Surgical modalities should be appropriate for disease as well as the age of the patient: Dr Kaushal C MalhanAltamash Sayyed
The number of patients with arthritis who are going to be there in India is going to be hugely more than anywhere else in the world. The expected estimates say that India will have nearly 15 percent of the world arthritis population by 2025.
In an interview with ETHealthworld, Dr Kaushal C Malhan, Consultant Orthopaedic Surgeon, Fortis Hospital, Mulund, Mumbai, talks on why there are increasing cases of people suffering from arthritis today. Edited excerpts:
How do you see the arthritis scenario is India as compared to the West?
Arthritis has changed over the last many years. When I returned to India about 13 years back, we saw completely different demographics of arthritis than we see today. We used to see patient who were much older (aged 60-65) coming for surgery but now unfortunately the problem is going into the younger patients.
Today we are seeing patient at the age of 40-50 coming and demanding surgery because their joints are really worn out and their condition is really bad. This has actually happened all over the world and it was suggested in the WHO report that India has a much younger population than the rest of the world.
The number of patients with arthritis who are going to be there in India is going to be hugely more than anywhere else in the world. The expected estimates say that we will probably have nearly 15 percent of the world arthritis population by 2025. This is going to be a tall order in terms of management problem, logistics and economics of the whole issue and therefore it is very important that we look at it very seriously.
Tell us about the changing treatment modalities in arthritis.
Joint replacement surgery is purely working on the parts which are bad in the knee or hip. You have to deliver the good and give the patient a new joint. This should be done in a manner that you do as less collateral damage as possible and you do not damage the good parts. That is how we have moved from total joint replacement to partial joint replacement.
The options for the treatment of arthritis would vary depending upon how bad the arthritis is and its type. It is essential to establish whether it is inflammatory, early arthritis or end stage disease.
The role of surgery comes when you are in the end stage or you are at a stage where you can actually foresee that if we do not make an intervention at this stage then the patient will face a problem or greater degree of complications. There are many different types of options like medications, exercises and lifestyle modifications. I think these are key things in the early stages and these need to be looked at seriously.
One of the main factors contributing to the rise of the arthritis in the younger generation is the fact that we have a more sedentary life and the environmental changes. I think there is a role for those basic things to start with. Things like viscosupplementation where lot of people may not be aware that in early or moderate disease one can actually give gel injections. These are actually synovial fluid injections which you can give in various joints and lubricate them so that you can keep the joint going for much longer. This along with local exercise and local modalities of exercise can do a great deal.
If you have a situation where the patients have gone beyond this stage and they are now in end stage disease, then one need to look at surgical modalities. It is very important that we understand as doctors that the surgical modalities will have to be appropriate to not just the disease but also the age of the patient because the kind of disease, expectation and recuperating ability that a 40-50 year old patient would have is completely different from a 70 year old patient.
How do you ensure better and faster recovery for patients with arthritis?
Here in India I saw that the patients with arthritis were much younger and I was drawn into trying to do joint replacements of knees and hips in a manner where we would be encroaching on normal tissues much less.
We would be putting in joints which would be taking out much less bone. The advantages that it has are faster recovery, better mobility and you go home much faster so the cost of treatment also goes down. The most important thing is that you return to work which the patient are most demanding.
Indian patients are generally more averse to surgery, they want less pain and they want to get back faster. The key thing is to do the surgery in a manner that you don’t damage the tissues inside and that starts with the incision, goes down to how you expose the tissues, how you deliver the elements that are bad inside, what kind of implants you use and how much bones you damage.
Where is orthopaedic surgery placed in medical tourism?
Medical tourism is quite big nowadays and it can be divided into patients who would come from the Middle East, African countries and the West. We also have patient coming us from the Canada, US, UK, demanding surgeries which in their own countries would cost many times more.