Arthritis is a disease that affects millions around the world. There is little we can do to prevent it, besides maintain a healthy lifestyle and control our weight. It is very painful and most afflicted with arthritis find it hard to perform their daily tasks. Thankfully, treatments such as Total Knee Replacement are available in India today and are accessible to everyone.
When arthritis occurs, the cartilage is worn away and the underlying bone becomes exposed. The exposed bone ends roll against each other which results in pain, loss of movement, swelling and deformity.
We interviewed Dr. J.J. Bunshah, M.S (Orth.) D. (Orth.) who operates from a number of hospitals in Mumbai, India.
HealthJockey (HJ): What does the Total Knee Replacement Surgery involve?
Dr.J.J. Bunshah: It involves removing the worn out cartridge and replacing it with and artificial knee joint
HJ: When would you recommend this treatment?
Dr. J.J. Bunshah: This is a very important thing. Often, this surgery is misused. You can get arthritis and perhaps everyone will get it at some point. But, less than 10-15% will require this surgery. Unfortunately, the knee replacement surgery has got very ‘glamorized’ after our ex-PM underwent it. Doctors may tell you to undergo it. But, this is one surgery for which I tell the patient that the decision is made by the patient and never ever by the surgeon.
Once we reach 60-70 years, we all are going to have pain in the joints. But, once this pain starts to affect our normal lifestyle, where we reach a point where every step is painful, then one will need a knee replacement.
HJ: What are the types of Arthritis?
Dr. J.J. Bunshah: There is Osteo-arthritis which is an age-related arthritis. So this afflicts elderly people. Now, we also have the younger population getting affected by something called Rheumatoid arthritis. It is a very different kind of arthritis which can affect the youth as young as teenagers. So these young people would also require to undergo knee replacement surgery if they are in severe pain and are unable to go about their daily life.
HJ: Arthritis is partly a lifestyle disease. So, what can we do to prevent it?
Dr. J.J. Bunshah: The bottom line is that partly it is hereditary. But, what is most important is weight control.
HJ: What does the post-surgery care involve and what can people do to make it last longer?
Dr. J.J. Bunshah: Immediately on the day of the surgery itself, when the patient is wheeled out from the operation theatre, there are usually one or two tubes kept to drain out the excess blood. This is usually the case with all types of surgery, which is removed within 24-48 hours. Once these tubes are removed, we see to it that the patient starts walking. As soon as possible, there is something known as the CPM (Continuous Spasm Motion Machine), which moves the knee up and down. It’s a kind of physio-machine which makes the knee go up and down. The next day, the patient is made to stand and start walking.
HJ: Is there any particular diet that the patient has to follow?
Dr. J.J. Bunshah: Unless a patient has other medical problems. For instance, if a patient is diabetic, then he/she may need to be put on a special diet.
HJ: Is there an ideal age?
Dr. J.J. Bunshah: There is no ideal age. It depends on the severity of the patient’s condition and pain he/she is undergoing. You may have an X-ray which looks fairly good, but the patient is going through agony in terms of pain. On the other hand, you may have a patient who has a very horrible-looking X-ray and a patient with severely deformed news.
HJ: What is the recovery period like?
Dr. J.J. Bunshah: Within 48 hours a patient is walking, he/she is then put on a walker. Later on they switch on to a stick. How soon they switch from a walker to a stick varies from individual to individual. For instance, an elderly person may require the walker for a little longer. The stitches are normally removed on the eight to tenth day. By the time the patient goes home, he has got 0 to 90 degree movement. After six weeks, you can say that the patient will be fairly normal.
The older knee replacement used to bend only 100-120 degrees. Now we have newer ones called high-flex knees which allow the knee to bend completely. The patient will even be able to squat down. This is important from our Indian patients’ point of view, as abroad people don’t really need to squat down to use the bathroom.
HJ: Is there any discomfort involved?
Dr. J.J. Bunshah: Most certainly. A patient has to be told that yes, they will undergo pain. Of course, we do everything to ease the pain. There are various newer technologies we use. For instance we put a catheter in the spine to administer pain killing drugs which numb the legs for 48-72 hours. Sometimes we give a block, known as a femoral block that also eases pain. After all this, the patient will have operative pain, which soon eases off.
HJ: What is the approximate cost of the knee joint?
Dr. J.J. Bunshah: The knee joint or the implant costs as much as Rs.80,000-90,000, which is the best imported implant available in the country till date. We also have an Indian implant which costs about Rs.30,000-40,000. The remaining surgery will depend on which category, which hospital the patient is getting operated in.
HJ: What would your charge be for the surgery?
Dr. J.J. Bunshah: It depends. In the hospital where I operate from, i.e. Parsee General, there are many wards- ranging from the free ward, to the semi-private, to the private and nursing home. So, it is only in the private and nursing home sector that I can take my full charges. In all the other categories, the price is fixed by the hospital.
HJ: What about people who simply cannot afford this treatment?
Dr. J.J. Bunshah: We then refer them to various trusts that can sanction them the money.
HJ: How long does the knee replacement last for?
Dr. J.J. Bunshah: There are various statistics. But the rule of the thumb is that generally after 15-20 years, less than 5% will require revision, which means that the other 95% will be fine and will not need revision. May be after 20-25 years, 10% will require revision. But, it’s not just time; it’s also the wear and tear. The knee replacement is a kind of a metal on plastic. Hence the plastic tends to get worn out after many years. So, in a young and active person say aged 40 years, it would wear of much faster. But, in an 80 year old who leads a sedentary lifestyle, it would last longer. The young person would wear out in 10 years, while the older less active person in something like 30.
HJ: Are there any alternatives to such a knee replacement surgery?
Dr. J.J. Bunshah: The next one is called conservative treatment which means you have to treat it non-operatively. There are radius drugs, exercises, wear a knee brace, give injections in the knee joint etc. But, the knee replacement surgeries are very effective and allow those undergoing it to walk without pain.
HJ: Do many hospitals in Mumbai offer the Knee Replacement Surgery?
Dr. J.J. Bunshah: Yes many of them.
HJ: Would you say these replacement surgeries are new to India?
Dr. J.J. Bunshah: Not at all. In India we have been offering this surgery for nearly 15-20 years.
HJ: Would you say that with time, the knee replacements have improved?
Dr. J.J. Bunshah: Absolutely.
HJ: Like India’s ex-PM Vajpayee, do you know of anyone notable who has undergone the Knee Replacement Surgery?
Dr. J.J. Bunshah: Well, not that I can think of. But, you know, such a surgery is a very routine one – one that many people resort to because of the pain they undergo suffering from Arthritis.