Joint replacement surgery has been proved to be immensely successful in improving quality of life for Hip and Knee arthritis. It is accepted popularly across the world. There however remain a lot of discrepancies between services offering these treatments and an even larger number of doubts about various aspects that need clarification. In a country like India, a large number of deserving patients do not have access to joint replacement due to their poor socio- economic status. The good news though is that we have an ever increasing educated middle class who are getting public/ private insurance and would like their near and dear ones to have the best treatment using part- or fully self- funded means. The purpose of this article is to clarify misunderstandings related to cost and quality of joint replacement surgery.
Joint replacement is by no means a cheap operation. Most of these however are ‘elective’ i.e. planned operations. An individual or his family has therefore enough time to plan the finances and logistics related to the treatment. Similarly there are a lot of options/ choices one can make in the operation to make it suitable for their budget and means. We shall try to provide answers to the following questions many patients come up with:
What is the cost breakdown? Is it costly due to expensive implants?
A big portion of the cost is attributed to the implants used. While implants are costly, it is not because they are expensive materials but due to the rigid manufacturing process where both technicality and expert manpower are required. The major chunk of operation cost still relates to the operation theatre setup and disposable single use materials that have been proved to reduce complications. One can do the same operation without using many of these. However, It would tend to put the patient at a higher risk of complications. Experts are best to seek guidance on how much of single- use materials should be considered as the bare minimum when cost- cutting is desired. Rest of the cost is made up by the choice of the room/ward of stay, medications and staff charges which are standardized.
Can I get the surgery done at a discount rate?
Most people who would like to bargain for the cost of the operation do that by opting for hospitals where the package quoted for the surgery is less. It is also common to make calls/ e-mail regarding cost of operation even before the patient is seen. The only factor in peoples’ minds is the metal implant. Many opt for an expensive implant as they think that as the only important factor for success. In fact, there is no proof from multiple scientific studies that patients’ activity would be different from so called ‘superior’ implants. Similarly, fancy materials like golden colors/ ceramic surfaces are marketed as superior and even cost more, with no documented advantage. Hence if the cheapest implant can produce a similar result as the most expensive one, more important factors are:
- experienced dedicated specialist surgeon and disciplined theatre personnel
- modular operation theatre
- robust theatre equipment and sterilization protocols
- patient monitoring and safety equipment like calf pumps to prevent vein thrombosis
- single use equipment mentioned in the section above and so on.
Every discerning patient must seek information on whether the above are available in their cost package. Dedicated specialist centres are available predominantly in the private sector in India, but we also have excellent facilities in some medical college and government sector hospitals. Well organized hospitals often manage competitive ‘cost packages’ that would benefit patients best. It is important to determine whether the cost package quoted has taken into account the following:
- Whether the patient has been seen by the doctor as different medical conditions that the patient might have would require appropriate management and that would have a bearing on cost.
- The complexity of the individual patient’s arthritis might demand a specific variety of implant design, This is best advised by the treating surgeon. A Knee or Hip joint specialist surgeon should be able to advise on options of implants that are suited to respective patients.
- Rehabilitation after surgery is vital and must be included in the initial cost accounting. There is no point considering discounts where the important components are left out and the patient then has to pay significantly higher than they have planned for.
Are imported implants of better quality?
The true quality of an implant depends on the rigid standards and error ranges set by the company at the manufacturing unit. There are a number of unstandardized imported implants available at cheap rates and some indigenously made implants are also of very good quality standards. It’s important that the surgeon has knowledge of the materials and manufacturing process.
Cheaper cost options for an implant have to be discussed with the specialist surgeon. These depend on different materials (metal alloys/ ceramics, etc.) that are suitable for certain patients as also techniques of operation (use of cement) which can make an operation cheaper while maintaining the best quality. These choices are available with both imported and locally manufactured Indian implants.
What is the difference from having exclusive specialist centres?
Dedicated centres that cater to specialty surgery have led the way in demonstrating consistently excellent results and set high standards for others to follow. New state of the art facilities are designated as ‘center of excellence’ when they have their own results comparable to the best published by working as per the best practice guidelines.
From the patients’ perspective this is ideal because every patient then follows a set pathway that ensure their safety as well as puts them at the highest probability of a good result.
Patients are well prepared before the surgery such that more than 95% do not need any ICU care and almost 100% stand up the same day as surgery. The rehabilitation discipline continues after the operation and ensures that by the time the patient goes home, they are able to manage with minimal aid from others. Displayed average results of patients having had treatment at the individual facility makes it easy for patients to see the success rates they are against.
KMC Hospital, Ambedkar Circle, Mangalore is 250 bedded and caters to all multi- specialty facilities. We inaugurated an exclusive “Comprehensive Centre for Hip & Knee care” which is the first of it’s kind in India to be recognized for the entire spectrum of Hip & Knee joint ailments: non- operative and joint preservation treatments to complex joint replacement. The basic purpose therefore of having a planned surgery is to have a better quality of life subsequent to it. Ours being a ‘comprehensive leading edge centre’, we aim chiefly to nullify complications related to operations. This correlates directly with the treatment being cost- effective.