Joint replacement surgery comes of age
Doctors in private hospitals still are not sure whether they will be able to replace all four joints at once anytime soon. "We do two joint replacements at a time and then give a break," said Dr SKS Marya, chairman, orthopaedics, Max Healthcare.Updated: Sep 02, 2013 01:03 IST
Relying on a walker to support his weight, Manoj Kumar Das, 48, takes small steps across the corridor of the physiotherapy division at the All India Institute of Medical Sciences (AIIMS).
It is hard to believe when doctors tell you that Das was virtually bedridden, moving only on a wheelchair, for more than a year in his home in Bhubaneswar, Odisha.
He was diagnosed with a musculoskeletal condition called juvenile rheumatoid arthritis more than 10 years ago and the symptoms had become worse over the past year.
“I am a librarian at a government college, and would go to work on a wheelchair. I was practically bedridden and had to be lifted and put on the wheelchair. It had become very painful and the condition was getting worse,” says Das.
Doctors say he was suffering from extreme arthritis symptoms, with severely deformed bones, weak muscles and stiff joints. This sort of condition forces most people to resign to their fate and not even make attempts to seek treatment.
However, the indomitable spirit that Das showed in coming all the way to Delhi despite his painful condition was perhaps what encouraged doctors at AIIMS to take the risk of replacing all his four joints — both hips and both knees — in one go, making it the first such attempt in the country.
Usually, a maximum of two joints are done at once because of the high risk involved.
“This is not for every patient. You have to be very sure not just as a surgeon but as a team. Though we have been contemplating it for many years, Das’s was a fit case to start because of his condition. His soft tissues were harder than his bones, the only thing he could move was his chest to breathe,” said Dr Rajesh Malhotra, professor, department of orthopaedics, AIIMS, who led the surgical team.
What also worked for Das was that he had no underlying medical condition such as diabetes and hypertension. And he also had a very positive frame of mind. So when the doctors told him about the experiment, he readily agreed. “I thought if the experiment worked, I would no longer have to suffer this excruciating pain,” he said.
The team obviously was in for a lot of challenges.
“Giving him anesthesia was a task in itself, considering his spine was fused. We had to put epidural catheter through caudal space (just above the tailbone, there’s a small area where access to the epidural space is possible),” said Dr Anjan Trikha, professor, department of anesthesia, AIIMS.
His left hip joint was replaced first and then the right one. However, doctors replaced both his knees together to save the surgical time.
“The longer the surgery, the greater the risk, so we decided to do both knees together. We waited after the first two joints and went ahead after we were very sure that the patient could take it,” said Dr Trikha.
The surgery took place on July 24 and within three weeks, Das showed tremendous improvement. The physiotherapy team also worked very hard with him. “His muscles were totally wasted and we had to give electrical currents to revive them. Passive physiotherapy in such patients starts on Day One after the surgery. From just moving his chest, he has become functionally independent,” said Dr Kanchan Mittal, superintendent physiotherapist.
But doctors in private hospitals still are not sure whether they will be able to replace all four joints at once anytime soon. “It’s too early to say whether it’s a good or a bad thing. We do two joint replacements at a time and then give a break. Medical risks go up the more joints you do together, and our patients are very aware so the answerability also goes up for us manifold,” said Dr SKS Marya, chairman, orthopaedics, Max Healthcare.