Chembur businessman gets life back year after botched knee surgery

Nanavati surgeon who corrected Kris Kesavan's knee op explains why implant infection occurs and what specialists have planned to combat it

Retired Chembur businessman Kris Kesavan, 78, underwent a bilateral knee replacement surgery in November 2015 at a city hospital. He surmised that at his age this was expected and wouldn't take long for him to be back on his feet. He was wrong.

Brainstorming solutions
Life turned topsy-turvy for the regular marathon runner and sports enthusiast when the implant got infected, as he was prescribed a heavy and strong dose of antibiotics and sleeping pills for more than a year for the excruciating pain and other problems. Not only did running become out of the question, he couldn't continue with his favourite tennis and swimming either.

Cut to 2018: the septuagenarian has successfully overcome the problem and now goes on his regular morning walks as well as drives his car, thanks to Dr Pradeep Bhosale, director, Arthritis and Joint Replacement Surgery, Nanavati Hospital. With an aim to understanding the science of bone and joint infection, microbiologists and orthopaedic surgeons in the city are planning to form the Osteoarticular Infection Society and conducted a preliminary meeting on November 24-25 to get inputs from specialists across India and the globe.

Confirming this Dr Bhosale said, "We are concerned about the increase in cases of post-operative infections in patients undergoing knee replacement surgery as well as those getting the non-orthopaedic implants, right from dental to replacement of cardiac valve. Hence, we are keen on roping in all stakeholders and finding out ways to tackle this."

A painful nightmare
Recalling the ordeal he survived, Kesavan said, "The first surgery failed, and a second was done within a month for correction, but that failed, too. I had shooting pain soon after the surgery; then came the fever. But it was only when pus started oozing from the implant area that I realised something had gone wrong.

"All of this affected my mental health, too: I stopped eating properly and was surviving on antibiotics, painkillers and sleeping pills for a year-and-a-half. It became so bad that I was scared to face the next day and begged God to give me death. It was a miserable time for my family [wife and five daughters] who were going through their own anguish seeing me in this state every day."

Kesavan added, "I went to nine famous orthos, but none could guarantee me an infection-free life. I was clueless and even considered amputation. That's when my daughter brought me to her home in London, and we met an Indian-origin doctor there, who said he would have to operate on me. From there, I was referred to Dr Bhosale in Mumbai; he finally got me my leg and life back."

How the infection occurs
Dr Bhosale explained, "If the infection occurs after joint replacement, it is challenging to treat. Most times, bacteria stick to the implant and form a self-protecting biofilm around them. This helps them survive, proliferate and spread, while preventing absorption of antibiotics in the blood.

"Many times, isolation of germs is a difficult task due to this biofilm. The only way to eradicate the infection is to remove the implant. It requires a two-stage surgery — stage I is cleaning of the joint by removing the implant and filling the gap temporarily with bone cement loaded with suitable antibiotics, and stage II, which comes once the infection is gone, is a definitive revision knee replacement surgery done with good surgical planning. Patients can get back near normal function with proper surgical technique and expertise."

Dr Bhosale, who has more than 14,000 joint replacement surgeries to his credit, added, "Many times, to save money, patients, and even doctors, prefer performing the implant surgery at small centres, which might lack modern equipment, risking the entire process. This should be avoided as far as possible."

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