Hip replacement surgery and implants to be used - Dr Shreedhar Archik

Dr Shreedhar Archik - Orthopedics Surgeon Mumbai Dadar

I get a lot of patients for hip replacement surgery. I have noticed a common trend in these patients and that made me write this article. Patients who require a hip replacement are so disabled that they are pretty much ready to go ahead and get their surgery doneASAP.

However when we start budgeting the confusion starts. The hip prosthesis available in the market differs in the cost and that cost difference is the root cause of confusion.

Let’s try to understand the process in a bit more details.

The picture below shows various components used in a hip replacement surgery. There are 2 pieces on the “ball “side “of the joint i.e. the stem and the femoral head and 2 components on the socket side of the joint i.e. acetabular shell and the liner.

Hip is a ball and socket type of a joint

The stem and the acetabular shell come in different varieties but the end result and the cost is pretty much similar across all companies. The cost can go up a little bit for the new improved products but the cost escalation is around 15000 rupees.

However the liner and the head can come in different forms. At the time of writing this article the combinations we have in the market are of 3 types 1. Metal head and a plastic (polyethylene) liner as seen in the first picture. 2. A ceramic head and a plastic liner 3. A ceramic head and a ceramic liner.

There is a subtype called Oxinium head which goes on a plastic liner. This is a metal head treated with ceramic kind of lining.

You may ask why so many different types exist? Well we do get patients as young as 20 to 30 years who need a hip replacement. Research continues even today to find out a hip that will last as long as possible in such young individuals. Research shows that the ceramic on ceramic combination lasts longest. It is also the costliest combination. As we go from type 1 to type 3 mentioned above the cost goes up exponentially.

Patients are unaware of this and when they get a quote higher than the first quote sometimes assume that the hospital or the doctor is expensive.

If you or one of your near and dear ones is getting scheduled for a hip replacement, then make sure you discuss the prosthesis your surgeon is going to use and the cost with the above information in mind. Most surgeons will also be in a position to guide you about which would be a good prosthesis for your disease condition. Short statured female patients have different morphology and need a specially designed hip which automatically will cost a bit more than the standard hip.

There is also a lot of confusion about a particular company and its products. Recently Johnson and Josnson had to recall a hip replacement product and pay hefty damages to all the patients. This led to a panic about Johnson and Johnson Company in general. I get a few patients who specifically ask me “ notto put in a Johnson and Johnson product”. Every company has had its share of such failures which does not mean that the company products are bad. It is better to trust the surgeon about the implant choice as no surgeon would like a patient with a problematic implant on his roll!

The second worry most of the patients have is “how do I make sure that my body has the same implant as promised? Can a surgeon charge me for one implant (higher cost) and use another (cheap) implant”? It is a reasonable question. Many patients do not know that all the implants which go inside a human body need to have stickers with information about the product in detail and by law should be given to the patient. All good hospitals will give you these stickers without you even asking. Therefore make sure that your discharge card has these stickers pasted on them. Many hospitals actually give the implant boxes to the patients as well.

Take home message: Always discuss the implant material and the cost with your surgeon. If you are unable to decipher the information decide a budget and ask the surgeon to put the best possible implant for that cost.
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