Knee replacement surgery in India is world class and patients get huge cost savings. Patients from the UK, US and Canada increasingly prefer India as destination number one for Joint replacements of knee, hip and shoulder and hip resurfacing. Indian surgeons are well trained and Indian hospitals have infrastructure at par with the west.
A large population of baby boomers lacking insurance and unable to afford private treatment in the socialized health systems of the West has fuelled the demand for joint replacements. High success rate, affordable costs, safety of the surgical procedure, are main factors attracting overseas patients to Indian hospitals and knees are at the top of the list.
Costs are very reasonable and are lesser than a similar procedure in countries like Thailand, Singapore, South American countries and only amount to one tenth of the cost in the West. A price range of $5000 to $7000 US dollars is quoted for a knee replacement depending upon the type of implant chosen and the class of accommodation.
Implants & prosthesis are designed and manufactured in the west and have FDA approval. In some cases, even implants which did not have FDA approval like the Birmingham hip, Oxford knee, were available in India before they were obtainable in the US and now readily available today.
If you know that your surgeon is overseas trained, then it is re-assuring. Infrastructure of the hospital is vitally important. The operating theatres in some leading Indian hospitals provide “Ultra clean air” with ideal parameters. Exponential Laminar airflow is ideal where air is changed 25 times per hour.
The delivered air is treated by special HEPA (High efficiency particulate air filters) with 99.99 % efficiency so that the chance of infection is reduced to the level of < 1 %. Less than one colony forming units of bacteria should be present.
Let us look at some of the recent advances in total knee replacement available in India.
Minimally Invasive Surgery
If you ask your friend who has undergone a knee replacement about the worst thing about the surgery, he or she is likely to blame the amount of post operative pain. Some amount of post-op pain is inevitable from any operation. The amount of tissue dissection in normal knee replacements causes iatrogenic damage to the lining of the joint and results in pain postoperatively. A minimally invasive knee replacement or less invasive knee replacement is carried out through a smaller incision and produces less amount of pain.
In this procedure the same prosthesis is implanted using smaller incisions and specially designed instrumentation. Duration of hospitalization will be shorter, there is no need of transfusions, pain is reduced and the cosmetic effect is better. Best of all, rehabilitation will also occur faster with a return to normal activity may be possible in 6 weeks.
Alternative Modes of Anesthesia & Analgesia
Many anesthetists and surgeons prefer regional and local modes of abolishing operative pain. Spinal, Epidural and local nerve blocks may be administered by skilled anesthetists with the benefits being increased safety, as there is less stress upon the body. Diabetics, Hypertensive, and people with ischemic heart disease can undergo safe surgery. As the patient is not unconscious and is only sedated, he is unlikely to feel postoperative nausea and vomiting.
A drink or light meal can be given soon after surgery as tolerated and this comes as a big boon to many elderly who are unable to tolerate overnight starvation and thirst. With multi modal post operative pain relief, instead of relying on opioids, multimodal analgesia employs a battery of pain relief methods and drugs. There is almost a total relief of pain and the patient will not regret the surgery experience at all. Cryotherapy oral drugs, pain pumps, epidural anesthesia are all used to make your experience as pleasant as possible
The Gender Specific Knee
The Gender Specific Knee recently launched in India is meant to improve overall function after a knee replacement in women. Women constitute 60 percent of patients undergoing a total knee replacement for knee osteoarthritis. Until now knee implants used were designed on the average measurements of knee shape and size of men & women. The Gender Special or Sex Special or Woman Special Knee is the only knee implant specifically designed for women.
It is based upon findings presented at the meeting of biomedical and biomechanical engineers in the US last year. It was first introduced in the US last year and has been launched in India recently. The surgical technique is not significantly different.
The new knee prosthesis can be implanted through the highly successful technique of minimally invasive (MIS) or less invasive surgery (LIS) in which the incision is only 4- 5 inches long. Post operative pain is significantly reduced and hence patients can be discharged from hospital within a week.
High Flexion Knee Prosthesis
Religious customs of Islam dictate kneeling five times a day for prayers. Westerners also demand more flexibility from their artificial knees and are intolerant of first generation implants which allowed the patient only to sit in a chair. Westerners like to pursue hobbies like gardening and demand flexible knees. Sex is made easier by flexible knee replacements.
These special knee implants provide more flexion or bending which particularly suits Indian, South Asian habits of kneeling for prayer and sitting cross legged. The design features of such knees incorporate cut outs at the front, rotating platform or mobile bearings, increased bony resection at the back amongst others.
Navigational Surgery
Navigational surgery or computer assisted enhances the accuracy of the operation. With the computer to guide, surgeons can make bony cuts with more precision and place the right size of implants. Not only this, computer assisted surgery (CAS) allows the operation to be performed by minimally invasive surgery (MIS). Perfectly positioned implants are less likely to loosen over time, decreasing the revision rate and ensuring survivorship of the implant.
A knee replacement is safe, affordable and efficacious for Western patients seeking to outsource their surgery to India. It is one of the top sought after surgeries for medical tourists coming to India for healthcare.
Dr. A. K. Venkatachalam is a Consultant orthopedic surgeon at the Knee & Hip Surgery Center at Bharathiraja Hospitals http://www.kneeindia.com. You may reach him by email at akvenkat@gmail.com.
