressing clean and dry. Your healthcare provider will tell you when it is okay to take a bath or shower. Once you are able, let soap and water run over your surgery area. Do not scrub the area. Pat the area dry and put on a clean bandage as directed. Pain Management • Some amount of pain is expected after the surgical procedure. • Ice packs can be used for pain reduction • Paracetamol or Nsaids can be considered for pain management especially during the first four weeks. Shoulder rehabilitation protocol The shoulder is perhaps the most challenging joint to rehabilitate both postoperatively and after conservative treatment. Early passive motion according to pain tolerance can usually be started after the first postoperative day. The program of rehabilitation has to be adjusted to the ability and expectations of the patient and the quality and stability of the repair. The full exercise program progresses to protected active and then self-assisted exercises. The stretching and strengthening phases follow. The ultimate goal is to regain strength and full function. Activities of daily living (ADL) can generally be resumed while avoiding certain stresses on the shoulder. Mild pain and some restriction of movement should not interfere with this. The more severe the initial displacement of a fracture, and the older the patient, the greater will be the likelihood of some residual loss of motion. Generally, shoulder rehabilitation protocols can be divided into three phases. Gentle range of motion can often begin early without stressing fixation or soft-tissue repair. Gentle assisted motion can frequently begin within a few weeks, the exact time and restriction depends on the injury and the patient. Resistance exercises to build strength and endurance should be delayed until bone and soft-tissue healing is secure. The schedule may need to be adjusted for each patient. Phase 1 (approximately first 6 weeks) Bandage • Immobilization on a shoulder abduction pillow in neutral position of rotation Range of motion • Passive motion within the pain free interval for abduction, adduction and flexion • No internal or external rotation • Shoulder joint motion up to 90° • ADL for eating and writing allowed Physiotherapy • Passive motion up to 90° • Relaxation/stretching of neck muscles • Training of elbow and hand functions • Specific stabilization therapy for the shoulder joint • Isometric exercises in all directions • CPM up to 90° of abduction Massage • Neck • Shoulder girdle • Thoracic spine Training therapy • Training of the contralateral arm (overflow cardiovascular training) Phase 2 (approximately week 7-11) Bandage • No longer required Range of motion • Assisted/active motion within the pain free interval, also beyond 90° • Careful rotation Physiotherapy • Free motion of shoulder girdle (scapula, clavicle, cervicothoracic junction, cervical and thoracic spine) with specific mobilization • Strengthening exercises especially for ADL • Eccentric muscle activity Massage • As required Ice/warmth • As required Training therapy • Mobilization bath, wound permitting • Training of hand and forearm muscles • Set for shoulder therapy Phase 3 (after week 11) Range of motion • No restrictions on Shoulder movement • Muscle growth for shoulder girdle and all arm muscles Physiotherapy • All physiotherapeutic techniques allowed, active and against resistance • Increasing eccentric muscle activity Training therapy • Handcycling • Training for specific ADL and sports • Machine training • Free weight training

OVERVIEW Fractures (Broken Bones) of the Shoulder, Elbow and Wrist are common from both minor and major accidents. These are incapacitating in the short term as they commonly require the use of a cast or brace and restrict the use of the affected limb. DESCRIPTION Upper limb fractures occur from either direct trauma or indirectly from forces applied to the limb (eg twisting injuries). The type of fracture depends on the size and direction of the injury to the limb. Low energy injuries (such as falls from a standing height), usually result in less complex fracture patterns and less soft tissue injury. Typical symptoms of a fracture include: • Pain • Swelling • Deformity • Difficulty lifting things Lower energy injuries can be missed and may be passed off as ‘sprains’ or ‘strains’. If you have had an injury that is not responding to treatment, it is advisable to see your doctor and obtain X-Rays to rule out a fracture. Higher energy injuries (such as motorcycle and car crashes) typically fracture bones in multiple places, into smaller pieces, and commonly disrupt the soft tissues resulting in large amounts of bruising and swelling. These can be challenging to treat and frequently require surgery to restore the bones to their anatomical position to make healing quicker and your function better in the long term. TREATMENT The treatment of lower limb fractures requires careful tailoring to the individual patients demands and the type of fracture sustained. Non-operative treatment of upper limb fractures may involve: • Braces or Slings • Plaster Casts • Activity Restriction • Physiotherapy Dr. Jain always encourages non-operative treatment whenever possible, however, many fractures do much better with surgical intervention as surgery can speed up recovery and improve the short and long term outcome. As there many different types of upper limb fractures, there are a large range of surgical options that can be used, these can include: • Plates + screws • Wires • Rods/Nails • External Fixators Sometimes a combination of these is used, and Dr. Jain will discuss the surgical plan with you pre-operatively. He uses the latest technology in orthopedic trauma implants to give you the best outcome possible. After surgery, Dr. Jain will discuss your operation as well as plan your rehab in line with your goals and expectations. He uses a highly qualified team of physiotherapists and rehabilitation specialists to get you back to your activities as quickly as possible. Dr. Jain has extensive experience treating fractures, he has completed Training at Cascais Hospital in Lisbon (Portugal, Europe) with world recognized leaders in Orthopedic Trauma Surgery, and has worked as an Orthopedic Joint Replacement & Trauma Consultant at Tata Hospitals. He routinely attends conferences and visits trauma centers worldwide to refine his skills and stay on top of the most recent advances in trauma surgery.