Total Knee Replacement in India

Overview:

There is a huge of number of people in the world who all are affected by arthritis, as a result of which they suffer from incapacitating pain which hinders their everyday activities – such as walking, climbing stairs or standing for long periods. Total knee replacement or arthroplasty is a well-established treatment at the end stage of a degenerated knee joint. This operative treatment generally relieves pain, improves physical function, and has a high level of patient satisfaction, especially in the elderly. This procedure is recommended by a doctor if medications or other simpler forms of treatment do not help to alleviate the pain. This surgery helps a person to be more active and self-dependant.

What is Total Knee replacement?

A Total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint which provides motion at the point where the thigh meets the lower leg. The thigh bone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. The term “Total Knee Replacement” is a misnomer. The knee is not being totally replaced; rather, the knee is simply being resurfaced. Only the worn-out arthritic ends of the femur (thigh bone), tibia (shin bone), and patella (kneecap) are removed and replaced.

Candidate for Total Knee replacement:

Whether to have total knee replacement surgery should be a cooperative decision made by you, your family, your family physician, and your orthopaedic surgeon. Your physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you could benefit from this surgery. Alternatives to traditional total knee replacement surgery that your orthopaedic surgeon may discuss with you include a unicompartmental knee replacement or a minimally invasive knee replacement. Reasons that you may benefit from total knee replacement commonly include:

• Severe knee pain that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. You may find it hard to walk more than a few blocks without significant pain and you may need to use a cane or walker.
• Moderate or severe knee pain while resting, either day or night
• Chronic knee inflammation and swelling that does not improve with rest or medications
• Knee deformity: a bowing in or out of your knee
• Knee stiffness: inability to bend and straighten your knee
• Failure to obtain pain relief from nonsteroidal anti-inflammatory drugs. These medications, including aspirin and ibuprofen, often are most effective in the early stages of arthritis. Their effectiveness in controlling knee pain varies greatly from person to person. These drugs may become less effective for patients with severe arthritis.
• Inability to tolerate or complications from pain medications
• Failure to substantially improve with other treatments such as cortisone injections, physical therapy, or other surgeries

Most patients who undergo total knee replacement are age 60 to 80, but orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on a patient's pain and disability, not age. Total knee replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Symptoms for Total Knee Replacement:

Night pain is particularly distressing. If dysfunction of the knee is causing significant reduction in the patient's quality of life, this should be taken into account. Correction of significant deformity is an important indication but is rarely used as the primary indication for surgery. Roentgenographic findings must correlate with a clear clinical impression of knee arthritis. Patients who do not have significant loss of joint space tend to be less satisfied with their clinical result following TKA. Exhaust all conservative treatment measures before considering surgery. Knee replacement has a finite expected survival that is adversely affected by activity level.3, 7, and 8 generally; it is indicated in older patients with more modest activities. It is also clearly indicated in younger patients who have limited function because of systemic arthritis with multiple joint involvements. Young patients requesting knee replacement, especially those with posttraumatic arthritis, are not excluded by age but must be significantly disabled and must understand the inherent longevity of joint replacement. Rarely, severe patellofemoral arthritis (see image below) may justify arthroplasty because the expected outcome of arthroplasty is superior to patellectomy. Isolated patellofemoral replacement still is undergoing clinical investigation.

Preparation for total knee replacement:

Before surgery, joints adjacent to the diseased knee are carefully evaluated. This is important to ensure optimal outcome from the surgery. Replacing a knee joint which is adjacent to a severely damaged joint may not yield significant improvement in function. Furthermore, all medications which the patient is taking are reviewed. Blood-thinning medications such as warfarin (Coumadin) and anti-inflammatory medications such as aspirin may have to be adjusted or discontinued prior to surgery. Routine blood tests of liver and kidney function and urine tests are evaluated for signs of anemia, infection, or abnormal metabolism. Chest X-ray and EKG are performed to exclude significant heart and lung disease which may preclude surgery or anesthesia. Finally, it is less likely to have good long-term outcome if the patient's weight is greater than 200 pounds. Excess body weight simply puts the replaced knee at an increased risk of loosening and/or dislocation. A similar risk is encountered in younger patients who may tend to be more active, thereby adding trauma to the replaced joint.

Procedure for Total Knee replacement:

The term “Total Knee Replacement” is a misnomer. The knee is not being totally replaced; rather, the knee is simply being resurfaced. Only the worn-out arthritic ends of the femur (thigh bone), tibia (shin bone), and patella (kneecap) are removed and replaced. Less than half an inch (~9mm) is removed from the ends of the bones and being replaced with metal and plastic caps, the TKA components. Total Knee Replacement is a Resurfacing and Realignment procedure. It is “Human Carpentry” in which the rough, arthritic, painful joint surfaces are removed and replaced with smooth-gliding metal and plastic surface components while the ligaments are realigned and balanced to straighten the knee. The procedure is designed to produce a pain-free stable knee that delivers better motion and better performance than your preoperative arthritic knee. Total Knee Replacement or Total Knee Arthroplasty is an implant procedure performed under general or spinal anesthesia. The operation lasts approximately two hours during which the damaged joint surfaces are resected and replaced with the metal and plastic implants. The procedure itself takes approximately 2 hours. Your orthopaedic surgeon will remove the damaged cartilage and bone and then position the new metal and plastic joint surfaces to restore the alignment and function of your knee. After surgery, you will be moved to the recovery room, where you will remain for 1 to 2 hours while your recovery from anesthesia is monitored. After you awaken, you will be taken to your hospital room.

The Post-Op Course after Total Knee replacement:

Total Knee Replacement is generally an inpatient procedure. Immediately after the surgery, you will be placed in a CPM (Continuous Passive Motion) machine which will passively move your knee through a range of motion while you are in bed. Physical Therapy is started on the day after the surgery and it involves joint mobilization, transfer training and walking. You will initially train at using a walker for transfers and walking. You may later transition to using crutches or a cane. If you can achieve a knee range of motion of 0 – 95 degrees, safely perform transfers and walk well, you will be discharged from the hospital and sent home with help to continue your recovery. If you seem to need more time to meet those goals and / or if you do not have sufficient help at home, you will be transferred to extended care rehabilitation center where you will continue your rehabilitation until you a safe to be discharged home. Within two weeks, you will become very independent in your activities and you will have returned to near your preoperative functional capabilities in activities of daily living. You will continue your rehabilitation through outpatient physical therapy and a home exercise program. Golfers often return to their recreational participation within four to six weeks. After hospital discharge, you will have regular follow-up visits at my office so that I can monitor your healing and guide your rehabilitation and activity until you achieve maximum medical recovery.

Recovery after Total Knee replacement:

It is important for patients to continue in an outpatient physical-therapy program along with home exercises for optimal outcome of total knee replacement surgery. Patients will be asked to continue exercising the muscles around the replaced joint to prevent scarring (contracture) and maintain muscle strength for the purposes of joint stability. The wound will be monitored by the attending physicians and their staff for healing. Patients also should watch for warning signs of infection including abnormal redness, increasing warmth, swelling, or unusual pain. It is important to report any injury to the joint to the doctor immediately. Future activities are generally limited to those that do not risk injuring the replaced joint. Sports that involve running or contact are avoided, in favor of leisure sports, such as golf, and swimming. Swimming is the ideal form of exercise, since the sport improves muscle strength and endurance without exerting any pressure or stress on the replaced joint. Patients are recommended to take antibiotics before, during, and immediately after any elective procedures in order to prevent infection of the replaced joint. Though infrequent, patients with total knee replacements can require a second operation years later. The second operation can be necessary because of loosening, fracture, or other complications of the replaced joint.

Alternatives to Total Knee replacement:

The decision to undergo total knee replacement surgery is yours. It is important that you be aware of your options, other than total knee replacement surgery. You may simply decide not to have surgery and live with your arthritic knee. The following is a list of alternatives to total knee replacement surgery you may wish to explore.

• Specialized Braces : There are specialized braces that can be helpful in some cases of knee arthritis. These braces are designed to create a force which transfers load from an area of the knee where the cartilage is more worn, to an area of the knee where the cartilage is less worn. These braces are helpful in cases where there is still some cartilage remaining in the knee, and the pressure of the brace causes less discomfort than the knee arthritis.
• Arthroscopy : There are less invasive surgical procedures available which can be helpful in some cases. These include arthroscopy. Arthroscopy requires only small incisions around the knee which allow the insertion of small instruments, which are about the size of a pen or pencil. With arthroscopy, degenerated and worn cartilage can be trimmed and smoothed, which reduces the source of inflammation. Additionally, the lining of the knee (the synovium), can be trimmed, and this also decreases inflammation.
• Cartilage Transplantation : It is now possible to transplant articular cartilage from one location to another. Healthy cartilage, from an area of the knee that does not bear weight, can be transplanted into another area of the knee where weight-bearing cartilage has been damaged. Cartilage transplantation is best for localized areas of damaged cartilage in an otherwise healthy knee. Unfortunately, in most cases of osteoarthritis and rheumatoid arthritis, the degeneration and wear of articular cartilage involves the majority of the joint surfaces. Cartilage transplantation is not a good option in such cases.
• Osteotomy : Some cases, where the leg is imperfectly aligned, can be treated by an osteotomy. An osteotomy is an operation that cuts the bone, either above or below the knee, and re-aligns the knee to a better position. This is a bigger operation than an arthroscopy and patients usually stay 1 or 2 days in the hospital. It takes 6 to 8 weeks for the bone to heal. Physical therapy is usually required to restore knee motion and strength. Complete recovery takes a number of months. An Osteotomy is a good operation, especially for younger patients, and those where the leg is clearly not straight and the cartilage wear is confined to one portion of the knee.
• Uni-Compartmental Arthroplasty : In a few cases, only a portion of the knee joint surfaces have worn out and need to the replaced. When only a portion of the knee is replaced, this is called a uni-compartmental arthroplasty. Patients usually stay 2 or 3 days in the hospital and it takes a couple of months for the knee to recover. Physical therapy is usually required to restore knee motion and strength. Unfortunately, in most cases of arthritis, the joint surfaces are diffusely worn. Uni-compartmental arthroplasty is, therefore, less commonly performed than total knee replacement.
• Arthrodesis / Knee Fusion : In cases when the risk of failure of total knee replacement is considered to be very high, an Arthrodesis, or knee fusion may be recommended instead. In this operation, the ends of the femur and tibia bones are cut flat, the cut ends are pressed together such that the leg is just slightly bent, and then held in this position by pins, or plates and screws. Over a couple of months the ends of the bones grow together, hence the term knee fusion. The knee fuses in a nearly straight position and cannot be bent. Although the knee no longer moves, it is not painful and most patients walk with only a slight limp.

Total Knee Replacement in India:

Of late, India has become the most preferred medical destination for Total Knee Replacement. The reason behind this paradigm shift is the presence of hi end medical infrastructure abreast with state-of-art technologies which is virtually equivalent to those in USA, UK and Europe. India has some of the best orthopedic hospitals and treatment centers in the world and some truly superior facilities, with almost zero patients wait list. The hospitals and orthopedic medical centers have high end facilities, equipped with latest technology equipments and gadgets. Hospitals adhere to international standards of clinical care, safe environment, medication safety, respect for rights and privacy, international infection control standards.

The panel of Indian orthopaedic surgeons is highly qualified, having the experience of thousands of Total Knee Replacement surgeries - They are trained and worked in some of the prestigious medical centres in England, USA & Europe. They have a good success rate and are world renowned medical professionals known to cater service both India and abroad. And besides, India has world heritage places and exotic beaches, where the patients can rejuvenate while they recover following any orthopedic surgery.

The Total Knee Replacement in India is available at various hospitals in the following cities with latest amenities and state-of-art-facilities.

The cost of Total Knee Replacement in India:

Significant cost difference is the key in bringing patients all across the world for Total Knee Replacement in India. India is not only cheaper but the waiting time is almost zero. This is due to the outburst of the private sector which is comprised of hospitals and clinics with the latest technology and best practitioners.

Some of the common countries from which patients travel to India for surgery are:

ABOUT INDIA

Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.

• Mumbai - Mumbai, formerly known as Bombay in English, is the capital of the Indian state of Maharashtra. This port city (India's largest and busiest) accounts for a major share of the government's revenue, and has one of the world's largest harbour. There are many things to love about Mumbai. One is simply the geographical names, like The Queen's Necklace and Elephanta Island, all with roots in the British Empire.
• Hyderabad - Also known as City of Nizams. The city of Hyderabad has its own individual character, which is evident in the beautiful, ancient palaces and the equally modern, and state-of-the-art offices and buildings. Medical tourism at hospitals in Hyderabad combines care for your health with international tourism. The primary reason behind its surging popularity is better healthcare services at an affordable budget.
• Goa - Popularly known as the ‘Rome of the East’, Goa boost of natural, magnificent churches and exquisite works of man. Plunge into the clear blue water of the large pool, or soak in the blissful sunshine on the picturesque island. Goa is an interesting location for getting your health propped up and getting those long postponed surgeries done. You have modern facilities, short waiting times and very affordable prices for procedures, hospital services and medicines.
• Bangalore - The progressive and modern city of Bangalore is the state capital, being located within India's Karnataka state. Bangalore is often referred to as the country 'Garden City', due to its high concentration of parks and green spaces. Bangalore has few of the world’s best doctors and medical practitioners, who have been trained by the rigorous Indian medical education system as well as in countries like UK and USA.
• Nagpur - Nagpur City has many distinctions. It is also the second greenest in India and is located at the very center of the heartland, almost equidistant from Kolkata, Chennai and New Delhi and Mumbai. The present city was founded in the early 18th century by Bhakt Buland, a Gond prince of the kingdom of Deogad in the Chhindwara district. The Nagpur District has a varied culture, as well as being in the central part of India, the market in Nagpur is flooded with products from all over India. Nagpur has few of the world’s best doctors and medical practitioners, who have been trained in countries like UK and USA.
• Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet.
• Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jam-packed burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors.
• Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism.
• Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India.
• Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery.
• Gurgaon - Located in the National Capital Region, Gurgaon is one of the most rapidly growing cities in Greater Delhi. In the last few years Gurgaon has boomed as the hub of IT and other new-age businesses. Gurgoan is the latest destination for Medical Tourism in India as it is the latest modern upcoming city near Delhi.
• Chandigarh - Located near the foothills of Shivalik range of the Himalayas, Chandigarh is one of the most beautiful and happening cities of India. Chandigarh has great potential for Medical tourism as the unpolluted and excellent environs give many opportunities to patients to recover from their illness.

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