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Thanks to the PM, patients no longer cringe at knee replacement surgery

Savera R Someshwar

"Just this morning," says Dr Sanjay Agarwala, chief of surgery and head, orthopaedics and traumatology, Hinduja Hospital, Bombay, "I had this 50-year-old woman patient who came to me with a painful knee problem. She was hoping I would recommend knee replacement surgery for her."

The lady in question did need surgery -- only it was to be high tibial osteotomy (where the bone, which is out of alignment, is cut to bring it back to as normal a position as possible) instead of the more intensive knee replacement. Her disappointment was obvious.

"Actually," says Dr Agarwala, "we have a lot to thank the prime minister for. Earlier, whenever we recommended knee replacement surgery, we would actually see the patient cringe."

Lately, though, Dr Agarwala has been observing a dramatic change in his patients's reactions. It began with newspaper reports about the prime minister's knee problem and the fact that he had decided to go for in for a surgical solution. Then followed a slew of articles detailing the ailment and explaining the treatment.

"Now," says Dr Agarwala, "many of my patients actually know what knee surgery is all about."

Since knee surgery is elective, many Indian patients in particular hesitate to exercise the option. Unlike a by-pass operation, it is not a life-and-death option, but merely one that improves the quality of life of the patient. "In fact," says Dr Agarwala, "many of your relatives who are over 60 must already be experiencing problems with their knees and surgery could well be a viable option to relieve their pain."

In fact, most patients who are recommended knee removal surgery tend to be in the 60-plus bracket. Because of the higher age group, surgeons conduct a series of tests -- checking the blood count, kidney, liver, electrolyte, sugar, blood protein, HIV, hepatitis B and C, ECG and chest X-rays -- to ascertain the patient's ability to withstand surgery.

Though knee surgery is non life-threatening has a 95 to 97 per cent success rate, there are things that can go wrong. The main risk comes from any kind of pre or post-operative infection.

A few hours before surgery, the knee is held up in bent position to drain it of blood. A tourniquet is then applied, to be released only after the operation is complete. When the blood rushes back to the knee, there is the risk of fluid accumulation in the operated area.

The blood could also clot in the operated area, leading to a risk of the heart attack if it moves into the blood stream. There is also the risk of deep vein thrombosis (a clot in the vein.)

"Of course," says Dr Agarwala, who has conducted more than 700 knee replacements and over a thousand hip replacements, "these risks are minimal and inherent in any kind of surgery. After all, there are risks around you all the time. We have patients who come in here, nursing fractured bones, because they had an accident crossing the road."

The Hinduja hospital has, on request from the Breach Candy hospital, sent across certain surgical equipment required for knee surgery. The equipment is on loan for two days. "We have sent across five multiple trays, with 20 pieces of equipment each. We think this equipment will be kept as back-up. For now, we have no such surgeries for the next two days. But in case we need the equipment, we will ask for it to be sent back," says orthopaedic surgeon Dr Shantanu Patil.

The PM's surgery: The full coverage

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