Q. Where can I meet the doctor?
You can meet him by prior appointment at the following hosptials
1) Chennai Meenakshi multispeciality hospital, Luz church road, Mylapore- tel- 044 42938938
2) TOSH ( Trauma and Orthopedic speciality hospital, Ormes road, Kilpauk, Chennai. Tel-044 49034903.
3) MJRC clinic ( own clinic) -27, 1st avenue, Besant nagar, Chennai Time- 6- 8 pm. Tel- 9176640002 & 9282165002.
Question: What is the cost of a knee replacement in India?
A.Cost of knee replacement in India starts at 6000 USD for a five day stay for international patients. For domestic patients, cost starts at 1. 85 lakhs for a four day stay.
Bilateral knee replacement can save cost. Cost starts at 3. 75 lakhs INR for a seven day stay. Both knees are done separately. If you are fit, then both knees can be done after assessment.
Question : How long should a patient remain in hospital after a knee replacement?
A. After a single total knee replacement, 4-5 days of hospitalization is sufficient. This is to provide pain relief and mobilization. For sequential bilateral knee replacement you will get ten days in hospital. For simultaneous bilateral surgeries under one anesthesia, you will get 6 days in hospital.
Question : When can the patient stand up after a knee replacement?
A. You can do so within 24 – 48 hrs after the operation.
Question : Do I operate on both knees simultaneously?
A. If you are young & fit, then both knees can be done in one sitting (Bilateral simultaneous TKR). An approximat cut off age for bilateral simultaneous knee replacements is 65 years. In older patients and those with co morbidities I advice a gap days or months between the two procedures.
Question : For how long will I have to use a walker?
A. You may need a walker for about 15 days and a cane or crutches for another fortnight. Then you can walk without any aids.
Question : How long is the waiting time for surgery?
A. I can operate on patients with notice of a day or two for a straight forward primary knee and one week for revision knees. If you want patient specific instrumentation, then four to five weeks are required between the MRI scan and operation for cutting blocks to be manufactured and shipped.
Question : What prosthesis do I use?
A. I use only standard prosthesis made in the US. These are all imported to India by the same international companies. The costs of the prosthesis are cheaper in India.
Question : When will the patient be pain free after surgery?
A. Post-operative pain is controlled to tolerable levels by excellent multi modal anesthesia with regional blocks and analgesics. Two to three weeks of pain medication are required in most people.
Question : How long does the operation take?
A. A primary total knee replacement takes between about an hour to 90 minutes. Anesthetic induction time is about 30 minutes. Extubation and shifting takes another 15 minutes. The turnaround time is about 3 hours. A difficult knee may take about two to two and half hours.
Question : What anesthesia will I receive?
A. You can have the operation done under general anesthesia (fully unconscious) or a regional anesthesia( spinal or epidural) in which you will be sedated but not knocked out. Regional anesthesia is a safe mode for diabetics and elderly people. Both are often supplemented by regional nerve blocks.
Question : I am diabetic. Can I have the operation?
A. Many patients in our practice are diabetic. My anesthetist is very competent at epidural anesthesia and hence the operation is pretty safe. Wound healing is good in well controlled diabetes. If control is poor, I recommend working with your diabetologist to achieve adequate control.
Question : What kind of physical activity can I do after the operation?
A. Non-impact sports like walking, golf are allowed. You can walk as much as you want. This is the purpose of the operation to allow you to regain mobility.
Question : When can the patient go back to work?
A. This depends on the nature of the job. In a sedentary or desk top job it would be possible after a month to six weeks. If the job requires a lot of standing and walking, then two months are required.
Question : Can I travel overseas after the operation?
A. You can do so after three weeks. You will stay in hospital for five days and the rest in a resort or hotel. This is to ensure adequate wound healing, painlessness and functional recovery. I review my patients at one week, two weeks and after a month after the surgery.
Question : Can I drive a car after surgery?
A. You can drive when you are ready to give up crutches. This varies but the earliest that my patients have done so is at 3 weeks. With the less invasive techniques that I practice, patients recover faster and hence can become independent earlier. If you need to use aid for longer, then it is advisable to self drive after you are support free.
Question : What is the ideal age for a knee replacement?
A. The ideal age is more than 65 years. I don’t refuse the procedure to younger patients with incapacitating pain. My youngest patient so far is twenty five years and my olderst patient in India is 87 years. Durable implants and smart tools technology have made this possible.
Question : What are the alternatives to knee replacement in younger people?
A. Where suitable, I perform cartilage surgery by arthroscopic and open methods. Abrasion chondroplasty and microfracture are arthroscopic procedures. Autologous cartilage implantation is suitable for small to medium areas of cartilage loss. In this your own cartilage cells are removed, cultured and put back in a damaged area of your knee. An osteotomy is advisable you have mal alignment; if your job is strenuous and the cartilage wear is one sided only (Seen on weight bearing x rays).
Question : How much bend can I get in the knees post-operatively?
A. Post op bending achieved is dependent on the pre op bend, body mass index (BMI), prosthesis & rehabilitation. With the High Flexion knee, you can get about 155 degrees. This is desired by people from the Indian sub-continent and the Middle East. Even people from the west now want more than 90 degrees of bending. You must be willing to undergo physical therapy to gain this amount of movement. Standard knee implants allow about 110 degrees of bending.
Bilateral Total Knee Replacements
Question : What is a Bilateral Total Knee Replacement?
A. When the cartilage has worn away in both knees, artificial knees (prostheses) can relieve pain. Surgery to resurface both knees is termed bilateral Total Knee Replacements.
Question : What is a Simultaneous Bilateral Total Knee Replacement?
A. A simultaneous procedure means that both knees are replaced on the same day, under one anesthesia. This takes place as a single surgery, within one hospital stay and is followed by a single rehabilitation period.
Question : What is a Sequential or staggered bilateral total Knee Replacement?
A. A staged or sequential procedure means that the two operations are performed as two separate events. Surgeries are typically performed several days or months apart.
Question : Who should have a Bilateral Total Knee Replacement?
A. The most common reason for Bilateral Total Knee Replacements is symptomatic severe arthritis in both knees reducing the quality of your life. Another indication is significant deformities in both knees, a situation in which failure to correct both knees deformities simultaneously would compromise the clinical result.
Question : What are the advantages of a Simultaneous Total Knee Replacement?
A. The advantages of having a simultaneous procedure include: only one surgical event, a single anesthesia, a shorter overall hospital stay, and the possibility of rehabilitating the patient symmetrically.
Question : What are the disadvantages of Simultaneous Total Knee Replacements?
A. The disadvantages of having a simultaneous procedure include an increased morbidity, increased blood loss and lack of one good leg (as perceived by some patients)
Question : What are the advantages of a Staged Total Knee Replacement?
A. The advantages of having a staged procedure include apparently lower stress level for the cardiovascular system, fewer cardiovascular, renal and pulmonary complications, lower incidence of DVT, blood transfusions. This is an excellent choice for patients with cardiac, vascular or pulmonary diseases or those above 75 years.
Question : What are the disadvantages of a Staged Total Knee Replacement?
A. The disadvantages of having a staged procedure are that it requires two hospital stays, two anesthesias and delays full return from disability. However a sequential bilateral knee replacement done a few days apart, obviate these negative points. The total duration of the hospitalization will be about 10 days.
Question : What are the results in terms of function and relieve of pain?
A. In both type of procedures, simultaneous and staged, results are excellent and equivalent in terms of relieve of pain and daily activities. Patients should expect a greater than 95% chance of success at 15 years.
Question : Is there any contraindication for a simultaneous procedure?
A. Yes. There are some contraindications and this is why we believe that the selection of the appropriate patient determines the outcome of the simultaneous procedure. The usual contraindications for knee replacement include an active knee infection, or severe neurologic compromise of the leg. This procedure is also relatively contraindicated in patients with significant cardiac, lung vascular conditions. Patients above 65 years old typically are not recommended for simultaneous procedures.
Question : Who would be the ideal candidate for a Simultaneous procedure?
A. The ideal candidate for a simultaneous Total Knee Replacement should be younger than 65 years old, without associated cardiac, pulmonary or vascular diseases. This patient should also complain of severe arthritic pain equally symptomatic in both knees, that interferes with his/her activities of daily living and significantly reduces the his/her quality of life.
Q. What is the cost of ACL reconstruction in my practice?
A. The cost starts at 95,000 INR with Indian implants. Imported implants and bio absorbable implants will cost more.