Dr. Vinay S. Joshi · Kokilaben Dhirubhai Ambani Hospital
Hip Replacement Surgery
Eliminating hip pain and restoring full mobility — with advanced bearing surfaces and techniques tailored to each patient's anatomy and lifestyle.
The hip is a ball-and-socket joint that bears the body's weight during every step. When the cartilage lining the joint is destroyed by arthritis, injury, or avascular necrosis (AVN), the resulting bone-on-bone contact causes severe pain, stiffness, and loss of independence. Hip replacement surgery removes and replaces the damaged joint with a precisely engineered prosthesis that restores smooth, pain-free movement.
Dr. Vinay S. Joshi has performed over 1,000 hip replacements, including more than 60 specialised ceramic-on-ceramic replacements. He has particular expertise in complex cases involving avascular necrosis (AVN), bone deficiency, and revision surgery, and is one of the few surgeons in India with dedicated training in all major hip approaches.
Total Hip Replacement is the definitive surgical treatment for end-stage hip arthritis. The damaged femoral head (ball) and acetabulum (socket) are replaced with a prosthesis consisting of a metal stem fixed into the femur, a metal or ceramic femoral head, and a metal cup with a smooth inner liner fixed into the pelvis. Together, these components recreate a smooth, pain-free ball-and-socket joint.
Patients with severe osteoarthritis, rheumatoid arthritis, avascular necrosis, or hip fractures causing persistent pain, night pain, limping, difficulty with stairs, and inability to perform daily activities despite adequate non-surgical treatment including physiotherapy and anti-inflammatory medication.
Dr. Joshi is trained in multiple approaches including the posterior approach (most common in India), the direct lateral approach, and the minimally invasive 2-incision technique. The approach is chosen based on the patient's anatomy, body composition, and the degree of deformity present.
Uncemented implants rely on bone growing directly onto a textured or coated surface (biological fixation) — preferred for younger, active patients. Cemented fixation uses bone cement to immediately secure the components — preferred in patients with weaker bone quality or older age. Dr. Joshi determines the optimal fixation strategy for each individual.
Patients walk with a frame on day one after surgery. Hospital stay is typically 4–5 days. Weight-bearing as tolerated begins immediately. By 6 weeks, most patients are walking unaided. Full recovery — including return to driving and light work — is achieved by 3 months. Implants are designed to last 20–25+ years.
Dr. Joshi has performed over 60 ceramic-on-ceramic (CoC) hip replacements — one of the highest volumes of this specialised procedure in India. In a CoC replacement, both the femoral head and the acetabular liner are made from advanced alumina or delta ceramic, eliminating the metal-on-polyethylene wear that is the primary cause of long-term implant failure.
Ceramic bearings are the hardest, smoothest, and most wear-resistant material used in hip replacement. They produce up to 4,000 times less wear debris than metal-on-polyethylene bearings. This near-elimination of debris dramatically reduces the risk of osteolysis (bone loss), aseptic loosening, and the need for revision surgery.
Ceramic-on-ceramic is strongly recommended for patients under 65, active patients who will place significant demands on their hip over decades, patients concerned about metal ion release or allergy, and any patient with a long life expectancy where implant longevity is a priority.
Fourth-generation delta ceramics (alumina matrix composite) are virtually fracture-proof, addressing the rare fracture concern of earlier ceramic generations. Delta ceramic heads are now considered the safest and most durable bearing surface available in hip arthroplasty, with 20+ year survivorship data now emerging from European registries.
Successful ceramic-on-ceramic arthroplasty requires precise cup positioning to prevent the rare phenomenon of "ceramic squeak" caused by edge loading. Dr. Joshi's extensive experience with CoC procedures ensures optimal cup orientation and component positioning for silent, smooth, long-lasting function.
Avascular Necrosis (AVN) — also called osteonecrosis — is the death of bone tissue due to a loss of blood supply. In the hip, AVN affects the femoral head, causing it to collapse over time, leading to severe pain and ultimately arthritis. It is one of the most common causes of hip replacement in younger patients in India, often linked to high-dose steroid use, alcohol, sickle cell disease, or trauma.
AVN is classified into 4 stages. Stage I–II: pre-collapse — bone tissue is dying but the femoral head shape is preserved. Stage III: early collapse — the subchondral bone fractures. Stage IV: late collapse — the femoral head has deformed and secondary arthritis has developed. Surgical strategy depends on stage at presentation.
In early-stage AVN, Dr. Joshi performs core decompression — drilling a tunnel through the femoral neck into the necrotic zone to reduce intra-osseous pressure, restore blood flow, and stimulate healing. This minimally invasive procedure can halt or reverse AVN progression when performed at the right stage, avoiding or delaying the need for hip replacement.
Once the femoral head has collapsed (Stage III–IV), hip replacement becomes necessary. AVN replacement presents unique surgical challenges: abnormal bone geometry, bone deficiency in the necrotic zone, and younger patient age requiring maximum implant longevity. Dr. Joshi uses ceramic-on-ceramic bearings with uncemented fixation for AVN patients to maximise durability.
AVN in India frequently presents in patients under 50 — far younger than typical arthritis patients. This demands both the most durable implant choice and the most precise technique to achieve a 25–30 year implant life. Dr. Joshi's specialist experience in younger-patient hip arthroplasty makes him uniquely suited to managing this condition.
For patients diagnosed with AVN at an early stage (Stage I or II) before femoral head collapse occurs, Dr. Joshi offers Regrow Therapy — a bone-preserving biological approach combining core decompression with advanced cell-based and biological augmentation. The goal is to regenerate bone tissue, restore blood supply, and avoid hip replacement altogether in young patients.
Regrow Therapy combines core decompression (drilling to reduce pressure and open a channel) with the introduction of concentrated bone marrow aspirate (rich in mesenchymal stem cells) and platelet-rich plasma (PRP) into the necrotic zone. These biological agents stimulate new bone formation and vascular ingrowth to repair the damaged area from within.
Patients diagnosed with AVN at ARCO Stage I or Stage IIA — where the femoral head is still spherical and intact. MRI is essential for early diagnosis and staging. Ideal candidates are under 50 years old, with a necrotic lesion comprising less than 30% of the femoral head. Early diagnosis dramatically improves the success of joint-preservation therapy.
Under general or spinal anaesthesia, Dr. Joshi uses fluoroscopic guidance to drill a precise tunnel from the femoral neck into the necrotic zone. Bone marrow aspirate (from the patient's own iliac crest) is processed bedside to concentrate stem cells, which are then injected into the decompressed site along with PRP and bone graft material to promote healing.
In appropriately selected patients (Stage I–IIA, lesion <30% of head), Regrow Therapy achieves arrest of progression in 70–80% of cases, with many patients experiencing significant pain reduction within 3–6 months. Serial MRI at 6 and 12 months monitors healing. If progression occurs despite treatment, hip replacement remains available as a next step.
Revision hip replacement — replacing a previously implanted artificial hip — is one of the most technically demanding procedures in orthopaedic surgery. Dr. Joshi is one of Mumbai's most experienced revision hip surgeons, managing cases involving implant loosening, infection, dislocation, bearing wear, periprosthetic fracture, and complex bone deficiency.
The most common reasons for hip revision include: aseptic loosening (implant loosening without infection, often from wear debris); periprosthetic joint infection (PJI); recurrent dislocation; bearing surface wear; periprosthetic fracture (bone fracture around the implant); implant failure or fracture; and pain from an incorrectly positioned component.
Revision surgery involves removing well-fixed components without damaging surrounding bone, managing bone deficiency left behind by the removed implant, reconstructing anatomy with augments, cages, or custom implants, and selecting new components that can achieve reliable fixation in compromised bone — all while managing significantly higher surgical risk.
Each revision case undergoes extensive pre-operative workup including X-rays, CT scan for 3D assessment of bone loss, infection markers (ESR, CRP, joint aspiration), and often consultation with an infectious disease specialist. Dr. Joshi uses the Paprosky bone deficiency classification system to plan the exact reconstruction strategy, including augments, cages, and long-stem components where required.
While revision surgery carries higher complication rates than primary replacement, carefully selected and expertly performed revision procedures achieve excellent long-term outcomes. Recovery is longer — typically 4–6 weeks non-weight-bearing followed by progressive rehabilitation over 3–6 months. Dr. Joshi will provide a detailed, personalised recovery plan at your consultation.
From early AVN prevention to the most complex revision surgery, Dr. Joshi provides comprehensive, personalised hip care at Kokilaben Dhirubhai Ambani Hospital.
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