1. Life is Mobility, Mobility is life! Success story of Total Knee Replacement Surgeries rendered through Chief Minister’s Comprehensive Health Insurance Scheme Dr A.K. Tharun MS Ortho, FATS Germany, MBA Surakksha Multispeciality Hospital Salem BONNE SANTE ’ 16 1

2. Introduction Osteoarthritis is the commonest ailment in advancing age group and cause of disability amounting to 17.5 %. Total knee Replacement (TKR) is the most successful orthopaedic surgery with success rate of over 95%. The outcome of TKR surgery is pain free and mobile joint with an active lifestyle and return to normal work status. Many studies have proved improved physical activity of patients after surgery. ISLETCON 2015 2 BONNE SANTE ’ 16

3. The Global Scenario For a single TKR surgery, US spends 40000 $ per surgery UK spends 9300 € (NHS has spent 585 million Euro 2015) Europe around 18500 € Asia - Singapore around 24900 SGD India spends 2,50,000 -3,00,000 Rupees. In Tamil Nadu, through CMCHIS, Rs. 65000 (815$) per TKR surgery which is very crucial for a cost dependant nation like India. ISLETCON 2015 3 BONNE SANTE ’ 16

4. Methodology A case series of 200 patients who were diagnosed with Degenerative Osteoarthritis and were operated upon with Total Knee Replacement. Patients who underwent TKR surgery under CMCHIS during the period of 2011 to 2016 were included in the study. They were evaluated for their pain levels, movement and ability to walk. Patients who were counselled properly had successful results. ISLETCON 2015 4 BONNE SANTE ’ 16

5. Case Study 60 year old male Degenerative Osteoarthritis Flexion and Varus Deformity Total Knee Replacement – USFDA Periodic Post of evaluation Return to ‘Activity of Daliy Life ‘ ISLETCON 2015 5 BONNE SANTE ’ 16

6. One such success story 6

7. Challenges faced and addressed Challenges faced with the procedure Nature of implants developed by the western nations to suit their functional life style like sports and sedentary life style. High expectation of our patients ranging from absolute pain free, squatting on the floor and sitting cross legged after the surgery. Poor socio economic status patients do have a poor general condition like low haemoglobin, low immune status ISLETCON 2015 7 BONNE SANTE ’ 16

8. Challenges faced and addressed TECHNICAL Severe Varus Deformity Proper pre op planning Stem extension implants / Constrained Implants Overcome - Using Autologous Bone Grafts and screws FINANCIAL The upgraded implants are expensive Able to be salvaged using the Conventional Implants ISLETCON 2015 8 BONNE SANTE ’ 16

9. Successful replacement or just another knee replacement? Success of surgery depends on higher quality of life, decreased pain and better mobility. Outcomes depend on significant decrease in pain scores and improves range of knee motion. In a developing nation like India 5 years ago TKR was not affordable for the general population. Now with support of CMCHIS we are able to cater to the general population to provide quality health. We are proud to contribute to the success of CMCHIS which is a bridge for both the provider and beneficiary 9 BONNE SANTE ’ 16

10. Way forward in CMCHIS – Our suggestions Need for knee replacement surgery registry – State level US/UK/Sweden/Germany – Register 60 – 70% surgeries under CMCHIS in TamilNadu Inclusion of Revision TKR surgeries To include trauma surgery in CMCHIS for private hospitals Assess recent trends and developments in the health care Industry ISLETCON 2015 10 BONNE SANTE ’ 16