Dr. NEERAJ AGGARWAL MBBS –SMS Medical College, 1999 MS – SMS Medical College, 2003 Senior Residency KEM Mumbai 2004 Fellowship in Joint Replacement Depuy Fellow, Mumbai 2005 Fellowship Joint Replacement Surgery Germany, Ranawat Adult Reconstruction Fellow, New York Areas of Specialization: * Primary Joint Replacement surgery Knee, Hip, Shoulder * Revision Joint Replacement Hip, Knee * PSI for Joint Replacement * Difficult Intra Articular Fractures * Osteotomies for Arthritis management * Head salvage surgeries for AVN Hip Work Experience: * 2006-2011 Consultant at Monilek Hospital and Tagore Hospital * Having done more than 7000 major Trauma surgeries * 1000 Joint Replacement Surgeries * At present, he is only and Sr. Joint Replacement Surgern at Narayana Multispecility Hospital, Jaipur Awards: * Various Awards by various social groups and clubs. * Gold Medalist in MBBS and topper in diff pre PG Examinations. Achievements: * Arthritis awareness CME’s in more than 15 districts of Rajasthan. * One of the Pioneers of Joint Replacement Surgeries in Rajasthan.

1. TOTAL HIP REPLACEMENT IN
JAIPUR
What is a hip replacement surgery?
Hip replacement, also called total hip arthroplasty, is a surgical procedure to replace a worn out
or damaged hip with a prosthesis (an artificial joint). This surgery may be considered following a
hip fracture (breaking of the bone) or for someone who has severe pain due to arthritis. Various
types of arthritis may affect the hip joint. AVN arthritis affects young patients in India and may
require THR at young age. Osteoarthritis, a degenerative joint disease that affects mostly middle-
aged and older adults, may cause the breakdown of joint cartilage and adjacent bone in the hips.
Rheumatoid arthritis, which causes inflammation of the synovial lining of the joint and results in
excessive synovial fluid, may lead to severe pain and stiffness. Traumatic arthritis, arthritis due
to injury, may also cause damage to the articular cartilage of the hip. The goal of hip replacement
surgery is to replace the parts of the hip joint that have been damaged and to relieve hip pain that
cannot be controlled by other treatments.
Anatomy of the hip
Joints are formed where bones meet. Most joints are mobile, allowing the bones to move without
friction or discomfort. The hip joint is a ball-and-socket joint, which allows backward, forward,
sideways, and rotating movements. The ball part of the hip joint is the head of the femur (thigh
bone), and the acetabulum is the socket, a cup-like structure in the pelvis. The hip joint has
significantly more bony contact and stability compared with other joints, such as the shoulder.
A hip joint consists of the following:
Femur: Thighbone or upper leg bone.
Acetabulum: A socket or cuplike structure that holds the femur head.
Cartilage: A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the
friction of movement within a joint.
Synovial membrane: A tissue that lines the joint and seals it into a joint capsule. The synovial
membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
Ligament: A type of tough, elastic connective tissue that surrounds the joint to give support and
limits the joint’s movement.
Tendon: A type of tough connective tissue that connects muscles to bones and helps to control
movement of the joint.

2. Bursa: A fluid-filled sac located between bones, ligaments, or other adjacent structures that
helps cushion joints.
When you require THR?
Hip replacement surgery is a treatment for pain and disability in the hip. The most common
condition that results in the need for hip replacement surgery is Avascular Necrosis(AVN) and
arthritis. it is characterized by the loss of joint cartilage in the hip. Damage to the cartilage and
bones limits movement and may cause pain. People with severe pain due to degenerative joint
disease may be unable to do normal activities that involve bending at the hip, such as walking or
sitting, because they are painful.
Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a hip injury,
can also lead to degeneration of the hip joint. Hip replacement may also be used as a method of
treating certain hip fractures. A fracture is a traumatic event that may result from a fall. Pain
from a fracture is severe and walking or even moving the leg is difficult. If medical treatments
are not satisfactory at controlling pain due to arthritis, hip replacement surgery may be an
effective treatment.
How to do THR?
A hip replacement involves an incision several inches long over the hip joint. After soft tissue
dissection and limb length markings head is dislocated and neck cut is performend than you get
the view of socket and it is reamed to fit a appropriate size cup which can be fixed with screws
depending on fixation and a lined is locked in the cup. Than femur is prepared by drill and rasp
and appropriate trial is done if surgeon is happy the original implants are implanted. . The doctor
will determine the best procedure for a person, based on that individual’s situation.
What to know about implant?
Unlike knee prosthesis hip prosthesis comes in lot of design and its right of every patient to
understand about implant which they are going to receive. Generally we encourage our patients
ot ask questions about implants.
Three most important things are
Fixation of Implant: weather cemented, uncemented or hybrid. A cemented prosthesis attaches
to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous
surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the 2
types is used to replace a hip than it is known as hybrid.
Bearing Surface: different types of bearings are used: Metal on Poly, Metal on Metal, Ceramic
on ceramic, Ceramic on poly. Metal on Metal Has been withdrawn by many companies due to
metal ion side effects rest all other bearings are on use. For younger patients ceramics are better,
Size of Head: Increase in head size brings more lieberty of motion but it also reduces the
thickness of poly so a middle path has to followed.

3. Risks of the procedure?
As with any surgical procedure, complications can occur. Some possible complications may
include, but are not limited to, the following:
• Bleeding
• Infection
• Blood clots in the legs or lungs
• Dislocation
• Changes in leg length or gait
• Need for revision or additional hip surgery
• Nerve injury resulting in weakness or numbness
There may be other risks depending on your specific medical condition. Be sure to discuss any
concerns with your doctor prior to the procedure.