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The PM's new knee could last 12 years: Dr Laud

Archana Masih in Bombay

"Do you think I look stressed?"

About to go in for surgery at the Laud clinic in north central Bombay, Dr N S Laud, the orthopaedic surgeon assisting on the prime minister's surgery two days from now, is friendly and relaxed -- a disposition that has been acquired after years of experience and which will see him through Tuesday's operation as well.

It is a usual day at his clinic. In a corner at the reception is a felicitation -- a model of a human hip -- which reads: Dr N S Laud 'The Master.' Sitting beside the felicitation are some people inquiring about the likely surgery of their relatives. One man is rather anxious about a relative's treatment during the week the prime minister is in the city .

Just behind the reception, Dr Laud is being wished the very best by another colleague over the phone. "Yes, it is an honour and I am proud," says the doctor and goes on to tell another caller how he appreciates the PM's gesture in opting to have the surgery in India.

Explaining his reservations about giving information about the PM's surgery, he says in view of the patient's special status he has been instructed not to do so. He, however, adds that he will only know all the details after Dr Chittranjan S Ranawat -- the chief surgeon operating on the PM -- arrives in the city.

Dr Laud has been assisting Dr Ranawat in India since 1982. Their association goes a long way -- to their days at the Indore Medical College. "After he moved to the USA, I first met him in '74 in New York. What impressed me most was that he not only was doing replacement surgeries but was also designing joints -- he was involved in the reconstruction of joints to offer the normal motion."

After Dr Ranawat's hip and knee replacement demonstration at the Breach Candy hospital in 1980, Dr Laud has been assisting him in approximately six to eight surgeries every year in India.

A knee replacement surgery procedure normally takes between an hour and 15 minutes to an hour and 45 minutes. The entire procedure (from being wheeled in to being wheeled out) could take up to two-and-a-half to three hours.

For the surgery, a small cut is made in front of the knee. The knee joint is opened and the damaged surfaces of the bones are removed and replaced with metal surface on the upper side and plastic surface on the lower side. The surface of the knee cap is also replaced with a plastic button. These surfaces are fixed to the bone with bone cement, after this the muscles and ligaments are stitched back.

The artificial knee joint is made of specialised steel, titanium, cobalt chromium alloy and ultra high density polyethelene. These materials are imported and the joints are manufactured in India. Imported joints are also available.

The replacement joint for the PM is being brought by Dr Ranawat from New York. According to Dr Laud, joints manufactured in India cost approximately Rs 75,000. Joints from the US cost between $ 18,000 to $ 20,000, and in UK between 9,000 to 10,000 pounds.

Explaining a normal knee replacement surgery, Dr Laud says the procedure would preferably require epidural anasthesia because this can control pain for 48 to 72 hours.

Before surgery, the patient has to undergo a cardiac, pulmonary and diabetic assessment. An X-ray is taken to ascertain the size of the knee; a physician and anaesthetist assess the patient.

After getting the patient's consent, s/he is asked to starve for six to eight hours. Medication is administered to reduce apprehension. Pre-anaesthetic medication is given before anaesthesia.

The post-surgery procedure includes medication to reduce pain and prevent infection. Six hours after the surgery the patient can be given fluids like tea, coffee, water and juice.

Physiotherapy begins the following day for the foot and ankle. Exercise are prescribed for the heart and lungs. For some time the patient is put on a continuous passive motion machine which helps mobility.

By the fifth day the patient can stand with support and walk with the help of a walker. The sutures are usually removed by the tenth day and physiotherapy continues for eight to ten days.

If the operation is 'well done' the artificial joint replacement can last up to 12 to 15 years. "Last year Dr Ranawat presented a case from 1974 to us," adds Dr Laud.

Giving an overview of osteoarthiritis and osteoporosis in the country, the surgeon says as more and more people live longer these problems are on the rise due to the hazards of modern living. The mobility of the knee joint is gradually affected with age due to overuse, prolonged walking, overweight, diabetes and hyper-tension.

Knee replacement surgery in India costs between Rs 250,000 to Rs 325,000.

Pleased with the awareness generated about knee replacement among the public due to the PM's ailment, Dr Laud nurtures a larger vision: "Among the many challenges in this millennium -- one would be to try and make this surgery possible to the common man of our country."

The PM's surgery: The full coverage

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