Saturday, 19 March 2011

What an iro-knee !

One of the major advances in the medical science over last 50 years has been the evolution of the artificial knee and hip joint replacement surgery. Extensive past and ongoing research has led to a tremendous improvement in the long term results of the joint replacement procedures benefiting millions of patients over the years, especially in western countries. The knee and hip replacement surgery is now well accepted as the standard treatment for arthritis of these joints by the general population in these countries. The procedure allows increased mobility and functional activity, relieves pain and improves quality of life tremendously. The procedure is so sought after that in certain countries like UK, there is a waiting period for 1-2 years before surgery is performed. This is one of the reasons why medical tourism has grown in leaps and bounds in last few years in India. 
 Patients from Europe, the US and other affluent nations visit for routine procedures like knee replacement surgery either due to high cost of the procedure in their own countries, lack of complete insurance cover or long waiting times for surgical procedures.  Patients from countries with poor health infrastructure like Afganistan, Iraq, Nigeria and other African nations visit India for better healthcare facilities.  Advantages for medical tourists include reduced costs, availability of latest medical technologies and a growing compliance on international quality standards. Total knee replacement surgery in USA will cost in excess of 20,000 USD on an average, however majority of healthcare providers in India are charging 6000-8000 USD. India’s medical tourism sector is expected to experience an annual growth rate of 30%, making it a Rs. 9,500-crore industry by 2015. Estimates of the value of medical tourism to India go as high as $2 billion a year by 2012. The major healthcare providers in the India are doing all they can to get a share of the pie and they are focusing extensively on the international patients.

Number of knee replacement surgery in India has also grown up in leaps and bounds due to medical tourism. The acceptance of joint replacement surgery as a standard treatment of severe arthritis has increased amongst the general population, especially in the metropolitan cities. Indian patients with medical insurance cover and health cover from employers are increasingly opting to undergo the surgery improving their quality of life significantly.  However, irony remains that while our healthcare providers are increasingly treating international patients with joint problems, majority of the elderly population of our country who do not have an insurance cover cannot benefit from advances in the medical science and improved health care infrastructure in India as they cannot afford the joint replacement surgery.
 On an average the cost of a knee replacement surgery in Delhi NCR area is anywhere between 2 lacs to 3 lacs rupees. Cost of the implants is a major contributor and usually accounts for approximately 30 % of the total expenditure. Almost all artificial implants, that have a proven track record, are manufactured in Europe/USA and are imported. At present, there is not even a single Indian manufacturer that is producing artificial joint implants of the desired quality and standards. There is an immense opportunity waiting for the health care providers as well for the implant manufacturers if they could reduce the cost of these procedures and implants while maintaining the quality standards. It is likely that in near future the cost of joint replacement surgery will come down substantially as Indian manufacturers will acquire the technical knowhow to produce good quality implants locally or international implant manufacturers will reduce their implant costs. If and when it happens, a large proportion of local population as well as people from other developing countries will benefit and joint replacement surgery in India will become as common as in western countries.

Friday, 11 March 2011

Ankle arthritis following avascular necrosis of talus.


Dear Michael
 
Your Xrays show AVN of Talus with arthritic changes in Tibiotlar(ankle ) joint as well as some arthritis in the Talo-navicular joint(midfootJoint). 
Unfortunately there are not many surgical options that would provide you with long term  pain relief. One of the options would be to fuse the ankle joint. This procedure will give you pain relief, but will stiffen up your ankle completely. There is not much mobility at the ankle joint currently so main benifit of the ankle fusion will be the long term pain relief. However after ankle fusion you are likely to develop pain ,discomfort and arthritis of the remaining midfoot joints few years down the line(10-15 years). If and when it happens, these joints can also be fused but they will produce further stiffness of the ankle and foot.
 
Second option will involve ankle joint replacement. This procedure is certainly feasible, should provide you with pain relief and mobility at the ankle however artificial ankle joints do not last long(5-7 years) in young individuals.  Also, poor skin condition ove the ankle joint secondary to previous injuries may complicate joint replacement surgery by increasing the chances of wound breakdown and infection. Artificial ankle implant will eventually lossen and ankle will again become painful. When it happens the usual course is to remove the artificial joint and do an ankle fusion -- which willl be significantly difficult to achieve compared to if you go for it now and will also result in significant shortening of leg as replacement involves removal of the bone from the ankle.
 
There are no satisfactory answers to your problem, however in my opinion better longterm results and minimal complications of ankle fusion makes it a better surgical alternative compared to ankle replacement surgery especially in young individuals leading an active lifestyle. Surgery should be delayed as long as possible and surgical intervention should only be considered if you have significant pain that is limiting your function and conservative treatment (injections in the joint, braces, physiotherapy and analgesia) have failed.
 
Please feel free to contract me if  you have any further queries.
Good Luck!
 
 
 

Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK

Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon

 

 

 

Web: http//www.arthrocure.com





Ankle Arthritis following Avascular necrosis of Talus



Patient name:
Michael Morrissey  
Age: 24 years
Nationality: Irish
Briefs: The patient had a 
road traffic accident in April of 2007 and suffered a compound fracture to the left talus. The body of the talus has become avascular. He has loss of ankle joint space. And he cannot move my ankle and he can do very little standing or walking because he suffer a lot of pain in his ankle. He is looking to avoid fusion so he is asking if there is anything we can do to help him.

 


Wednesday, 2 March 2011

Left Knee Meniscus injury and MCL sprain

 
Hi Mohit
 
I suggest that you should stop taking nucoxia  on a regular basis now and only take it if it is painful.
I suspect that the stiffness is due to MCL strain and should settle with time(it usually takes a minimum of 6 weeks for mild MCL sprains to settle). If you feel that stiffness if improving with time then wait for 2-3 weeks, it might settle as the sprained ligament heals. I would like to examine you again, you can fix up an appointment to see me at Columbia Asia over next few days.
 
Kind regards
 

Dr Jayant Arora
MS(Ortho), DNB(Ortho), MRCS(Edinburgh)
Fellowship in Joint Replacement and Arthroscopic Surgery, Newcastle, UK

Senior Consultant Orthopedics and Joint Replacement Surgeon
Columbia Asia Hospital
Gurgaon

 

 

 

Web: http//www.arthrocure.com




From: MOHIT KHEMANI <mohit85@yahoo.com>
To: Jayant Arora <arorajayant@yahoo.com>
Sent: Wed, March 2, 2011 8:24:07 PM
Subject: Left Knee Meniscus:Mohit Khemani

Doctor Jayant
Hello
Just to give you a catch up on me. I had this left knee meniscus surgery done 3 weeks back. now all dressing and the pins are out and i have been doing those two exercises half an hour a day.
Doctor the stiffness still persists. If I am sitting for a long time and get up its more. At times i also feel a slight pain in case it moves sideways..otherwise walking and driving has been really normal.
Have been taking Nucoxia 90 for 18 days now.
Is this normal or i should do something more?
Thanks a lot for your time.
Best Regards
Mohit Khemani
Ps: More info on me I am Rashmi Hingorani's Brother.




Left Knee Meniscus injury and MCL sprain



Doctor Jayant
Hello
Just to give you a catch up on me. I had this left knee meniscus surgery done 3 weeks back. now all dressing and the pins are out and i have been doing those two exercises half an hour a day.
Doctor the stiffness still persists. If I am sitting for a long time and get up its more. At times i also feel a slight pain in case it moves sideways..otherwise walking and driving has been really normal.
Have been taking Nucoxia 90 for 18 days now.
Is this normal or i should do something more?
Thanks a lot for your time.
Best Regards
Mohit Khemani
Ps: More info on me I am Rashmi Hingorani's Brother.