|THE FEAR FACTOR IN JOINT REPLACEMENT SURGERY
The population of India is aging. This demographic change brings along new medical challenges which are age related and affect various parts of the body. Arthritis is the number one disability not only in the USA but in Asia as well. The increasing trend towards affluence is leading to an obesity epidemic in India. Increased body weight directly affects the weight bearing joints which undergo wear and tear and succumb to arthritis. In addition, the typical Indian cultural apathy to exercise adds to the burgeoning problem of arthritis.
However there have been enormous strides in the super speciality of Orthopaedics which deals with Joint replacement surgery. Many international papers in peer reviewed journals of Orthopaedics have published long term follow-up data which show very good outcomes related to activity level and painless mobility.
However there are many patients who deny themselves an opportunity to get back their independence because they are scared of surgery. The most common reason is that they have heard of, or know someone who has not done well after surgery! The second common reason to deny or avoid surgery is the cost factor.
It is obvious that one cannot extrapolate the bad experience of one patient to oneself! The chances are that if the operation is done by an experienced surgeon backed with a good team using the best implant manufactured by a reputed company in a hospital which maintains good practice standards, then the outcome is likely to be good.
There are inherent risks in any operation but they are small and need to be disclosed to the patient. Infection, DVT (deep vein thrombosis), scar related problems, neurovascular problems in severe deformity, can be expected. However in percentage terms it is 5 % compared to a 95 % success rate!
With increased awareness this 5 % risk is also reduced significantly by premptive measures like using prophylactic antibiotics, clean air theatres, space suits, clean hand campaigns, DVT stockings and early mobilisation and judicious use of drugs to thin the blood. In some good centres the risk is nearly zero!
One must also caution the patient about delayed infection. It can happen many years after the index surgery! Lowered immunity, local trauma leading to haematomas, and high dose or longterm steroids can lead to this complication.
In such situations one requires to remove the old implant and do a staged revision procedure. If an accepted protocol is followed then the results of such revision surgery are satisfactory.
Thus there is no real need for fear! The patient should arrive at an informed decision after knowing all the facts about the proposed surgery and should not hesitate to ask questions to their Doctor! Once a good communication platform and rapport is established then the odds for a good outcome are high!