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Can my mother go in for a second joint replacement surgery?

Q: My mother underwent a hip-joint replacement surgery 12 years ago. The problem had been there since her infancy (10 months) when she had an accident. Consequently the problem aggravated and she underwent the operation at CMC Vellore the following year. Twelve years later she has been experiencing lot of pain in her hip joint and more so in her knee joint leading to problem in walking. She is able to continue her daily life only through painkillers otherwise it becomes extremely painful. What she needs to know is whether she should continue medication or go in for surgery? And if at all surgery, is a second surgery advisable on safety grounds? She was told by certain doctors that a second surgery might not be safe.

A:It has been 12 years since your mother’s hip joint was replaced. However, you have not given any details on her age or the type of prosthesis that was inserted. Was it a cemented or an un-cemented prosthesis? This is important as the life expectancy of a prosthesis is dependant on not only the bone and joint condition but also on the age, the level of activity of the patient. Earlier the life expectancy of the prosthesis was estimated to be around 10-15 years. These days with advances in technique and materials this has been further prolonged to 15 to 20 years or more. Coming to your mother’s current problem. We need to know the cause of the pain in her hip. Is it because of loosening of the implant (the usual cause) or some other problem (breakage of an implant, etc)? Either way, if it is painful enough restrict of activity it is better to have surgical intervention and have a revision hip. The quality of life is far better if the patient is free from pain. Yes, it is far more difficult to do a revision hip but these days these are routinely done in most centres even in India. I would suggest you select an orthopaedic surgeon in whom you have confidence and go ahead with the procedure. The risk factor is dependant on the associated illness that the patient has. These include: blood pressure, diabetes, coronary artery disease or other medical conditions that compromise surgical intervention.

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