Introduction to Hip Replacement Surgery
Hip Replacement Surgery, also known as Total Hip Arthroplasty, is a common orthopedic procedure performed to relieve chronic hip pain and restore joint function in patients with severe hip damage. The surgery involves replacing the damaged or diseased portions of the hip joint with artificial prosthetic components, typically made from a combination of metal, ceramic, and medical-grade plastic. These implants are designed to replicate the natural movement of the hip, reduce pain, and improve the patient’s ability to perform daily activities. Originally developed in the West in the 1960s, hip replacement has evolved over the decades with advancements in surgical techniques, implant materials, and post-operative care, making it one of the most successful surgeries in the medical field. In India, the demand for joint replacement surgeries has been steadily rising due to an aging population, increased awareness, and better access to specialized healthcare. According to estimates, over 100,000 hip replacement surgeries are performed annually in India, and this number is expected to grow with the rising incidence of lifestyle-related joint degeneration and trauma cases. Indian patients, who were once hesitant about surgical options, are now increasingly opting for hip replacement as a reliable solution for regaining their independence and returning to active, pain-free lives. With shorter hospital stays, improved pain management, and faster recovery times, modern hip replacement surgery in India offers world-class outcomes at an affordable cost, attracting not only domestic patients but also international medical tourists.
Dr. Sunny Dole is a leading hip replacement surgeon in Pune, known for his expertise in treating complex hip disorders with advanced surgical techniques. With specialized training in joint replacement surgery and extensive experience in managing avascular necrosis (AVN), arthritis, and traumatic hip injuries, Dr. Sunny Dole offers personalized care that prioritizes mobility, pain relief, and long-term joint function. He has successfully performed numerous hip replacements using state-of-the-art implants and minimally invasive methods to ensure faster recovery and improved outcomes. Practicing across reputed hospitals and consulting at Kothrud Orthopedic Clinic, Dr. Sunny Dole is widely trusted by patients for his skill, compassionate approach, and commitment to restoring quality of life through orthopedic excellence.
Why Hip Replacement Surgery is Needed?
Hip replacement surgery is increasingly becoming a necessity in India due to a combination of demographic, lifestyle, and medical factors. Unlike Western countries where osteoarthritis is the leading cause, in India, the most common cause of hip replacement surgery is avascular necrosis (AVN) of the femoral head. AVN is a condition where the blood supply to the head of the femur is compromised, leading to bone death and joint collapse. It often affects younger individuals in their 30s and 40s and is commonly associated with prolonged steroid use, alcohol abuse, trauma, and more recently, post-COVID complications. As AVN progresses, patients experience severe pain, stiffness, and difficulty walking, with hip replacement becoming the only definitive treatment once the joint is damaged beyond repair. In addition to AVN, other causes like osteoarthritis, rheumatoid arthritis, and hip fractures—particularly in elderly individuals with osteoporosis—also contribute to the rising number of hip replacements in the country.
India’s rapidly urbanizing population and changing lifestyle patterns have led to a surge in obesity, sedentary habits, and metabolic disorders, all of which can further accelerate hip joint degeneration. Unfortunately, due to lack of awareness and fear of surgery, many patients delay seeking medical care until the condition becomes severe. However, with advancements in surgical techniques, availability of skilled orthopedic surgeons, and increasing awareness, more patients are now opting for hip replacement at the right stage. The procedure offers long-term relief from pain, restores mobility, and significantly improves quality of life. As a result, hip replacement surgery in India is not only addressing a major orthopedic health burden but is also becoming a vital step in helping patients of all ages return to independent, active lives.
What Are Types Of Hip Replacement Surgeries
Hip replacement surgery comes in several forms, each tailored to the patient’s condition, age, activity level, and the extent of joint damage. The primary goal across all types is to relieve pain, restore mobility, and improve joint function. Understanding the different types of hip replacement can help patients and families make informed decisions in consultation with their orthopedic surgeon.
1. Total Hip Replacement (Total Hip Arthroplasty), commonly known as 'THR' – The Most Common Type
Total hip replacement, also known as total hip arthroplasty, involves replacing both the ball (femoral head) and the socket (acetabulum) of the hip joint with artificial prosthetic components. The femoral component is usually made of metal or ceramic and is attached to a stem inserted into the thigh bone, while the socket component is made of high-grade plastic, ceramic, or metal. This type is recommended for patients with severe arthritis, avascular necrosis, or advanced hip joint damage. It is the most commonly performed hip replacement surgery in India and worldwide.
2. Partial Hip Replacement (Hemiarthroplasty)
In partial hip replacement, only the ball part of the hip joint is replaced, leaving the natural socket intact. This procedure is most often used for treating certain types of hip fractures in older adults, particularly when the socket remains healthy. While it involves a shorter surgery and recovery time compared to total replacement, it is not suitable for patients with arthritis or socket damage.
3. Hip Resurfacing
Hip resurfacing is a bone-conserving alternative to total hip replacement, usually recommended for younger, active patients with strong bone quality. Instead of removing the femoral head, it is trimmed and capped with a smooth metal covering, while the socket is also replaced with a metal cup. This preserves more of the patient’s natural bone and may offer easier revision surgery in the future. However, it is not suitable for patients with osteoporosis, AVN, or severe deformities.
4. Revision Hip Replacement
A revision hip replacement is performed when a previous hip replacement fails due to implant wear, loosening, infection, dislocation, or other complications. It involves removing and replacing the old implant with a new one. Revision surgeries are more complex and require specialized expertise, as the bone and soft tissues may be compromised.
5. Cemented vs. Uncemented Hip Replacement
These terms refer to how the artificial components are fixed to the bone:
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Cemented hip replacement uses a special surgical bone cement to anchor the implant and is often preferred for older patients or those with weaker bones.
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Uncemented (press-fit) hip replacement relies on the implant's surface design to allow natural bone to grow onto it over time, making it suitable for younger, more active patients with good bone quality.
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In many cases, a hybrid approach is used, where one component is cemented and the other is uncemented.
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Dr Sunny Dole, personally prefers Uncemented Hip Replacements as they are Biomechanically more stable construct. But in severely osteoporotic bones you have much less choices than using cemented prosthesis.
Each type of hip replacement surgery has its own benefits and considerations. The choice depends on individual patient factors, including age, bone quality, activity level, and underlying diagnosis. In India, with increasing expertise in orthopedic surgery and access to modern implant technologies, patients have more options than ever before to receive personalized and effective hip replacement solutions.
The Silent Thief of the Hip: Understanding AVN
Avascular Necrosis (AVN) of the hip, often referred to as "the silent thief of the hip," is a serious orthopedic condition that quietly and progressively destroys the hip joint without significant symptoms in the early stages. AVN occurs when the blood supply to the femoral head—the round ball at the top of the thigh bone—becomes compromised. Bone, like any living tissue, needs a constant blood supply to remain healthy. When this blood flow is disrupted, the bone cells die (a process known as necrosis), leading to weakening, collapse of the femoral head, and ultimately, severe joint dysfunction.
What makes AVN particularly dangerous is that it initially causes minimal or vague symptoms. Patients often report mild groin pain, hip discomfort, or stiffness that may be brushed off as muscle strain, fatigue, or early arthritis. However, beneath the surface, significant damage to the bone structure is silently progressing. As the disease advances, pain becomes more constant, movement becomes restricted, and everyday activities like walking, climbing stairs, or even sitting cross-legged can become extremely painful.
In India, AVN is now recognized as the most common cause of hip replacement in young and middle-aged adults, much more so than primary osteoarthritis. Several factors contribute to the high incidence of AVN in India:
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Steroid Use: Long-term or high-dose corticosteroid therapy (used for conditions like asthma, autoimmune diseases, and notably during severe COVID-19 infections) is a leading cause.
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Alcohol Abuse: Chronic heavy alcohol consumption can damage blood vessels and bone cells, leading to AVN.
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Trauma: A hip fracture or dislocation can directly disrupt blood flow to the femoral head.
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Medical Conditions: Sickle cell disease, lupus, and certain blood clotting disorders are associated with a higher risk of AVN.
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Idiopathic Causes: In many cases, the exact cause remains unknown.
The progression of AVN is typically staged:
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Stage 1: Early AVN with normal X-rays but positive MRI findings. Symptoms are mild.
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Stage 2: Early bone damage visible on X-ray, but the femoral head remains round.
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Stage 3: Collapse of the femoral head begins; the joint surface becomes irregular.
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Stage 4: Advanced joint destruction with secondary arthritis.
Diagnosis is usually confirmed by imaging tests, with MRI being the most sensitive tool for detecting early AVN, even before changes appear on standard X-rays.
Treatment of AVN depends on the stage at diagnosis:
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In early stages (before collapse), non-surgical options like medications, restricted weight-bearing, bisphosphonates, core decompression surgery, and stem cell therapy may help preserve the hip.
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In advanced stages (after collapse of the femoral head), hip replacement surgery (total hip arthroplasty) is the most reliable treatment to restore mobility, relieve pain, and dramatically improve quality of life.
Hip replacement outcomes for AVN patients in India are excellent, with modern implants and techniques offering 20 years or more of reliable joint function. For young patients concerned about the lifespan of the implant, newer generation materials like ceramic-on-ceramic bearings and highly cross-linked polyethylene liners are offering even longer durability.
Conclusion: Don’t Ignore Persistent Hip Pain
In India, a significant number of patients with AVN present late, often when the damage is already severe. Early recognition and timely orthopedic consultation can make a major difference between preserving the natural joint and requiring complex surgery. If you are experiencing persistent hip pain—especially if you have risk factors like steroid use, alcohol intake, or a history of trauma—don't ignore it. Seeking expert advice early can help detect AVN before major damage occurs and can save your hip from being silently stolen away.
Treatment Options for AVN of the Hip – Stage-wise Approach
🔹 Stage 1: Early AVN (Pre-collapse, Normal X-ray, Positive MRI)
Goal: Preserve the femoral head and prevent disease progression.
Treatment Options:
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Medications:
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Bisphosphonates (e.g., Alendronate): May help delay bone collapse.
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NSAIDs (e.g., Ibuprofen): For pain relief.
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Statins: Sometimes used for their protective vascular effects.
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Lifestyle Modifications:
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Strict non-weight bearing or limited weight bearing on the affected hip.
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Use of crutches or walker.
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Core Decompression Surgery:
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A minimally invasive procedure where small holes are drilled into the femoral head to reduce pressure, improve blood flow, and promote healing.
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Can be combined with bone grafting or stem cell therapy for better results.
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Biological Treatments:
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Bone marrow stem cell injections during core decompression may help regenerate bone.
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Hyperbaric Oxygen Therapy (HBOT):
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Occasionally used to enhance oxygen delivery to the affected bone, though not routinely practiced.
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🔹 Stage 2: Early Collapse with Bone Changes (X-ray shows sclerosis or cysts, but head not deformed)
Goal: Preserve the joint and prevent further collapse.
Treatment Options:
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Continue core decompression (if not already done).
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Osteotomy (in select cases): Cutting and realigning the bone to redistribute weight away from the affected area.
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Vascularized bone grafting: Graft is taken from another part of the body (usually fibula) along with its blood supply and transplanted to the necrotic area.
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Close monitoring: Regular imaging to track progression.
🔹 Stage 3: Collapse of Femoral Head Begins (Irregular shape, but joint space preserved)
Goal: Manage symptoms and prepare for definitive surgical treatment.
Treatment Options:
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Hip Resurfacing: In younger patients with good bone stock, this bone-conserving procedure caps the femoral head instead of removing it.
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Total Hip Replacement (THR): Increasingly considered at this stage, especially if pain and disability are significant.
🔹 Stage 4: Advanced AVN (Complete collapse with secondary arthritis and joint space narrowing)
Goal: Restore mobility, relieve pain, and improve quality of life.
Treatment Options:
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Total Hip Replacement (THR):
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Most effective and definitive treatment.
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Involves replacing the damaged femoral head and acetabulum (socket) with prosthetic components.
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Modern implants offer 20+ years of durability.
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Ceramic and highly cross-linked polyethylene components are preferred in younger patients.
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Revision Hip Replacement: May be needed in cases where a previous implant has failed or in complex, late-diagnosed cases.
Why Early Detection Matters
The earlier AVN is diagnosed, the greater the chance of saving the natural hip joint and avoiding major surgery. That’s why persistent or unexplained hip pain, especially in patients with known risk factors (steroids, alcohol, post-COVID therapy, trauma), must be thoroughly evaluated with MRI.
Prolonged Steroid Use as a Cause of AVN of the Hip – Explained for our Reader
Many people are surprised to learn that the medicines they take to reduce inflammation or fight disease can sometimes silently damage their bones—especially in the hip. One such condition is Avascular Necrosis (AVN), also known as osteonecrosis, which means "bone death due to lack of blood supply." Among its top non-traumatic causes is prolonged use of steroid medications.
🩺 What Are Steroids?
Steroids (corticosteroids) are powerful medicines often used to treat a range of health problems like:
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Asthma
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Arthritis
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Lupus and other autoimmune conditions
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Severe allergic reactions
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Inflammatory bowel disease
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After organ transplants
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COVID-19 (during severe infections)
These medications work by reducing inflammation and calming down an overactive immune system. They are life-saving in many cases and are commonly prescribed in tablet, injection, or intravenous (IV) forms.
⚠️ How Can Steroids Harm the Hip?
When taken in high doses or for a long time, steroids can interfere with how blood flows to the hip bone (femoral head). They can:
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Increase fat in the blood, which may block tiny blood vessels in the bone
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Affect bone cells and reduce bone strength
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Raise pressure inside the bone, reducing circulation
Over time, the lack of proper blood supply causes the bone to become weak, collapse, and lose its smooth shape—this is AVN.
📉 Who Is at Risk?
People most at risk of steroid-induced AVN include:
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Those taking high doses of steroids (e.g., more than 20 mg/day of prednisolone for several weeks)
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Patients on long-term steroid therapy
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People who had steroids during COVID-19 treatment
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Young adults with autoimmune diseases
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Athletes or bodybuilders using steroids without medical supervision
🦴 How Does It Feel?
In the early stages, AVN of the hip may not cause any symptoms. But as it progresses, you may feel:
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A deep, aching pain in the groin, hip, or buttock
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Pain while walking or climbing stairs
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Stiffness and limping
✅ What Can You Do?
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Always take steroids only under a doctor’s guidance
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Never self-medicate or use gym steroids for muscle gain
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If you’ve been on steroids and have hip pain, don’t ignore it
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Get an MRI scan early, even if your X-ray is normal
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Early-stage AVN can sometimes be treated without surgery
Dr. Sunny Dole, expert orthopedic and joint replacement surgeon in Pune, regularly treats patients with steroid-induced AVN. Early diagnosis and the right treatment plan can help preserve your natural joint and prevent surgery in many cases.
Understanding Idiopathic AVN of the Hip: When the Cause Is Unknown
Idiopathic AVN of the hip means that the bone in the hip joint loses its blood supply and starts to weaken or collapse, but the exact cause is unknown. "Idiopathic" simply means doctors don’t know why it happens. It can affect healthy people who have no history of injury, steroid use, alcohol intake, or any medical condition. This type of AVN often starts silently, with mild pain in the hip or groin, and may gradually worsen over time. Since there's no clear reason behind it, early diagnosis through an MRI and regular follow-up with an orthopedic specialist are very important to prevent joint damage and reduce the need for surgery.
Other Common Indications for Hip Replacement Surgery: Other than Idiopathic and Avascular Necrosis of Femoral Head (AVN)
Osteoarthritis (OA)
Osteoarthritis (OA) is the most common reason for hip replacement surgery. OA occurs when the cartilage that cushions the hip joint wears down over time, leading to pain, swelling, and reduced mobility. It is most often seen in older adults and can severely impact daily activities.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune condition where the body’s immune system attacks the joints, leading to inflammation, pain, and joint damage. Over time, this condition can cause significant deterioration of the hip joint, making a hip replacement necessary when conservative treatments are no longer effective.
Hip Fractures
Hip fractures are a common injury, especially in older adults with osteoporosis. If the fracture is severe or does not heal properly, a hip replacement may be recommended. This is especially true if the fracture affects the femoral head, the ball-shaped part of the hip joint.
Developmental Dysplasia of the Hip (DDH)
Developmental dysplasia of the hip (DDH) is a condition where the hip socket does not develop properly, leading to joint instability. Over time, this can cause arthritis and pain in the hip joint. In severe cases, hip replacement surgery may be necessary to improve function and reduce pain.
Post-Traumatic Arthritis
Post-traumatic arthritis develops after an injury to the hip joint, such as a fracture or dislocation. Even after the bone has healed, the joint may not function properly, leading to arthritis and pain. If the damage is significant, hip replacement surgery may be needed to restore mobility.
Congenital Hip Problems
People born with hip problems, such as hip dysplasia or other deformities, may experience joint degeneration as they age. These congenital issues can lead to pain and difficulty moving, and in some cases, a hip replacement may be needed later in life.
Tumors
Bone tumors or cancers affecting the hip joint may require hip replacement surgery if they cause significant joint damage or if removing the tumor involves removing part of the joint. A hip replacement can improve mobility and help with recovery after tumor removal.
If hip pain is limiting your daily life and conservative treatments no longer help, it may be time to consider hip replacement surgery. Dr. Sunny Dole, a highly experienced orthopedic surgeon in Pune, offers advanced hip replacement procedures designed to restore mobility and relieve pain. With his patient-centered approach, he ensures each case is thoroughly evaluated, and the most suitable surgical plan is crafted to meet your individual needs.
Dr. Sunny Dole consults at multiple trusted hospitals and clinics across Pune, making expert orthopedic care both convenient and accessible. From initial consultation to post-surgery recovery, you’ll receive comprehensive support every step of the way. Plan your hip replacement with Dr. Sunny Dole and take a confident step toward a pain-free, active future.
