He was on painkillers for the last eight years. The only way to manage his life and improve it was by consuming painkillers regularly. During the pandemic, in 2021, things took a turn for the worse when he was asked to resume office…

A 30-year-old from Delhi, who was suffering from excruciating pain in his right hip and knee, got a new lease of life recently after undergoing a successful hip replacement surgery. The man was diagnosed with juvenile rheumatoid arthritis (JRA) and had been on painkillers for close to a decade. After the surgery, he can now walk, sit, exercise, play cricket, ride a bike, travel without any discomfort and do many other activities that he could not do in the past. According to WebMD, ‘JRA’ — often referred to by doctors as juvenile idiopathic arthritis (JIA) — causes joint inflammation and stiffness. Inflammation can cause redness, swelling, and soreness in the joints. In JRA, an autoimmune disorder, the body mistakenly identifies some of its own cells and tissues as foreign, and the immune system begins to attack them.

The Case

In this particular patient’s case, he was diagnosed with JRA during his teenage years. He was on painkillers for the last eight years. The only way to manage his life and improve it was by consuming painkillers regularly. During the pandemic, in 2021, things took a turn for the worse when he was asked to resume office. The patient experienced ‘severe pain’ in his right hip and knee while climbing the stairs. He was forced to quit his job.

When he was absolutely unable to walk, the man sought medical help through teleconsultations and discovered that his right hip joint and cartilage were ‘damaged’ due to JRA.

The man was treated by Dr Pankaj Walecha, specialist, hip and knee surgeon at Apollo Spectra in Delhi. It was decided that a hip replacement surgery had to be performed.

A Detailed Investigation

Dr Walecha said on detailed check-up, it was found that the patient experienced severe pain when raising their right leg, along with a ‘restricted and painful’ rotation of the right hip. He had also lost the ability to cross his legs; sitting down was a challenge, too.

“Moreover, a limp was evident in his gait, and the right leg seemed shorter compared to the left. Relevant blood tests were done to identify the cause of the damaged hip joint. It was found that he has JRA, a type of rheumatoid arthritis that can start as early as the age of 13-14 years. In many patients, it involves the eyes (uveitis) as well. Hip X-rays were done to assess the damage to the bone and to plan the treatment. After a detailed discussion, the patient decided to undergo a total hip replacement surgery last year. The anesthesia team did a detailed pre-surgery checkup to ensure patient safety.”

Total Hip Replacement Surgery

Hip joint is a ball-and-socket type of joint, and in any kind of advanced arthritis just like JRA, the ball and socket are both damaged, said the doctor. He added that a total hip replacement surgery is a procedure in which the damaged ball and socket are replaced.

“Most commonly used implants are uncemented (where the implant integrates with the bone) and are made up of titanium. Currently, uncemented ceramic on highly cross-linked poly is one of the best implants for hip replacement surgery. In advanced stages of hip arthritis, hip replacement surgery is the only treatment. Waiting or postponing the surgery only prolongs the agony. If diagnosed in early stages, with proper medications for rheumatism, joint damage can be prevented,” he stated.

According to the doctor, a well-performed hip replacement surgery also ‘equalises the leg length discrepancy’ for a majority of patients.

Surgery And After

In this case, the patient’s surgery lasted for nearly an hour. He was made to walk within a few hours of surgery. While initially he walked with support, within a few days, he was able to walk on his own. He was discharged after two days of surgery and given physiotherapy sessions for faster recovery. Patients usually need physio for 3-6 weeks depending on their pre-surgery muscle weakness. Post-surgery, they are not only able to walk, but are pain-free, too, and can sit on the floor, do exercises, play low-impact games, ride a bike, and travel.

“Most patients can work out in the gym with some precautions after three months of recovery. But, not all patients are allowed movements after hip replacement surgery, as it depends on their disease and the damage caused by it,” said Dr Walecha, adding that taking painkillers regularly can damage the kidneys and other internal organs, and is not a long-term solution.