Located in Nagpur, Alexis Hospital is an initiative of the Zulekha Healthcare Group, UAE to serve the Central Indian population with high quality healthcare treatments to diverse medical conditions at affordable rates.

Osteoarthritis & Joint Replacement Surgery

Did you know that Lancet journal called total hip replacement ‘the Operation of 20th Century’ and that joint replacement surgery is one of the most common orthopaedic surgeries worldwide? ‘Osteoarthritis’ (OA) is a painful disabling joint disease. For simplicity, OA can be described as damage to the cartilage that protects the surface of joints. Any damage to cartilage is permanent, as its healing capacity is limited. Joint replacement surgery provides long life pain relief and pain free function. OA of knees and hips is most common, and presently, joint replacement surgeries of knees and hips are most popular and successful.

Worldwide, OA is the leading cause of disability: a more frequent cause of limitation of activity than heart disease, cancer or diabetes, the second most commonly reported chronic ailment, and third leading cause of work limitation. Worldwide, there was a 120 percent increase in number of Total Knee Replacements and 73 percent increase in number of Total Hip Replacements from 2000 to 2009.

Huge Numbers of Patients with Disability Due to OA in India Need Joint Replacement

In India, the awareness about joint replacement is as low as 10 percent. According to a FICCI report, only two percent of patients in India who need joint replacement are undergoing the surgery at present. Indian joint replacement surgeons have a certain advantage over their fellow colleagues in the world. Firstly, surgeons or institutions in India can perform more surgeries than anywhere else in the world due to sheer population size. Secondly, due to fear, Indian patients present very late for surgery with badly damaged and deformed knees & hips.

Indian surgeons routinely operate severely deformed joints; so the surgical skills are highly evolved, owing to the fact that we operate badly deformed and difficult cases in large numbers. India is a highly sought after destination for medical tourism because of highly skilled competent doctors and low cost of treatment. For example, joint replacement in India costs around one tenth of that in U.S. and is currently the most common reason for medical tourism in India.

With increasing penetration and acceptance of these surgeries from developed to developing countries and from HRA Class X to HRA Class Y cities in India, we continue to reach-out to more people disabled by OA. Awareness about joint replacement surgery in HRA Class Y cities like Nagpur, where I work, is still not widespread. Most people are reluctant to undergo surgery out of the fear of failure. However, with availability of trained surgeons and improved healthcare infrastructure, more people are undergoing these surgeries even in smaller cities with long term success. The number of joint replacement surgeries in India is poised to grow exponentially.

Lessons to be Learnt from the Success of Cataract Surgeries in India

In India, cataract is the most common cause of bilateral blindness. Lot of similarities exist between OA and cataract. Like OA, cataract too is a disease of the elderly, and medicines cannot prevent or cure either OA or cataract. In cataract, the intraocular lens gets damaged with age, leading to gradual progressive loss of vision. Cataract causes visual impairment, and OA causes physical impairment.

Treatment of cataract is surgical replacement of the damaged natural lens with an artificial lens and the patient starts seeing normally immediately after. Training, skill up-gradation, availability of affordable intraocular lenses (IOLs), and better healthcare infrastructure have fuelled the increase in number of successful cataract surgery so much that India is now working towards elimination of blindness due to cataract in foreseeable future.

Even up to a decade ago, people were not readily consenting for cataract surgeries and feared losing eyesight not to cataract but to cataract surgery. I remember seeing operated cataract patients wearing black glasses for months after a cataract surgery. Today, patients get operated in the morning and walk out few hours later without any fuss. Unless specifically told, nobody can even guess that one has undergone a cataract surgery few hours ago.

India is manufacturing IOLs that work as well as expensive imported lenses. For an example, there are manufacturers like Aurolab, that produce high quality affordable IOLs, facilitating large numbers of cataract surgeries and also for a common man. In fact Aurolab IOLs are exported to 120 countries.

Present & Future of Joint Replacement Surgery in India

Joint replacement surgery for OA involves removal of the damaged natural joint and replacing it by an artificial joint. With less invasive surgical techniques and improvements in anaesthesia and analgesia, joint replacements have become ‘almost’ painless. Not many years ago though, patients were admitted in a hospital for 10-14 days after a joint replacement. Today, our patients start walking on the same day of surgery and are ready to go home walking in 3-4 days. That day is not far when, even in India, joint replacement will become a day care procedure, where patient will walk out of the hospital on the evening of surgery, as is already happening in few centers in developed countries. Health education to increase awareness that disability of OA can be successfully overcome by surgery will help allay fear of joint replacement.

That day is not far when, even in India, joint replacement will become a day care procedure, where patient will walk out of the hospital on the evening of surgery

More than 80-85 percent of joint replacement implants used in India are imported. Imported implants make it difficult to offer these surgeries at affordable costs. Notably, the quality and longevity of imported implants is proven in long term published studies. Using un-researched and untested not-so-expensive locally manufactured implants when time-proven imported implants are available, is unethical. We should research, design and manufacture knee and hip implants in India that can last for long term. With these implants, we will do more high quality joint replacement surgeries in India than anywhere else in the world. Majority of our population who cannot afford high quality expensive imported implants will benefit from indigenously designed, manufactured and tested implants. This research needs funding and support from industry leaders and healthcare visionaries in India. We want to see India exporting knee and hip replacement implants to other countries. It is not impossible; we have done it in the past for IOLs for cataract surgery. Just like there is a - ‘Vision 2020: The Right to Sight’, Healthcare administrators in India and WHO should contemplate ‘Freedom from disability of OA’ program. Every patient of OA will be able to exercise his ‘right to walk pain-free’ only if there is greater awareness, availability of trained surgeons, and inexpensive but high quality implants in a healthcare environment that is affordable and accessible to all.