Total Knee Replacements in Mumbai – Post-operative Care
Thank you for opting to have your surgery done with us.
I hope that you are cognizant of the other methods of treatment of your problem which has been discussed with you by me, my staff and assistants in my clinic, in advance, at the time of your consultation, and I trust if you have had any queries, they have been answered.
Based on our discussions, we have determined the suggested plan of action as the best option under the circumstances, keeping in mind your requirements and our current expertise.
To help you understand the process, I am comparing it to taking a flight from Mumbai to a foreign destination.
Just like before a flight, you need passports, visa, ticket bookings, like-wise for the operation, you need to book a date for admission and a date and time for surgery.
Just like the visa process, we need to know that you are fit for surgery and therefore, you need to share your medical history with us, alongwith ALL the medication that you normally take including tablets such as Aspirin and Clopilet which are blood thinners and can cause bleeding at the time of surgery, and medication for Asthma (you may need more oxygen during the surgery) and Diabetes (if your blood sugars are high, then wound healing is very poor). All inputs by you help make us more prepared to help you.
Specific medication & conditions of the heart (ECG, 2D Echo), lungs (PFT/X-rays), liver and kidney etc., need to be known as various drugs can interact with these functions. The physical act of giving you anesthesia may require extra tests like specialized x-rays of your spine, CT or MRI screening of parts of your body, so that we are better prepared to tackle your spinal position during the process of the surgery.
Just like you have a security check before taking a flight, we need the Physician and the Anesthetist to look through these pre-operative medical reports and to examine you so that we may reduce the risks still further.
Just like in an aircraft before take-off, there is a safety drill in case of any risks, likewise, in any surgery we are taking RISKS but minimizing it by trying to cover as many events as we can.
Just as every landing at an airport, the pilot has to contend with cross-winds, haze, other flights, weather changes, quality of communication etc., similarly every surgical procedure is individualized, some are longer, some are shorter and there are multiple variables.
The OTC is like a ticket. Just like you pay for a ticket before your travel. The Hospital expects you to do an OTC (Operation Theatre Clearance) so that the hospital and you are both aware of the expected expenses. Against your paid ticket you get a boarding pass, likewise against an OTC, the institution permits you to be taken to the theatre for surgery. This is based on averages, but in your individual case the total expenses may be more if there are complications or emergency requirements which may or may not be related to the actual surgical procedure.
You need to be aware therefore that this is an estimate only based on an AVERAGE and is NOT a PACKAGE.
Recovery thereafter is a natural process, and we as doctors help nature help you, with medication, nursing, physiotherapy and other techniques required for your recovery. I reiterate that healing is a process dictated by nature, we only help in this. Just as nature has storms, weather changes, etc, recovery can sometimes in your individual cases be slower and therefore worrisome to you.
Such delays are also worrisome to us as individuals and as a team. The nurses, other staff and my team help the recovery process. Your concerns will be addressed.
Just like in the airline industry the cost of the ticket for travel supports the airline staff, the salaries, the fuel for the aircraft etc., for our team to successfully execute the whole process, there is staff in the hospital which is supported by the expenses incurred for your case, for administration, security, laundry, dining, meals, air-conditioning, water, catering etc.,
Like certain budget airlines offer cheaper fares and skeleton services many doctors and medical facilities will be able to offer you these at lesser rates. In our institutions we have overheads to ensure that checks and measures are carried out for your safety and these necessitate the charges quoted by us.
Just like in any travel there is an Economy class or Business Class or First class at different charges, helping you reach the same destination, similarly in the hospital there are various classes of admission with different levels of comfort, helping you attain the best results. My team’s training, experience, etc., should make this a smooth landing.
I hope this helps you understand the process and I really look forward to greeting you on the other side with every success in your case.
– DR. SANJAY AGARWALA
SA:bf:10th July 2018
Post-operative Care
In a small percentage of people, as with all major surgical procedures, knee replacement complications can occur. Below is a list of potential knee replacement complications and steps you can take to prevent their occurrence.
Thrombophlebitis
This condition is also known as deep vein thrombosis (DVT), and it occurs when the large veins of the leg form blood clots and, in some instances, become lodged in the capillaries of the lung and cause a pulmonary embolism. The following steps may be taken to avoid knee replacement complications due to blood clots:
- Blood-thinning medication (anticoagulants)
- Elastic stockings (TED hose)
- Foot and ankle exercises to increase blood flow and enhance venous return in the lower leg.
IMPORTANT: If you develop swelling, redness, pain and/or tenderness in the calf muscle, report these symptoms to your orthopaedic surgeon or internist immediately.
Infection
Although great precaution is taken before, during, and after surgery, infections do occur in a small percentage of patients following knee replacement surgery. Steps you can take to minimize this knee replacement complication include the following:
- Monitor your incision closely and immediately report any redness, swelling, tenderness, increased drainage, foul odor, persistent fever above 100.4 degrees orally, and increasing pain.
- Take your antibiotics as directed and complete the recommended dosage duration.
- Strictly follow the incision care guidelines your surgeon recommends.
Pneumonia
Because your lungs tend to become “lazy” as a result of the anesthesia, secretions may pool at the base of your lungs, which may lead to lung congestion or pneumonia. The following steps may be taken to minimize this complication:
- Deep breathing exercises: A simple analogy to illustrate proper deep breathing is to, “smell the roses and blow out the candles.” In other words, inhale through your nose, and exhale through your mouth at a slow and controlled rate.
- Incentive Spirometer: This simple device gives you visual feedback while you perform your deep breathing exercises. Your nurse or respiratory therapist will demonstrate proper technique.
Knee Stiffness
In some cases, the mobility of your knee following surgery may be significantly restricted and you may develop a contracture in the joint that will cause stiffness during walking or other activities of daily living. The following steps must be taken to maximize your range of motion following surgery:
- Strict adherence to the CPM protocol as prescribed by your surgeon
- Early physical therapy (Day 1 or 2) to begin range of motion exercises and walking program
- Edema control to reduce swelling (ice, compression stocking, and elevation)
- Adequate pain control so you can tolerate the rehabilitation regime