Q: I am suffering from avascular necrosis in both heads of femur. My age is 41 years and I got diagnosed on 23.05.01 through an M.R.I. after consultation with many doctors. I am under Ayurvedic treatement since 13.06.01 and it has prevented further deterioration. I feel that ultimately I will need replacement of hip joint. I want to know the following:1. Whether surgery could be done for both joints together?; 2. After surgery, will life will be normal?; 3. How much time it will take in healing and getting fit?; 4. How expensive will it be?; 5. What can one do to avoid surgery?; 6. Who are the specialists in India for replacement of hip joint?; 7. Which one is the best in South India and at which hospital; 8. Any precautions to be kept?

A:To answer your questions one-by-one: 1. Surgery for both the hips can be done at the same time. However, there is a lot of debate on whether surgery for both the hips should be done at the same anaesthesia time. There are surgeons who favour both surgeries to be done at the same time on the argument that the patient needs to be anaesthetised only once, hospitalised only once, given medicines only once and physiotherapy can also be done at the same time. However, there are those who argue that the two surgeries should be at an interval of some time because operation for both the hips may be too major for the patient to withstand, may require transfusion of blood, may need longer time for physiotherapy and therefore, may need longer time to get back to normal walking. Having said that, both sides argue strongly their cases and individual surgeons swear by their preferences. As a patient you decide for yourself because the medical literature is full of references for and against both. 2. After surgery whether life will be normal? I do hope life can be normal and all medical care is aimed at that, but unfortunately, it is never so. An artificial hip can never match the normal hip that we are born with. So far, technology has not been able to match what nature has given us. Obviously, there are limitations. Grossly speaking you will not be able to use an Indian toilet seat. You will have to use a western commode. You cannot sit cross-legged. You cannot sit on the floor. It is not advisable to participate in athletic activities. This also means you cannot do vigorous physical activities like mountaineering, long distance jogging, jumping from walls, jumping across streams/wide storm water drains. Unlike biological tissues which get stronger with use (for example, a weightlifter's muscles get stronger with exercise), artificial joints get weaker and wear out with use. In short, the more you use it the lesser the life. So, if you are 41 now, you may need to revise your hips in 15 to 20 years time. 3. How much time will it take in healing? This again depends on whether you have a cemented or a non-cemented total hip. The non-cemented total hips takes slightly longer time for support free walking. Since both your hips need to be operated, the total time taken for rehabilitation may take up to 3 months. This, of course, could vary depending on your ability and motivation to participate in the therapeutic regime. 4. How expensive will it be? This depends again on the type of prosthesis chosen by your surgeon. It could vary from about Rs.16,000/- to almost Rs.85,000/-. The cement less hips are more expensive than the cemented hips. 5. Eventually most patients with avascular necrosis will need surgical intervention. However, some patients carry on suffering the pain. So far, there are no prescriptions to avoid surgery. 6 & 7. These days total hip replacement is being done in most large hospitals of the country. I do not think it is wise on my part to specifically name one centre, because eventually, you have to choose your surgeon yourself. By naming centers or surgeons I might miss out on a new centre or a new surgeon who is better but I am not aware of. You choose yourself but make sure that in the hospital that you choose, this procedure is done regularly. You could ask this directly from the surgeon. 8. I think this should cover most of your fears. All that I can say is if your pain is significant enough to seek help make a decision to get operated, choose a surgeon then leave the decisions on your surgeon.