Friday, January 15, 2010


I’ve had knee pain since quite some time. Initially the pain was mild. It used to disappear for months after taking a few pills and doing some exercises. Slowly the pain increased and I had to take a pill every day. However I was still able to do everything I enjoyed like a long walk or a vacation or a family wedding. Now things have become much worse. My legs have become crooked. The pain killers work for a couple of hours at best. The docs say if I continue popping pain killers at this rate my kidney will break down. I cannot walk and have started to gain weight. Just the other day I visited my ortho and he said I need joint replacement surgery. O God, I’m scared. I don’t want surgery. What If something goes wrong? Neetu didi had got one done a few years back and she isn’t even walking anymore. I’d rather bear the pain and forget about surgery.

This is the situation many of us find ourselves in. Are we justified in our fear for surgery and are we better of accepting our handicap and living with it? The answer is NO. Today there is a very good chance that you can have a successful outcome from joint replacement surgery. With these few very logical tips you can maximize your chances of becoming independent and pain free.

Choosing your surgeon
This is the most important decision. For the right outcome the surgery needs to be done correctly. Joint replacement is a technically demanding surgery that requires a deep understanding, good surgical skill and lots of experience. There is a definite learning curve involved. So how do you choose the right guy? Your best chance is with a specialist. A surgeon doing 300 joint replacements a year is much more likely to get it right than one doing only 25. The other thing to look for is his reputation. A good reputation cannot be faked. One can earn it only by doing good work. Try to look for people operated by the surgeon and speak to them regarding their experience. Often you can get this list from the surgeon himself. This goes a long way in building your confidence.

You may come across an occasional patient that had a complication or bad experience. But you have to be statistically intelligent in judging that. It is stupid to drop a surgeon because one out of his 1000 cases went bad. You will never find a perfect surgeon. A good surgeon is enough.

Choosing the hospital
Generally one would leave that to the surgeon. But a patient should be aware that infection can ruin joint replacement surgeries. These surgeries should preferably be carried out in theatres with super aseptic conditions, laminar airflow and Hepa filters. Theatre condition and discipline is the most important determining factor for choosing the right hospital.

Choosing your joint
 Today information is at your fingertips. Newer prosthetic designs are flooding the market. Some promise better function, others better longevity and yet others both. Many of these designs are based on solid research and are really beneficial. However an equal number are marketing gimmicks to promote sales. One has to realize that joint replacement is a major industry and many a times new research is market based. The internet is an advertising platform. Like in any advertisement, information is blown up and full of half truths. Again your surgeon will come to your rescue. He is usually in the best position to help you make a decision. He knows the other side of the coin.

Your surgeon may have a preference for a particular joint. His preference will more often than not be in your best interest. Familiarity with a system is important to ensure the best result.  Forcing your surgeon to use a system he is not comfortable with may lead to a less than optimum result.

Having realistic expectations
This is probably the most important variable affecting the result of surgery. Don’t live in wonderland. You are not going to hop and skip and run around like a 14 year old after your joint replacement. The surgery will eliminate your pain and allow you to walk normally. But it is an artificial joint and will feel like one. Patients describe it in different ways but the underlying sentiment that the new joint doesn’t “feel normal” is constant. Having said that it is still worth getting it done because of the drastic improvement in function achieved after surgery. 
 With this better understanding, you can safely opt for joint replacement and become mobile and pain free again. Fear usually stems from ignorance. Once you learn about the surgery, hear from others experiences and understand the benefits and the risks involved, you will wonder why you didn’t opt for it earlier.