Dr Vikas Padha
World Arthritis day
Total knee replacement (TKR) is an excellent surgery for end-stage arthritis of the knee joint (final stage of osteoarthritis). In this stage of arthritis, the knee joint gets damaged irreversibly. This causes severe disability resulting from pain, deformity and limited function. Total knee replacement relieves pain, corrects deformity and improves walking ability. This excellent surgery has changed the lives of millions worldwide including Indians. With more than 90% reported survival rates at 15 years, total knee replacement is one of the most successful surgeries being done worldwide in today’s world.
This surgery is also called the knee transplant surgery. But this terminology creates a lot of confusion as layman thinks that total knee replacement is also a very complex surgery like organ transplant surgeries. For example: heart transplant, kidney transplant or lung transplant. But in reality, total knee replacement is a very different surgery when compared to organ transplant surgeries. In organ transplant surgeries, the organ of the donor is transplanted to the recipient which is a very complex surgery but in total knee replacement surgery, no such transplant of knee is done from the donor to the recipient. Here, only the damaged surfaces of ends of bones articulating with each other in the knee joint, (namely femur or thigh bone, tibia or leg bone and patella) are removed and are covered with artificial components made of materials like stainless steel, titanium and ultra-high molecular weight polyethylene. In a nutshell, only resurfacing of knee joint is done instead of transplantation and this is much simpler procedure and safer also when compared to kidney transplant or heart transplant. Here, the knee joint of the patient is retained and only the damaged portion of articulating surfaces of bones is covered by artificial components as already described. This confusion between knee replacement surgery and organ transplant Surgery has resulted in knee replacement hesitancy amongst the vast population who don’t agree to undergo knee replacement surgery readily just because of this confusion. Hence, this reality needs to be propagated to the masses so that the patients who need this surgery agree to undergo this excellent surgery without any further delay.
Vajpayee Era
Total Knee Replacement surgery caught ordinary Indian’s attention for the first time in the year 2000 when the incumbent Prime Minister of India Atal Bihari Vajpayee underwent total knee replacement of his left knee joint in October 2000 at Breach Candy Hospital Mumbai as he was suffering from the advanced osteoarthritis of knees. This surgery was done by US-based orthopaedic and joint replacement surgeon of Indian origin Dr Chittaranjan Ranawat, who also did total knee replacement of his right knee in June 2001. On both occasions, this surgery was widely covered by the Indian print and electronic media, and it was for the first time that total knee replacement surgery got such a wide publicity in India. A common man in the streets of India came to know about total knee replacement. During that period, total knee replacement was being done only in a few cities of India and in very few hospitals as the number of orthopaedic surgeons trained in total knee replacement surgery was very limited and the majority of them were trained abroad. Soon training of total knee replacement surgery also started in various institutions in India, especially in cities like Mumbai, Delhi and Pune. But the major concern was the very high cost of this surgery that made it unaffordable for the majority population across India. So in Vajpayee’s era, total knee replacement surgery remained accessible only to the rich people belonging to affluent sections of society and it wouldn’t be wrong to label total knee replacement surgery as the surgery of VIPs in Vajpayee’s Era.
With the passage of time, total knee replacement got coverage under various insurance policies and in schemes like ECHS and CGHS that made this surgery cashless for a large number of ex-servicemen, their families and central government employees, retirees and their families. This resulted in an improvement in the figure of total knee replacement surgery being done in India. Simultaneously the number of Institutions imparting training of total knee replacement in India also increased.
Modi era
Post-2014, the Modi era, witnessed a significant fall in the cost of total knee replacement surgery as the Modi Government introduced the policy of capping the prices of implants being used in knee replacement surgery resulting in a decrease in the total price of otherwise very costly surgery. This made total knee replacement affordable for a common man belonging to even the middle class. As a result, the number of total knee replacement surgeries being done in India increased by many folds.
However, the real turning point for total knee replacement surgery in India was the implementation of Ayushman Bharat Yojana which started in the year 2019. This scheme made costly surgery like total knee replacement accessible to those living below the poverty line in India resulting in a huge spike in the number of total knee replacement surgeries being done in India as surgery costing 2 to 3 Lacs in a private corporate hospital could be done free of cost in the same hospital with just Ayushmann Bharat card.
Scenario in UT of Jammu and Kashmir
The Union Territory of Jammu and Kashmir has universal coverage of the Ayushman Bharat scheme, meaning that every citizen of UT of Jammu and Kashmir has an Ayushman Bharat card and can get total knee replacement surgery done free of cost with this card. I am working as a Senior joint replacement surgeon in the first corporate hospital of Jammu and Kashmir namely Shri Mata Vaishno Devi Narayana Super Speciality Hospital, Katra Jammu and I have been doing total knee replacement surgeries for the last nearly 7 years in this hospital since my joining. Under the Ayushman Bharat Yojana only, I have done hundreds of successful total knee replacement surgeries for patients belonging to poor economic status who could have never afforded this surgery without an Ayushman Bharat card. I have done total knee replacements of patients belonging to far-flung hilly areas of Jammu and Kashmir in the world-class infrastructure and facilities available in corporate hospitals like SMVD Narayana Hospital, Katra Jammu. Many of my patients who underwent total knee replacement surgery belonged to the scheduled Tribes like Gujjar Bakerwals who are considered very backward tribes in India. This scheme has proved a boon for such patients who got a second lease of life after getting surgeries like total knee replacement done free of cost due to the vision of leaders like Prime Minister Narendra Modi ji, who thought of this noble scheme and implemented it in letter and spirit. A poor man getting costly surgeries like total knee replacement in the setup of a corporate hospital without spending a single penny is just unthinkable in this world. But this has become a reality now proving the famous tagline related to PM Narendra Modi ji: “Modi Hai To Mumkin Hai” because PM-ABJAY has opened doors of corporate hospitals with world-class facilities to the poorest of the poor in the country. So it can be safely concluded that a surgery like total knee replacement surgery which was known as the surgery of VIPs in the Vajpayee era has TRANSFORMED into POOR MAN’s Surgery in the Modi era.
On the occasion of WORLD ARTHRITIS DAY today, let us take a pledge to remove the following myths prevalent about total knee replacement surgery and instead spread facts about this surgery:
Myth: Total knee replacement surgery is not a successful surgery at all.
Reality: Total knee replacement surgery is one of the most successful surgeries with a very high success rate.
Myth: Total knee replacement is a very complex surgery like a heart transplant, surgery or kidney transplant surgery.
Reality: Total knee replacement is a very simple surgery in which only the resurfacing of damaged parts of the knee joint is done and is totally different from organ transplant surgeries like heart transplant, kidney transplant or lung transplant.
Myth: Total knee replacement is a very painful surgery.
Reality: With the advancement of modern techniques of anesthesia and advanced surgical techniques, total knee replacement surgery has become a very comfortable surgery with minimum pain.
Myth: The patient is not able to walk for months together after undergoing total knee replacement surgery.
Reality: The patient is made to walk with support just a day after total knee replacement surgery and can walk without support after 2 to 3 weeks depending upon how fast the rehabilitation is.
Myth: The patient needs to do painful physiotherapy after undergoing total knee replacement surgery
Reality: Physiotherapy is needed for just a couple of weeks after total knee replacement surgery and this is very comfortable in the hands of a skilled physiotherapist.
Myth: The patient is not able to fold the knee after undergoing total knee replacement surgery.
Reality: Patient regains full range of motion of knee joint after undergoing total knee replacement within a few weeks of surgery.
Myth: Patient is not able to climb stairs, drive the vehicle or run after undergoing total knee replacement surgery
Reality: The patient is able to climb stairs, Drive a vehicle and run after total knee replacement surgery.
Myth: Total knee replacement surgery is not covered under Ayushman Bharat Yojana in private corporate hospitals.
Reality: Total knee replacement is fully covered under Ayushman Bharat Yojana in a corporate hospital like Narayana Hospital, Katra Jammu. One can get the surgery done free of cost here with just an Ayushman Bharat card. Total knee replacement of both knee joints can be done one by one in a single calendar year under Ayushman Bharat Yojana.
Let us all take a vow to launch an awareness campaign aimed at spreading the truth about successful and excellent surgery like Total Knee Replacement Surgery amongst the masses.
(The author is Senior Joint Replacement Surgeon Shri Mata Vaishno Devi Narayana Hospital Katra Jammu)
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