Cost of Complex Hip Replacement Surgery in India

After hip replacement, certain things are not recommended: sitting on the floor, sitting cross-legged, and squatting, as these positions can damage the implant and cause loosening. High-energy sport activity should also be avoided. Following these recommendations, a well-fitted hip can last 30–35 years, and since most hip replacement candidates are of an older age profile, most patients will not need it again in their lifetime.

Stem cells are osteoprogenitor or osteopotent cells that can convert into osteoblasts, osteoclasts, or chondroblasts. For hip cartilage damage, we clean the damaged islands of cartilage with hip arthroscopy and inject stem cells; over time, review MRIs show the cartilage growing back, like grass growing, with less damage and fewer symptoms after about 6 months — though it does take time. In orthopaedics we harvest stem cells from the iliac crest, using a Jamshidi needle, taking around 120 ml of blood from the marrow (posterior or anterior, near the spine). This is then put into a centrifuge machine for about 45 minutes to 1 hour to concentrate the stem cells before injection.

Earlier, international companies like Johnson, Stryker and Zimmer supplied all the revision and complex hip replacement implants, but they have since withdrawn much of their hardware because of government policies and duties. Luckily we now have two or three Indian companies that have come up very well and collaborated to produce cost-effective implants. Earlier a hip replacement used to cost around $10,000–$12,000; now that has come down to between $7,000 and $8,000. Where there are problems, I also try to reduce my own surgical fees to help the patient.

It depends on the pathology and on the activity — for example, Andy Murray, the tennis player, had a hip replacement and could carry on with most of his activities, though one cannot guarantee 100%. If someone has had a total hip replacement, high-impact sports of that kind are generally not advisable — but they can change to a different sport. If the condition is femoroacetabular impingement (FAI) rather than arthritis, we do hip arthroscopy to remove the impingement, clean the cartilage, and inject stem cell therapy; the hip regenerates over about 6 months and results on repeat MRI are often excellent. Most sport-related damage is to ligaments or cartilage, not true hip arthritis — hip arthritis itself means the cartilage is gone and the anatomy is deformed, which is a different issue, and after that kind of hip replacement patients feel great satisfaction just resuming daily activities.

We look at the X-ray to see whether the hip joint space is maintained. If pain has started but mobility is still there and the joint space and cartilage are maintained, we don't straight away advise hip replacement — we have other options, such as the arthroscopic method, where we clean up osteochondral extra bone formation or damaged cartilage and repair it with stem cell therapy. That is a good option instead of hip replacement. Once the cartilage is completely damaged on CT or MRI, with no blood flow to the femoral head, then the only answer is hip replacement.

The cost of complex hip replacement surgery in India has fallen from around ten thousand to twelve thousand US dollars to between seven thousand and eight thousand US dollars, as Indian implant manufacturers have developed cost-effective alternatives to the international hardware that was previously used.

International companies such as Johnson and Johnson, Stryker and Zimmer previously supplied most of the hardware used for revision and complex hip replacement in India. Much of this international hardware has since been withdrawn because of duties and government policy changes, and two to three Indian companies have stepped in with cost-effective implants for complex hip arthroplasty.

Where a patient faces financial difficulty, surgical fees can be reduced on a case-by-case basis to help make treatment possible. Cost can also factor into the choice between cemented and uncemented implants, since cemented implants are comparatively more affordable.

Discussing a patient's history and X-rays in advance, including through the Jivo platform, allows the likely cost and length of stay for hip replacement surgery in India to be estimated before the patient travels.