Rare are the occasions when a patient belonging to defence cadre decides to share his first-hand experience of a base hospital of India. Transformative brings to you this exclusive Patient Review (Identity withheld for personal reasons)
I am penning down my experiences in Total Knee Transplant (TKR) in the hope that it may be of some use to others reading this post.
I recently got the TKR done in the Joint Replacement Centre (JRC) of the Army Hospital (R & R) for both knees (one by one). I went to the OPD of JRC with my recent X Rays and met the Sr Advisor and Head of the Department, JRC, Col Datta. (Though I did not carry referral from ECHS, it is better to carry one as they may ask for it.) He advised the transplant to be done one by one. I then took the appointment for operation as there was a waiting list. I was also given a list of test required for operation which should be done outside in any hospital. The tests included RT PCR also.
The Experience at a Base Hospital
A referral was taken from ECHS for the tests and on completion of went for Pre Anaesthetic Checks (PAC) in the R & R. A slip from the JRC, giving date of admission in the hospital and date of operation, is required for PAC. There the anaesthetics checks all the reports and asks you what medicines you might be taking (for BP etc). This is noted down in PAC for administering anaesthesia prior operation. You are advised to bring the medicines that you might be taking for the period of admission (total seven days). You are also advised to bring necessary toiletries and one urine bottle. You are admitted two days before the operation. Before admission you are tested for Rapid Antigen Test (RAT) and TR PCR (again for the latter). On negative report of RAT, which is ready in, say, half an hour, you are admitted in the hospital. When the RT PCR report becomes available, usually, by 1800 hrs, you are shifted to another ward. Next day, you are shifted to JRC ward and prepared for operation the following day. Depending on you turn, you are moved to the OT and administered the anaesthesia. In my case it was done in spine. It takes 20 minutes or so for anaesthesia to take effect and then the surgery is conducted. In my case the procedure took about an hour.
After surgery, you are moved to post-operative section in JRC ward. I felt no pain at all till the effect of anaesthesia was there (it was effective for about four hours after administration), though heaviness in leg was there.8. As the effect of anaesthesia, wore off, dull ache started in the muscles near the incision and increased in intensity but bearable (it was not continuous or piercing or sharp pain). Pain killer was given as required. It lasts for about 18 hours; then it subsides. After two days, there is no pain, though stiffness remains. The next day shifted to room in ward. The next day you are asked to stand and walk a few steps. When you stand, you are surprised to note that there is NO pain in the knee; since the transplanted knee has no nerves, it is gone. But the stiffness in the muscles is there. You walk a few steps with walker and are also instructed to do a few physiotherapy exercises. Thereafter, during the stay there, you are asked to walk with the help of walker more and more but not to strain yourself. On the fifth day after operation I was discharged. I was strongly advised not to engage any physio to do the exercises at home and do them on my own. After the first KTR (in my left knee) in last April, I started with the walks of twenty minutes each in the morning and evening and gradually increased the same to half an hour in the same times. Daily I felt improvement over the previous day. The stitches were removed after 21 days, discarded walker soon after that and started to walk with a stick. In about two months started walking without any aid. In about two and half month it was happiness to walk. The discomfort vanished totally. At home, swelling in the knee was there and advised cold compress lasting not more then 15/20 minutes each time two to three times a day. It also helps to reduce swelling if an incline in bed is made by placing a pillow at one end of the mattress and legs are put on the incline. There are two civilian attendants, each doing 12 hrs shifts, to look after patients needs in the JRC ward who is available 24 hrs to help the patients. Together, they are to be paid Rs 1000/- per day in cash. Also hospital stoppage charges at the rate of Rs 7/- per day are to be paid in cash. At home, did the walks regularly and also the physio exercises. These are required to increase muscles flexibility and need to be continued for the muscles to remain toned up. Please do not neglect the same as if not done the muscles will slowly atrophy.14. Experienced problems in bowel movements. Advisable to have fruits such as papaya to ease down the matter.
Post Operation Care at Home
I was given one months medicines with instructions on their consumption in the discharge certificate. You will need a WC chair at home to raise the level of most WCs at home. This reduces the strain on knees till they are strong enough. It is available in R & R for Rs 3000 approx. Prior discharge, the councillor in R & R advises you on care and exercises at home.18. It is IMPORTANT to avoid sudden jerks at all times.