In a first, hip replacement patient sent home 9 hrs after surgery at AIIMS

New Delhi: Recently, All India Institute of Medical Sciences (AIIMS) conducted India’s first outpatient hip replacement surgery on a 26-year-old man suffering from hip damage due to arthritis. The patient was discharged nine hours after the surgery, which involved removing the damaged bone and cartilage of the hip and replacing it with prosthetic components.

Normally, a patient undergoing hip replacement surgery is required to be admitted for 2-10 days for post-operative care, which not only adds to the cost of treatment but also increases the risk of hospital-acquired infection.

Dr Rajesh Malhotra, chief of orthopaedic services at AIIMS, told TOI that the patient, Sumir Orow, came to the hospital at 7am on Monday and surgery started at 8.45am. “By 11.30am, the patient was out of the post-operative room. Between 1pm and 2pm, we trained him to walk and climb the stairs and at 4pm, he was discharged from the hospital. This is the first time in India that a patient has gone home after hip replacement surgery this quickly,” he added.

“We had been training hard for the past few years to bring down the duration of stay of patients undergoing hip replacement surgery,” Malhotra said.

Conventionally, most surgeons conduct hip replacement surgery through posterior approach, by approaching the joint from the back of the hip. This causes significant loss of blood as layers of muscle have to be cut to reach the joint. Healing takes time.

Malhotra and his team adopted a newer method referred to as direct anterior approach. In this case, the patient was asked to lie down in a supine position — lying horizontally with the face and torso facing up — and an incision was made on the front of the hip instead of the back.

“The direct anterior approach allows the joint to be replaced by moving muscles aside along their natural tissue planes. Therefore, there is less pain, blood loss is lesser and, more importantly, the risk of dislocation of the hip also reduces because the structures at the back of the joint are left intact,” the AIIMS doctor said.

Select surgeons abroad and just a few in India use this method because it requires a vast experience. Also, preoperative planning and selection of patients has to be done carefully. “The daycare procedure can be performed in relatively younger patients with no comorbidities. The patient should be well-motivated to follow a fast-track method of mobilisation following surgery,” said Malhotra.

AIIMS is planning to start a daycare knee replacement surgery soon. “We have been discharging patients within 36 hours of surgery already and the target is to discharge them within 12 hours,” the orthopaedician said.

Due to the pandemic, many patients suffering from debilitating pain in the joints have been postponing surgeries. The AIIMS doctor said daycare operation would reduce the risk of infection.