Planning for Total Knee Replacement (TKR) Surgery – in Hyderabad, India

I have been researching various factors to have Total Knee Replacement (TKR – also called Total Knee Arthroplasty TKA)  Surgery for my mother.  My mother has been suffering from Osteoarthritis for almost 10 years and we weren’t confident of going for a TKR surgery so far. We looked into other matters such as therapy, medicine, and a shop for orthotic shoes as those can reduce foot and lower leg pain. However, it has become unbearable for my mother and upon diagnosis (x-ray), the doctor confirms that both knees are in the final stage (#4) of Osteoarthritis and recommended the bilateral TKR (TKR for both knees).

TKR surgery has become a common and reliable solution these days. Also, it has an increased success rate and faster recovery times than other treatments. These factors are helping to improve the confidence in patients to undergo this surgery.  The major two contributors for a successful TKR surgery are below:

1. Quality of the Surgeon – choosing the right surgeon is the most and very critical decision you have to make for a successful surgery and recovery. 
2. Implant used – for most of the times this decision is taken by the surgeon depending on his evaluation of your knee condition and his experience with particular model or brand of the implant.

 

Things to consider while choosing the quality surgeon for Knee Replacement:

• Finding a best Knee Replacement Surgeon requires you to gather as much as possible list of all Knee Replacement Surgeons in your region/city. 

• There isn’t any single place where you find complete list of Orthopedic Surgeons and their rankings
• A useful list I found is: Best Orthopedic Surgeons in Hyderabad

Surgeons who are highly experienced (no.of years) and also has International work experience

Surgeons who has high success rate – by references of other patients, searching internet for doctors profile and hospital profile

Surgeons who does more number of Knee Replacements in an year – choose doctors who at least have a track record of performing 1000 Knee Replacement a year

Surgeons with higher education credentials and National/International  associations/fellowships – most of the surgeons would have 

• M.S (Master of Surgery) or M.Ch (Master of Surgery in Great Britain)
• followed by any Orthopedics specialization like

• DNB – Ortho (certification by National Board of Examinations Govt. of India)  equivalent to MD/MS/DM/M.Ch or
• FRCS – Ortho (certification by one of the four Royal Colleges of Surgeons of the United Kingdom and Ireland)

Further relevant specialization like complex joint replacements, Sports Medicine  & Arthroscopy would be a value addition

Professional Orthopedic Memberships like

• Association of Orthopedic Surgeons
• Indian Orthopedic Association (IOA)
• Indian Society of Hip & Knee Surgeons
• Indian Arthroplasty Association (IAA)
• Arthritis Foundation of India Trust (AFI)
• Indo German Orthopedic Foundation (IGOF)
• British Orthopedic Association
• Arthroplasty Surgeons in Asia (ASIA)

Awards and Honors

Academic Contributions like books or article publications

Surgeons with Continued Research – by being part of any Center of Excellence in Orthopedics

Facility/Hospital he is associated with

Use of latest technology like minimally invasive TKR,

Friendliness with Patients to relief their stress and build more confidence

You need to have at least one time in-person interaction with the surgeon to build your comfort and confidence

 

Here are my efforts to find few best doctors for Knee Replacement in Hyderabad:

Sl.no	Doctor	Hospital	Education	Experience	Research	Remarks	References
1	K.J.Reddy	Apollo Health City	MS & DNB – Chandigarh; FRCS (Glasgow, Edinburgh); FRCS (Ortho)	30+ years; 14 years in UK; Was Chief of joint replacement surgery – Basildon & Thurrock NHS Hospitals	Chief Joint Replacement Surgeon –  Apollo Health City ; Plenty of publications	Doctor for Sania Mirza, Sir Richard Hadlee ; Board Member of ASIA	http://www.kjrclinic.com/; https://hyderabad.apollohospitals.com/dr-k-j-reddy-orthopaedics/
2	A. V. Gurava Reddy	Sunshine Hospitals	D.Ortho-DNB – Pune; M.Ch. Ortho (Uni. of Liverpool –  England); FRCS (London, Glasgow, Edinburgh)	25+ years; 10+ years in UK; 2000+ Joint Replacements in a year	MD – Sunshine Bone and Joint Institute; Tutor for FRCS & MRCS Training courses; Program Director – DNB	Highly regarded and Reputed in India and International;	http://www.sunshinehospitals.com/meet-dr-gurava-reddy/; https://en.wikipedia.org/wiki/A._V._Gurava_Reddy
3	Venuthurla Ram Mohan Reddy	Continental Hospitals	MS Ortho Surgery (PGIMER –  Chandigarh – 1995); MS Ortho Engineering  (Cardiff Uni. School of Med. UK – 2003); FRCS (Orthopedics – UK); FRCS (General Surgery Edinburgh – 2008); Dual Degrees in Medicine and Engineering	26+ years; 14+ years in UK; Fellowship In Knee And Hip Surgery at NHS UK; Fellowship In Advanced Knee And Hip Surgery at Australia;	Consultant Orthopedic Surgeon –  Continental Institute of Orthopedics;	Did both Masters in Orthopaedic surgery + Masters course in Orthopaedic Engineering;	https://www.timesmed.com/Doctor/Hyderabad/Orthopedist/Gachibowli/venuthurla-ram-mohan-reddy-orthopedist-tm; http://www.drrammohanreddy.com/dr-v-ram-mohan-reddy/
4	K Sudhir Reddy	Landmark Hospitals	MS Ortho (AIIMS); MCh Orth (Uni. of Dundee – UK) – Gold Medalist; FRCS (Trauma & Ortho Surgery – UK); FRCS (Edinburgh);	23+ years; 8+ years in UK; Did 6000+ TKR Surgeries; Fellowship (Revision Joint Replacement – Endo Klinik, Hamburg)	MD & Chief Joint Replacement Surgeon –  Landmark Hospitals;	Assistant Professor at MIMS; Renowned for Complex Surgeries	http://www.landmarkhospitals.net/about-us/message-from-managing-director/
5	Nitish Bhan	Continental Hospitals	D.Ortho-DNB – KIMS, Narketpally – 2012; MNAMS – Orthopedics – 2012; M.Ch Ortho (American Institute Of Medicine – Seychelles) – 2015;	11+ years; Sports Medicine – Chongqing China;	Consultant Orthopedic Surgeon –  Continental Institute of Orthopedics;	Assistant Professor at MIMS; Renowned for Complex Surgeries	http://www.drnitishbhan.com/dr-nitish-bhan/; https://www.timesmed.com/Doctor/Hyderabad/Spine-and-Pain-Specialist/Gachibowli/dr-nitish-bhan-1-orthopedist-tm
6	Krishna Kiran Eachempati	MaxCure Hospitals	MS Ortho (AIIMS); Fellow In Computer Assisted Hip And Knee Arthroplasty (Germany)	19+ years;	Chief Hip And Knee Replacement Surgeon –  MaxCure Hospitals;		http://maxcurehospitals.com/blog/dr-krishna-kiran-eachempati/

 

Orthopedic surgeons Hyderabad Excel File:

I took my Mother for in-person consultation with

• K Sudhir Reddy (Landmark Hospitals) – The doctor was too busy and paid hardly any attention to the patient.  Advised us to contact his assistant who will describe about the surgery and pricing.
• Nitish Bhan (Continental Hospitals) – The doctor was not available on the schedule despite taking the appointment.  However, he paid utmost attention and explained to my mother about why she needs the surgery.

 

Things to consider while choosing the Implant for Knee Replacement:

1. As said above, its recommended to leave the choice of implant to the surgeon itself. – Because it is found that in a good surgeon’s hands even an average implant will work very well. In a bad surgeon’s hands, even if you use the most expensive implant it may not work very well.
2. However, you should check with your surgeon on below aspects of the implants that he is going to use:

1. is the implant the newest design/model or is the implant having the longest track record?
2. do you use different implants depending on each patient, or become most comfortable with one implant for every patient?
3. how is the chosen implant appropriate for the patient’s condition

You may just need to learn about what these implants are made of? All of the implants should be made of bio-compatible metals (so that it will not be rejected, corrode nor react with the body).  Below are some of the commonly used implant materials:

1. Cobalt-Chromium Alloys –

1. most commonly used for the femoral implant since it is very sturdy and the Femoral implant has a lot of traction against the plastic spacer during movement
2. metal ions particles can sometimes cause reactions in the human body, especially in case of those patients who have allergy to special metals like nickel.

Titanium and Titanium cobalt Alloys – 

1. is used as frequently as cobalt-chromium
2. will not corrode, nor change inside the body and more elastic and favorable to the natural bone surrounding the implant
3. since this metal is softer, it tends to make up the Tibial part of the replacement where the plastic insert locks in.
4. used in cementless designs which rely on bone growth into the surface of the implant for fixation  implants
5. the most used titanium alloy in knee implants is Ti6Al4V

Tantalum  –  

1. it contains pores, the size of which makes this material very good for bone in-growth.
2. a new porous substance has been made of tantalum named Trabecular Metal
3. Trabecular Metal has an elastic nature which aids bone remodeling.

Zirconium alloy  –  

1. Oxinium oxidized zirconium is a new metal alloy containing 97.5% Zirconium and 2.5% Niobium that is oxidized to convert the surface of the material into zirconia ceramic
2. it is twice as hard as cobalt chromium alloys, it provides half the friction thus performs with higher quality and lasts for a longer time.
3. sell at a premium of 20-25% over the Cobalt-Chromium implants

Polyethylene –  

1. is a type of strong plastic found in the the tibial patellar (kneecap) component and the plastic spacer
2. the use of Ultra Highly Cross Linked PolyEthylene (UHXLPE) or Ultra High Molecular Weight PolyEthylene (UHMWPE) reduces even the minimal wear enabling the knee implants to last for a much longer time.

What an Ideal implant should have?

1. Allow for normal activities and motion – high flex upto 155 degrees
2. Last the expected 15-20 years or more. 
3. Have a good track record of use in joint replacement recipients (this should be 5-10 years minimum). 
4. Meets your condition, needs, and any additional requirements like sizes
5. Be a familiar brand and style to the chosen surgeon.

 

Pricing of various implants I gathered from Landmark Hospitals.  This is not an official price tags but only to give you an idea of what the pricing would be of various brands and models of knee Implants.  Further, a very good news is that Govt. has put maximum limits for the implants price in India; The new prices would include Rs. 55,000 for any basic implant and its almost 55% lesser than previous prices.

Sl.No	Brand	Model	Life	Price Per Single Knee	Remarks
1	Johnson & Johnson		20 Years	₹                          190,000	Basic Knee Implant
2	Stryker		25 Years	₹                          190,000	Basic Knee Implant
3	Smith & Nephew	Oxinium Verilast	30 Years	₹                          280,000	World 2nd Best Implant
4	Stryker	Scorpio NRG X3	30 Years	₹                          260,000	Natural Movement
5	Johnson & Johnson	Attune	30+ Years	₹                          320,000	Hi-tech and Advanced – includes a fixed bearing
6	Zimmer	Persona	35 Years	₹                          320,000	World Best implant has decades of clinical history
7	Smith & Nephew	Journey II	40 Years	₹                          360,000	More natural and advanced imaplnt than Persona
	Indian Govt. has put maximum limits for the implants price in India; The new prices would include Rs. 55,000 for any basic implant
	BioMet	Bought by Zimmer		Zimmer Biomet
	DePuy	Bought by Johnson & Johnson		Johnson & Johnson
	References:	https://www.peerwell.co/blog/2016/10/03/different-types-of-knee-replacement-implants/
	Name	Types	Price
	Standard TKR	Femur   :  25295	65111
		Bearing :  10028
		Tibia     :  25494
		Pattela  :  4295
		Total    =  65111
	Hi Flex TKR	Femur   :  27153	66969
		Bearing :  10028
		Tibia     :  25494
		Pattela  :  4295
		Total    =  66699
	Revision TKR	Femur   :  65909	112361
		Bearing :  16664
		Tibia     :  25494
		Pattela  :  4295
		Total    =  112361
	Source:  http://www.landmarkhospitals.net/services/orthopedics/