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Knee Replacement Surgery in India


Knee replacement surgery in India would be an excellent choice for those who want to experiment with the combination of health with travel.

Trends in medical tourism rise with the aim of hitting a new high every day. But, once you decide to combine medical treatment and vacation, you must know your options for the journey planned.

India has had many medical guests so far and the treatment they received contributes towards it being one of the top countries for Medical Tourism in the world.

Why India for knee surgery?

India is only a developing country. Even then, it has managed to reach the list of top ten medical tourism destinations in the world.

It is the same list that mentions developed nations like USA on it.

Infographic: Knee Replacement surgery in India

As a matter of fact, people are increasingly choosing India over other places for several reasons. Major ones accounting for this choice are:

International patient’s choice:

A lot of people have been choosing India over other medical destinations. A report by CNN[1]CNN Health
India wants to make medical tourism a $9 billion industry by 2020
“India’s medical tourism industry could grow by 200% by 2020, hitting $9 billion, according to Ministry of Tourism figures “
View in Article
  health suggests that Indian medical tourism is projected to grow at a CAGR of 200% by 2020, hitting $9 billion by 2020.

The average cost of surgery:

Total knee replacement surgery in India can cost $3,500-9,000, compared to $15,000-21,000[2]Saga magazine, UK
Paying for a new knee
“Recent figures indicate an average cost of £11,400, although this may go as high as £15,400 “
View in Article
in the U.K. and $49000[3]Healthline
Understanding Knee Replacement Costs
“The average hospital charge for a total knee replacement (TKR) in the United States is $49,500”
View in Article
in the U.S. That’s a considerable difference in amounts.

Quality of work:

Many medical practitioners in India have learned or practiced medicine in the U.S. for some duration; the exposure thus strengthens their experience in the field.

Apart from carrying out surgeries as per international standards, Researchers here work to provide new and better ways[4]Biomedical Research 2017
Comparison of training methods in improving knee extension lag after first four weeks of total knee replacement.
“functional training exercises resulted in significant reduction in post-operative
knee pain”

View in Article
of healthcare.

Strong medical regulations:

Even though there are countries that may compete with Indian pricing, it ends up affecting the quality of services provided by them.

NHP (National Health Policy)[5]NHP, Govt. of India
Key Policy Principles
“The health policy commits itself to the highest professional standards, integrity and ethics to be maintained in the entire system of health care”
View in Article
India recognizes some critical dimensions of high-quality healthcare – consistency, positive health outcomes, patient-centeredness, equity, and trustable service delivery.

A long history of medical tourism:

Being the land where therapeutic Ayurveda originated, India has always been magnetic for medical tourists. However, constant efforts are made to keep the medical tourists visit India.

A paper published by Harris Solomon[6]Google scholar
Healing Holidays
“Affective journeys: the emotional structuring of medical tourism in India”
View in Article
(approved by Brown University) describes how some institutes would affiliate themselves to Ivy League and other international institutes of prestige to make medical tourists feel welcomed and impart a sense of trust.

Safety of medical procedure:

Only the professionals registered with MCI (Medical Council of India)[7]MCI India
Code of medical ethics regulations
“No person other than a doctor having qualification recognised by MCI and registered with MCI/State Medical Council(s) is allowed to practice Modern system of Medicine or Surgery”
View in Article
are allowed to practice modern medicine or surgery.

Also, BIS (Bureau of Indian Standards) lays down standards of medical equipment and hospital planning for safe medical practices.

NABH[8]NABH
FROM CEO’S DESK
“NABH intends to be a robust, accessible and competent organisation to compliment the healthcare system to improve its efficiency and the predictability of healthcare outcomes.”
View in Article
, the National Accreditation Board for Hospitals and Healthcare, works to promote quality and safety in healthcare in India.

Medical tourism & leisure travel:

India undoubtedly holds a vibrant history, and generations have worked to maintain the portal to the Indian Past by preserving the years old monuments and artworks.

The Country Capital, for instance, was recently in the news as it is about to enter the list of world’s top 10 most popular destinations in the world.[9]Live mint
10 most popular cities with global tourists
“Currently, the city ranks at the 11th position in the list of world’s top 100 destinations and is forecast to be hold the 8th place in 2019.”
View in Article

Medical destinations compared:

COUNTRYCOST (W.H.O., 2003)
U.S.A.$48,000 (avg.)
INDIA$8,500 (avg.)
CANADA$12,000*
THAILAND$10,000 (avg.)
COSTA RICA$10,500*
MEXICO$14,650 (avg.)
*WHO did not release the cost of knee replacement surgery in Canada and Costa Rica. However, our interview with an international patient at Costa Rica revealed that the procedure cost him around 10,500 USD. Also, Vancouver observer, an independent online newspaper in Canada, published an article (2011) saying the avg. cost of surgery in Canada is $12,000.[11]Vancouver Observer
What’s a knee worth?
“My surgeon told me the average cost of knee replacement surgery is $12,000.”
View in Article

Wait time in the mentioned countries is almost nil, except in Canada, where one may have to wait for months to get an appointment.

Knee replacement surgery cost in India ($3,500-$14,000)

Before packing your bags and traveling to India, or any other medical destination for that matter, you would want to know the answer to- how much does the procedure cost?

Cost for knee replacement surgery in India ranges between $3,500-$14,000, thus it averages to $8,750 at a reputed institute.

This cost usually includes the room charges (for the specified period; mostly five days), surgeon’s fees, O.T. charges, anesthesia charges, DVT pump cost, cost of implants, regular pharmacy and consumables bill (up to a certain limit) and cost of Investigations related to the procedure and a complimentary travel aid from airport to hotel/hospital & comprehensive medical report.

Most hospitals charge for the blood products separately.

The inclusions of the package are discussed in detail in this article:

We provide pick-up and drop facility to commute between the airport and hospital/hotel in AC cars, guest house assistance, a local network sim-card, assistance in currency exchange and assistance in getting medicine after discharging from the hospital.

PRE-surgery tests

The patient takes some diagnostic and organ tests before the surgery. Medicos do it to analyze the measure of damage. This analysis helps the doctor to make a personalized treatment plan.

Some primary medical check-ups you have to undergo are:

  • An imaging test to recognize the present anatomy of your knee. Based on doctor’s advice, it could be either of these options:

X-RAY- This simple imaging technique creates a picture of indies of your knee in different shades of black and white. The doctor studies and compares it with the structure of a healthy knee.

X-ray of knee: pre and post surgery
X-ray Right: Osteoarthritis of the knee; Left: post-operation total Knee surgery (TKR) view

MRI- Magnetic Resonance Imaging is for a detailed scan of the affected knee. The scan is more detailed than an X-ray, it helps the doctor analyze the situation better.

MRI of knee
MRI of knee
  • Heart checkup- Cardiologist’s clearance for surgery is a must.  Your heart should be healthy to support the body through and after the surgery. If it is not, the doctor works on heart health before knee surgery.
  • A dental check-up to check for infections in the oral cavity. It’s to avoid any post-surgery trouble. The untreated bacteria from the mouth may travel into the blood and infect the knee implants.
  • Finally, a patient goes through a regular medical check-up. It scans for any disease which may affect the surgery.

The cost for tests mentioned is included in the surgery package; if you want to get these done from a separate institution, they may add up to less than $500.

Hospital bills

The surgery may require a person to stay in the hospital for 5 to 7 days. Depending on the hospital, you’re visiting your surgery package can vary.

The quotes mentioned do not include the price of blood products or extra implants. These may vary depending on factors like single occupancy or sharing room, kinds of implants selected and patient’s individual health requirements.

You can request us for the details for pricing and inclusions of the following hospitals.

  • Manipal Hospital- Delhi, India.
  • BLK hospital- New Delhi, India.
  • Artemis Hospital-Gurgaon, India.
  • Max Super Specialty Hospitals, India.
  • Medanta Hospital- Gurgaon, India.

Post-surgery healthcare:

Post-surgery recovery varies for every person because of the different health levels. Therefore, to some extent, it is possible to speed up recovery.

Getting yourself a physio or a personal physical trainer will be the best part of your investment for better knees.

Physiotherapy sessions in the U.S. can cost up to $150 per session or be covered by your insurance plan.

After the surgery, Physiotherapy is provided by the Indian hospitals at patient’s room (hospital/hotel) for a certain period of time (duration depends on Hospital and your medical package).

If you choose to relax and stay back in India for a short vacation, you can avail physio-therapy for an amount as low as $70 for a month.

Physiotherapy of Knee
Physiotherapy of Knee

You could use the money saved from therapy to install grab bars in the restroom, a toilet raiser, night lights, and grab rails along the stairs, which will support you while walk during the initial stages of healing and avoid any accidents.

Top orthopedic hospitals in India:

Manipal Hospitals, India:

  • Connecting through a network of 15 hospitals
  • Manipal is an ISO: 9001 certified hospital since 2003
  • Accredited with the NABH and AAHRPP
  • The Manipal Diagnostics is accredited with the NABL

BLK hospital- New Delhi, India:

  • Accreditation by JCI, NABH and NABL
  • Provide state-of-the-art health care
  • Introduce established newer technologies in clinical services without delay.
  • Provide reliable and updated diagnostic services.

Artemis Hospital- Gurgaon, India:

  • A state-of-the-art multi-specialty hospital.
  • JCI and NABH accredited.
  • One of the most advanced hospitals in India.
  • Medical practices and procedures are research-oriented and bench-marked against the best in the world.

Max Super Specialty- Delhi, India:

  • One of India’s leading providers of extensive, seamless, and integrated world-class healthcare services.
  • With a network of 14 hospitals, they offer treatment across all 29 specialties.
  • NABH and ISO accredited.

Medanta Hospital- Gurgaon, India:

  • 22+ super specialties under one roof
  • India’s first hospital to successfully perform cerebral/brain aneurysm with a pCONus stent implant
  • JCI, NABH and NABL accredited.
  • Many doctors are holders of prestigious awards like Padma Shri and Padma Bhushan.

Knee replacement surgery types

The type of knee surgery you will undergo will be decided by your doctor after thoroughly studying your knee.

In India, all the types mentioned below are performed by surgeons registered with MCI.

Partial and total knee surgery

Partial knee replacement is for patients with complications relating to one or two knee joints. When all three knee joints are infected, total knee surgery is required.

But this is not as simple as it sounds, depending on your reports, the doctor analyses and suggests the best treatment option for you.

Revision surgery

Are you in pain even after the surgery? It could be anything from a mis-fitted, loosened implant to infection debris.

In such a case, your doctor will advise you to undergo surgery once again; this is called a revision surgery.

Revision surgery is more complicated than the primary surgery and needs more surgical expertise.

It may be a total or a partial revision knee replacement depending on the prosthetic(s) replaced

Staged and bilateral knee surgery

Staged and bilateral are just some fancy medical terms for single or simultaneous knee surgery.

Knee scar after Bilateral Knee Surgery
When both the knees are operated at the same time, it is known as Bilateral or Simultaneous Knee surgery.

In staged knee surgery- one knee is replaced at one time. When the surgeon operates on both knees at the same time, it is called a bilateral knee surgery.

Eligible candidates for surgery

The intensity to which the knee is damaged can be different in every patient. It makes the doctors treat every case with a different outlook.

Depending on the knee disorder and general medical health of the patient, each candidate receives details of the possible option(s) for their knees.

People with knee arthritis consider replacement surgery as the last option, and it’s because the surgery shows the best results in older people.

Knee-replacement-surgery options in India

Conventional surgery methods

Surgeons in India have a good experience of performing primary and revision knee surgeries with a high level of complications. Such operations, though, aren’t performed on children, as their bones are still growing.

Latest technology and surgery methods:

Computer assisted TKR  followed with ERAS has seen to deliver better results for knee surgery patients. Orthopedics in India follow the protocol that involves these two to ensure best possible treatment for those seeking knee replacement surgery in India.

Computer navigated TKR (Improves accuracy)

When the surgeon can visualize the insides of a knee; it becomes easy for him to align the components precisely.

Total knee surgery (TKR) or arthroplasty (TKA), when assisted with computer aid, helps the surgeon to operate with more accuracy.

ERAS (Fastens recovery)

Enhanced recovery after surgery (ERAS) aims to reduce complications after the surgery.

This protocol starts to come in effect from pre-surgery duration. Activities like physiotherapy, education about the surgery, careful choice of anesthesia, and operation methods are an essential part of it.

These methods usually decrease the length of stay (LOS) for patients.

Which knee-implant brands are available in India?

  • Zimmer
Zimmer

Zimmer India manufactures a variety of knee implants. You can go through the link to their products Zimmer claims to be the manufacturer of more than 25% of implants used worldwide.

  • Zimmer Biomet
Zimmer Biomet

Biomet clubbed with Zimmer to function as one unit. Their vanguard complete knee system offers 90 different fits from which you can choose. You can browse through their other products here.

  • Stryker
Stryker

Stryker, the winner of Fortune world’s most admired companies (2019), offers multiple fits. You can have a look at its updated product list here.

  • Smith & Nephew
Smith & Nephew

Smith and Nephew customize the knee implants as per patient’s requirement under the tag Visionaire, for more information on the same click here.

  • ConforMis iTotal custom implants
ConforMis iTotal custom implants

Conformis says, “If it’s not conformis, it’s not made for you.” They make customized implants based on the pre navigated 3D model of your knee. It ensures that the implant looks the closest to your original knee. Know more about conformis here.


Reputed Medical teams to contact

India hosts between 12 to 15 thousand registered orthopedic surgeons. So, it can quite a task selecting the one who’s right for you.

Artemis Hospital-Gurgaon, Fortis Healthcare, and Max Super Specialty Hospitals are some institutes which have the best of the professionals. The teams have been working to result in satisfied patients one after another.

Some Reputed Orthopedic Surgeons who are currently working in India are mentioned below:

Dr. Ashok Rajgopal, MBBS, MS (Orth.), M.Ch. Orth, FIMSA, FRCS

Currently working with Medanta hospital

Specialization: Knee Surgery, Joint Replacement Surgery, Arthroscopic Surgeries

Why should you choose him?

  • 40 years of practice.
  • performed 28 knee surgeries in less than 12 hours.
  • completed 25,000+ TKR surgeries.
  • Awarded Padma Shri award for the recognition of surgical excellence and contribution to the field of Orthopedics in the year 2014.

Dr. IPS Oberoi, MBBS, MS (Orth.), M.Ch. Orth. (Liverpool, U.K.)

Currently working with Artemis Hospital

Specialization: Orthopedic Surgery, Orthopedics, Joint Replacement Surgery & Arthroscopy

Why should you choose him?

  • 7000+ joint replacements with 97% success rates.
  • Specialized in all arthroscopic and joint replacement surgeries.
  • One of the first and among only few surgeons to start minimally invasive reconstructive surgery that is Key Hole surgery (Arthroscopy) for Shoulder, Elbow, Hip and Ankle problems

Dr. Vivek Dahiya, MD, DNB

Currently working with Medanta hospital

Specialization: Knee Arthroscopy, Primary and Revision Total Knee Replacement, Knee Ligament Reconstructions, Knee Fractures.

Why should you choose him?

  • 22 years of practice.
  • Proficient in all techniques of Arthroscopy of the knee joint.
  • Vast experience involving primary and revision knee surgery.
  • Special interest in infection after knee surgery.

Dr. (Brig.) B.K. Singh, MBBS, MS

Currently working with Artemis Hospital, Gurgaon

Specialization: Orthopedics & Joint Replacement, Robotic Hip and Knee Replacements

Why should you choose him?

  • 35 years of experience in Armed Forces Medical Services.
  • 5000+ arthroplasties performed.
  • One of the few surgeons in India who has expertise in Robotic Hip and Knee Replacements
  • Undergone advanced training on Navigation and Robot Assisted Joint Replacement Surgery at Osaka, Japan in 2003

Dr. S.K.S. Marya, MBBS, MS (Orth), DNB (Orth), M.Ch. (Orth), FRCS, DSc.

Currently working with Max hospital, New Delhi

Specialization: Joint Replacement Surgery for the joints of upper and lower limbs (Primary and Revision) and Trauma Management based on AO Principles.

Why should you choose him?

  • 30+ years of experience
  • Performed more than 15,000 joint replacements of Knees, Hips, Shoulders, Toes and Finger joints
  • He has pioneered bilateral joint replacement of knee and hip joints
  • Initiated the Uni-compartmental (Half Knee) replacement and has done exclusive work on fractures in joint replacement.

Dr. Lalit Kumar Lohia, MBBS, MS (ortho)

Currently working with Manipal Hospital, New Delhi

Specialization: Spinal Disorders, Back Pain Treatment, Knee Arthroscopy, Neck Pain Treatment

Why should you choose him?

  • 10+ years of experience
  • a specialist in the field of Trauma, Foot and Ankle and Joint Replacement Surgery

Dr. J. Maheshwari, MBBS and MS Ortho (AIIMS)

Currently working with Max Hospital, New Delhi

Specialization:  Full Spectrum Knee & Shoulder Surgery

Why should you choose him?

  • 35+ years of experience in.
  • 5000+ arthroplasties with computer navigation performed.
  • Academic oriented practice keeps him up-to-date with cutting-edge technology.
  • Invented & published a number of new operations in Knee & Shoulder surgery

Dr. Rajeev Verma, MBBS, MS, SR, MRCS, M.Sc.

Currently working with Manipal Hospital, New Delhi

Specialization: Knee Pain Treatment, Joint Replacement Surgery, Hip Surfacing, Knee braces of osteoarthritis, Spinal Therapy

Why should you choose him?

  • 20+ years of experience
  • Specialized in Joint Replacement Surgery and Trauma Management on AO principles.

FAQs RELATED TO PRE-SURGERY PERIOD

  • Q- Is blood transfusion during knee replacement surgery required?
Q- Is blood transfusion during knee replacement surgery required?

Yes, blood transfusion is required because the joint replacement surgery is invasive, so some amount of blood is lost and needs replacing.

  • Q- Where does the blood required for transfusion during the surgery come from?
Q- Where does the blood required for transfusion during the surgery come from?
  • The blood for transfusion may come from blood banks, located mostly in the hospitals themselves.
  • Blood available in these banks is tested for any disease (minor or major) before transfusing it to the receiver.
  • If you know a volunteer of your blood match, you can receive his/her blood as well.
  • If you’re still skeptical about receiving blood from an external source or don’t want to follow these for any other reason, you can self-donate.
  • Blood from your own body will be received before the surgery (6weeks to 5days) and recycled in the hospital. Doctors transfuse the same blood into your body during the surgery.
  • Q- What is the waiting time for an appointment in India?
Q- What is the waiting time for an appointment in India?
  • Some medical teams have their consultants overseas, and you can immediately contact an experienced local consultant.
  • Our case manager can get you in touch with doctors within 24 hours of receiving the query.
  • After discussing the case, you can get an appointment within the first week as well. If the doctor is available, we can confirm the same as immediate as on the next day itself.
  • It’s possible to get the appointment and the surgery done in the same visit.
  • Q- How do I decide on the right model for my knee implant?
Q- How do I decide on the right model for my knee implant?
  • Cobalt-Chromium alloys: A robust, biocompatible material, when combined with titanium, is the most widely used material for knee implants. People with nickel allergies should not have this implant as some metal ions may release into the body due to joint movement
  • Titanium alloys- These implants rank the same as cobalt-chromium ones. Manufacturers avoid using pure titanium as it isn’t tough enough to provide the strength required
  • Polyethene: Ultra Highly Cross-Linked Polyethylene (UHXLPE) or Ultra High Molecular Weight Polyethylene (UHMWPE) Implants reduce the wearing off to minimum and makes the implants last longer.
  • Oxinium oxidized Zirconium: Introduced in 2001 with twice the toughness of metal alloys, it provides half the friction. This allows them to perform better and last longer.

These implants are nickel-free, thus eliminating the risks for nickel-metal allergy.

  • Q- Where are the knee implants manufactured?
Q- Where are the knee implants manufactured?
  • Mass production: General implants can be imported or manufactured at a company’s factory base. Like Zimmer India manufactures the implants to be sold in the India market.
  • Mass customization: Mass customization takes place after the individual files of 3D models are pre-navigated and sent to the brand-specific factory for 3D Printing. It is usually done in the native country.
  • Q- How does exercising before the knee replacement surgery help?
Q- How does exercising before the knee replacement surgery help?
  • The knee is a living tissue. So, your brain health affects your knee health, and we all know the effect of exercise on our moods. Thanks to the release of happy hormones post-exercise.
  • Exercising helps you to control the weight, which will decrease the amount of work your knees have to do.
  • Exercising promotes overall health making a recovery faster after the surgery.

FAQs RELATED TO THE SURGERY

  • Q- What will occur during the knee replacement surgery?
Q- What will occur during the knee replacement surgery?
  • Anesthesiologist guides you through the options of anesthesia and administers the one for which you give your consent.
  • After this, healthcare moves you to the operation ward, and the surgery is performed on you while you’re asleep.
  • An incision from 4 to 10 inches will is made over the damaged area of your knee. A less invasive surgery will require a smaller incision, though it is not mandatory that a surgery with smaller incision must be less invasive as well.
  • From here on, the surgeon uses his expertise to remove the damaged parts of the knee and carefully replace them with the prosthetics.
  • After entirely fitting the implants, the surgeon will cross check the fit of the implants by bringing them in motion (bending & rotating).
  • Once the surgeon is satisfied with the placement of the implants, he stitches/staples the incision to close it.
  • Q- How long will the knee replacement surgery last?
Q- How long will the knee replacement surgery last?
  • The real-time TKR takes about 2 hours. Still, the preparation of the surgery can add some more hours to it.
  • Revision knee surgery, on the other hand, being more complex, requires additional time. It usually takes 2-3 hours.
  • Q- Is anesthesia during TKR necessary?
Q- Is anesthesia during TKR necessary?
  • Knee surgery is one of the major surgeries, and anesthesia is recommended to avoid any pain stress to the body.
  • You may choose between localized or general (full body) anesthesia after consulting your anesthesiologist.
  • Q- Can I select the anesthesia?
Q- Can I select the anesthesia?

Anesthesia is selected after considering your age and medical health. Still, if you have a preference, you can discuss the same with your anesthesia doctor and decide.

  • Q- Would I incur any pain during TKR?
Q- Would I incur any pain during TKR?

Not any if you’ve been sufficiently sedated with anesthesia.

  • Q- How much blood would I lose during the joint replacement surgery?
Q- How much blood would I lose during the joint replacement surgery?
  • The surgery involves blood loss, but amounts may vary on your medical health and the extent of invasion of the surgery.
  • It is advised not to consume any anticoagulants or anti-platelet drugs (blood thinners) before the surgery as they can increase the amount of blood loss.

FAQs RELATED TO POST-SURGERY DURATION

  • Q- What are the precautions to take for the flight after surgery?
Q- What are the precautions to take for the flight after surgery?
  • Movement is crucial after the surgery to avoid blood DVT- Deep vein thrombosis (formation of one or more blood clots in the lower limb).
  • Chances of DVT increase if a person sits still for a longer duration, such as in a long flight.
  • While in a flight, legs fold at a right angle. It may lead to a kink formation in the veins under the knee. This further promotes DVT.
  • To avoid DVT one must avoid dehydration.
  • Ensuring optimum movement, as simple as moving up and down the aisle after regular intervals, can help.
  • One may take anticoagulants (blood thinners) after consulting the doctor.
  • Q- How is life after knee replacement?
Q- How is life after knee replacement?
  • It takes 3-6 months for complete recovery in a healthy body. It may also take up to 12 months.
  • No matter what other brands may tell you, no implant can function 100% as your natural knee.
  • The knee pain is minimized, not completely eradicated in most cases.
  • Simple movements like walking may restore to normal, but implants don’t allow you to run a marathon.
  • Q- Which shoes should I wear to avoid discomfort after surgery?
Q- Which shoes should I wear to avoid discomfort after surgery?

Patients should use good shoes of a proper fir with additional arch support.

  • Q- What exercises should be avoided after the surgery?
Q- What exercises should be avoided after the surgery?
  • As already mentioned, implants can help you walk, but if you try to push it, you may damage the new knee as well. Heavy movement or weight-bearing exercises like running and skiing must be avoided.
  • The patient should enjoy sports like football and soccer only as a spectator.
  • Q- Can I contact the doctor after surgery?
Q- Can I contact the doctor after surgery?
  • After the surgery you may contact your doctor directly for any query.
  • You may request our case managers for this service.
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