Dr. Rajeev Verma

Orthopaedic Care in India for International Patients

<div class="dp-transcript-content"> <p>ORTHOPAEDICS IN INDIA FOR INTERNATIONAL PATIENTS, EXPLAINED</p> <p>Asar Care | Orthopaedics Podcast with Dr. Rajeev Verma (Manipal Institute of Bone & Joints, Manipal Hospital, Dwarka, New Delhi)</p> <p>Featuring an operating theatre walkthrough with Dr. Rajeev Verma | Full transcript</p> <p>Educational content, reviewed by Dr. Rajeev Verma. Not medical advice. Please consult a qualified physician about your individual case. Outcomes vary by patient.</p> <p><span class="dp-transcript-time">00:00</span> <strong>BACKGROUND, AND A PASSION FOR ORTHOPAEDICS</strong></p> <p>Thank you so much for sitting down for this podcast, Dr. Rajeev Verma. It's an absolute honour to host you. To begin, I want to know about your background, and most importantly, what keeps you passionate about orthopaedic care.</p> <p>Thanks for inviting me. I am a trained orthopaedic surgeon, working as chairman at Manipal Institute of Bone and Joints, Manipal Hospitals, Dwarka, New Delhi, India. Why am I so passionate about orthopaedics? It is one of the branches of medicine where, if a patient comes in pain or has had a fracture, we can treat them and make them walk the very next day. That is the most rewarding aspect of my practice, and that is why I am passionate about orthopaedics.</p> <p><span class="dp-transcript-time">00:52</span> <strong>WHEN SHOULD SOMEONE SEE A SPECIALIST?</strong></p> <p>Many people put their joint pain down to old age and avoid the early signs. When is the right time for somebody to go for a consultation and take things seriously?</p> <p>One of the important things is, if any pain in the body lasts more than a week or ten days, especially in the joints, then they should go and see an orthopaedic surgeon. The other thing is, if they are having fever and swelling in the joints, that can be a sign of a serious infection in the joint, and they should see an orthopaedic surgeon. The other thing I tell all my patients: if any chronic pain is affecting their quality of life, even if it affects going to the market for grocery shopping or day-to-day activities, then they should definitely come and see us.</p> <p><span class="dp-transcript-time">01:56</span> <strong>MULTIPLE LIGAMENT INJURIES</strong></p> <p>We usually hear that one tear is bad, but what happens when a multiple-ligament injury happens, when more than one ligament is torn at the same time, and how serious is that issue?</p> <p>As we all know, India is a young country, so there are a lot of people involved in sports nowadays. I myself do all kinds of sports, especially long-distance running, and I play football and cricket. So you can get injuries if you are playing sports. If I showed you on a knee model: if you injure one ligament like the ACL, the anterior cruciate ligament, then you will have instability in the knee. But if a patient has multiple ligament injuries, that can lead to dislocation of the joint, which can affect their blood supply as well as their nerve supply. It can actually endanger their limb. Their limb can die because of injury to the blood vessels and nerves. So multiple ligament injuries are a serious injury for any athlete. If they have this, they should seek medical opinion as soon as possible. And if they seek early treatment, we can deal with that, and in the long term they can have a good, healthy joint.</p> <p><span class="dp-transcript-time">03:20</span> <strong>"YOU JUST HAVE TO LIVE WITH THE PAIN" - IS THAT TRUE?</strong></p> <p>Most people are told that they need to live with the pain and that there is no treatment for certain injuries. What would you say to them?</p> <p>That is absolutely wrong. In this day and age, with all the advancements in orthopaedics and all the new surgical treatments, we can treat a patient who has had multiple ligament injuries or any fractures and make them as good as they were before. You have seen professional footballers get multiple ligament injuries, and they even get tibia fractures because it is a contact sport. You have seen these professional sportspeople get back to their sport in six months. So if anybody has even a serious injury, we can treat them and get them back to their sport.</p> <p><span class="dp-transcript-time">04:22</span> <strong>WHY INDIA, BEYOND THE COST ADVANTAGE</strong></p> <p>That is very hopeful and motivating for anybody watching. When people fly internationally to India, their major concern is price, and they expect it to be affordable. But what actually draws international patients to India for orthopaedic care beyond just the cost advantage?</p> <p>Cost is one advantage, you have already alluded to it. But the other advantage is that we have the best facilities. Apart from the facilities, we have the latest technologies. All the doctors working in the good, big private hospitals in India are trained abroad. I myself have had a stint of around nine years of training in the UK, and I went to the US as well. The majority of us doctors have been trained abroad. So patients get the best care and best treatment with the latest technology, at a fraction of the cost. Imagine how beneficial it is for international patients. They can come here relaxed that their close ones will get the best treatment, which is as good as or better than anywhere in the West.</p> <p><span class="dp-transcript-time">05:30</span> <strong>WHAT TO EXPECT: CARE, TECHNOLOGY, FOOD AND COMFORT</strong></p> <p>Since you mention that so many technologies are available, when somebody walks into Manipal Hospital, what can they expect in terms of care and the technology you mentioned?</p> <p>In terms of care, we have the best facilities. And we all know that in Asia we give compassionate care. Our nurses are among the best in the world. Even our nurses travel from here to the USA, UK and Australia, and we are known for that care. So you can imagine we give the best nursing care and the best surgical care. The other thing international patients worry about is where they will stay and what food they will get. In India we have multi-cuisine options, including the influence of Middle Eastern food, so they can get their preferred food and other facilities to look after them.</p> <p><span class="dp-transcript-time">06:37</span> <strong>LANGUAGE SUPPORT AND FACILITATION</strong></p> <p>You mentioned food and language barriers, and people are often far away from their families, navigating a new country. How do your team at Manipal and Asar Care help take care of all of that?</p> <p>At Manipal, we have interpreters who can speak different languages. They are well-conversant in Russian, in Arabic, and in Turkish and other languages. Of course we can speak English, Hindi and other languages too. If a patient has a language barrier, they feel comfortable when somebody speaks their language. It is an icebreaker, so they can share their problem. It helps us too, because the interpreter understands both Hindi and the patient's language, so they can translate it better. Once the patient feels comfortable and opens up about their condition, we can make a better diagnosis and treat them better.</p> <p><span class="dp-transcript-time">07:30</span> <strong>HOW ASAR CARE SUPPORTS THE JOURNEY</strong></p> <p>How has working with Asar Care helped you with international patients?</p> <p>Asar Care provides a door-to-door service. A patient sitting somewhere in Iraq who wants an online consultation - Asar Care can facilitate that consultation with me. Once they are sure they need treatment and have to travel to India, we can guide them through the online consultation. If we need to order some tests, they can be done in their own country, they send us the reports, and then we can tell them what needs to be done, how much money is involved, and how many days in India are involved. That way, Asar Care can facilitate their travel for medical care.</p> <p><span class="dp-transcript-time">08:41</span> <strong>HOW REMOTE EVALUATION WORKS BEFORE YOU TRAVEL</strong></p> <p>How does the remote evaluation process work for someone exploring treatment before they decide to travel or board a plane to India?</p> <p>Everybody is worried about whether they really need to travel to a different country for treatment. The first question we can answer is whether the treatment is available in their country, especially robotic joint replacements, high-end multi-ligament surgeries, shoulder replacements, reverse shoulder replacements and rotator cuff surgeries, which are not normally available in various countries. If they show me their reports on an online consultation and tell me about their symptoms, I can tell them whether they need to travel and what we can do here. If I need to talk to a colleague or another expert, I can, and then we can tell them: you can travel to India with all these reports, this is the cost involved, and this is how many days you will need to stay.</p> <p><span class="dp-transcript-time">09:50</span> <strong>THE MOST COMMON PROCEDURES FOR INTERNATIONAL PATIENTS</strong></p> <p>What are the most common procedures you have performed for international patients, whether knee replacement, hip replacement, spinal surgery, ACL or shoulder repair?</p> <p>The most common is joint replacement surgery, especially robotic joint replacement, which is not available in most other countries. The other surgeries we have expertise in are sports injuries, like rotator cuff injuries around the shoulder or knee ligament injuries, which we perform regularly and which are not that common in their countries. Then there are the latest techniques, like the Autocart cartilage procedure, which is not available in other countries, as well as reverse shoulder replacement, which is not commonly done elsewhere but which we do here regularly. We also handle complex multiple trauma. If a patient has an arm fracture, forearm fracture, thigh fracture or acetabular injuries, sometimes centres are not well equipped to deal with these surgeries, and we can do them here.</p> <p><span class="dp-transcript-time">10:55</span> <strong>WHAT PATIENTS FACE IN THEIR HOME COUNTRIES</strong></p> <p>When patients come from other countries, what stories do they carry back about their local care, and what problems did they face?</p> <p>The infrastructure is often not that good, and sometimes the primary care or emergency care is not very good. If a patient has a road traffic accident, there is a concept of the golden hour, as with a heart attack. If the patient is not transported to a level-one trauma centre within an hour, the results are not good, and those facilities are not always there. So even though we are called a developing country, the medical care in India is as good as or better than a developed country.</p> <p><span class="dp-transcript-time">11:50</span> <strong>WHICH PATIENTS ARE SUITABLE FOR TRAVEL</strong></p> <p>Talking about patient suitability, what actually makes a patient suitable for the surgeries you mentioned?</p> <p>The suitability depends. We cannot do all the trauma surgeries here, because as I told you, if they are not treated within the golden hour, they will not get good results. The surgeries patients are most suitable for are elective surgeries. In orthopaedics, elective surgeries are for someone who has degenerative arthritis, like age-related degenerative changes in the knees, hips, shoulder or spine problems. They can travel and seek treatment. These elective surgeries are most suited for international patients travelling to our hospitals.</p> <p><span class="dp-transcript-time">12:40</span> <strong>THE FIRST 24 TO 48 HOURS AFTER SURGERY</strong></p> <p>What is realistically expected from orthopaedic surgery in the first 24 to 48 hours?</p> <p>In the first 24 to 48 hours, as with any surgery, they need very good high-dependency care. For major surgeries like bilateral knee replacements or bilateral hip replacements, they need close monitoring of their observations, like blood pressure, pulse and any blood loss. Sometimes we put in drains to drain fluid out of the wounds. They will also need pain relief that needs monitoring, because it can affect blood pressure. We have high-dependency units for complex cases and multiple surgeries, to make patients comfortable in the first 24 to 48 hours.</p> <p><span class="dp-transcript-time">13:21</span> <strong>RECOVERY, AND WANTING TO GO HOME EARLY</strong></p> <p>Recovery is the part patients are often most anxious about, especially international patients who want to fly back home early. Do you face cases where patients want to rush home, and how do you monitor recovery in those situations?</p> <p>Anybody who has travelled wants to go back home, and wants to go home cured. We face all these questions, but with experience you can tell them that they will take two or three weeks. If you tell a patient it will be three weeks, they get prepared and then they follow your instructions. We have to be strict with them and tell them: you need three weeks of care here, two weeks of rehabilitation, and removal of stitches at two weeks, because if they do not do proper rehab care, they do not get good results from surgery. It is in their interest, so they normally agree and listen to us.</p> <p><span class="dp-transcript-time">14:30</span> <strong>STAYING CONNECTED AFTER YOU RETURN HOME</strong></p> <p>Once a person returns home, how does the team at Manipal, along with Asar Care, stay connected with the patient to ensure recovery is smooth?</p> <p>The most important thing in orthopaedics is post-operative care. If we cannot stay connected in this day and age, we cannot get good results. So we give patients our numbers, we have a facility for online consultation, and Asar Care has local connections, so they can reach the patient's home and encourage them to take online consultations and do their exercises. I travel to Iraq and to all the Middle East countries. What I see lacking is good physiotherapy care, but once we know where there are good physiotherapists, we can give the patient the number of that physiotherapist or a rehabilitation specialist, so they can get in touch and follow the instructions we give them here.</p> <p><span class="dp-transcript-time">15:42</span> <strong>A REAL CASE: A 3D-PRINTED HIP IMPLANT</strong></p> <p>Sharing realistic stories, can you share a case where the situation was serious and how your team handled it?</p> <p>Recently we treated an African patient who had had multiple surgeries and had destruction of his hip joint. As we discussed about 3D printing, we actually made a 3D-printed implant, built on the basis of the 3D printing and CT imaging, and we did the surgery. It was a long surgery, around four hours, but in the end the patient was able to walk on his feet. It is one of the most remarkable cases we have done recently, and I can share the pictures and X-rays.</p> <p><span class="dp-transcript-time">16:50</span> <strong>IF YOU ARE IN PAIN AND HAVEN'T TAKEN THE FIRST STEP</strong></p> <p>What would you say to somebody who is in pain right now but is not taking the first step towards treatment?</p> <p>If you are in pain, you will be stressed, anxious and even angry, and you do not want to be a problem for your family and society. I am not saying come in for a small pain, but if you have been in pain for a week or so and it is affecting your quality of life, then please come and see us. We can help you get back on your feet.</p> <p>Thank you so much for these great insights, and thank you for sharing the lab as well. It was remarkable to walk through the operating theatres and see how you work.</p> <p><span class="dp-transcript-time">17:53</span> <strong>INSIDE THE OT: AI AND 3D MODELLING</strong></p> <p>How do advanced technologies like AI and 3D modelling at Manipal Hospital help patients even before they enter the operating theatre?</p> <p>This is an excellent question, because whenever we operate on a patient, we should know what we are dealing with. We can study their anatomy with 3D modelling, and plan how to do the surgery, what implants we need, what incision we need in the patient, and how much bone to cut. With that, we can plan it better and do the surgery properly.</p> <p><span class="dp-transcript-time">18:31</span> <strong>THE MAKO ROBOTIC ARM</strong></p> <p>How does the Mako robotic arm help in surgeries?</p> <p>The robotic arm helps to give accurate cuts when we are doing the surgery. The way it works is that when we plan a knee replacement, we take the patient's CT and reconstruct their 3D anatomy beforehand, and then we feed it into the robot, and the robot calculates the angles as well as the bony cuts. It gives precise cuts to within millimetres. So there will be less bone loss in the patient, less blood loss in the patient, and more accurate implant placement. Once you get a more accurate implant placement, that implant will have more longevity, the patient will have less pain, and the patient can get back on their feet and live a normal life.</p> <p><span class="dp-transcript-time">19:38</span> <strong>KEYHOLE (ARTHROSCOPIC) SHOULDER SURGERY</strong></p> <p>For shoulder conditions like rotator cuff tears or instability, what happens during minimally invasive keyhole surgery, and why is it better for the patient?</p> <p>Minimally invasive keyhole surgery is a recent advancement in orthopaedics. For a traditional shoulder surgery, you would make a 10 or 12 centimetre cut around the shoulder. Now, with our arthroscope, we make three to four small cuts, each about the width of a pen. We can pass our scope as well as different instruments to do our work around the shoulder joint, whether it is a rotator cuff tear or if the patient has had a shoulder dislocation, where we can repair the capsule in what we call a Bankart repair. We can do all the repair through micro incisions. Because we are using micro incisions, patients will have almost no blood loss and almost no surgical scar pain, and they can get their movement back as soon as possible.</p> <p><span class="dp-transcript-time">20:19</span> <strong>AUTOCART: SINGLE-STAGE CARTILAGE REPAIR</strong></p> <p>We have heard about a procedure called Autocart for cartilage damage. Could you explain, in simple terms, who is a good candidate for it?</p> <p>Autocart is done for sports injuries, especially in football, cricket or hockey players who injure their cartilage while playing. To give some background: earlier, we used to do two procedures. We would take cartilage from another part of the body or the same knee joint, grow it in the lab, and then implant it again, so the patient underwent two surgical procedures. In Autocart, wherever there is a lesion, we take the cartilage tissue from the side of the lesion, mix it with PRP (platelet-rich plasma) and implant it with fibrin glue. So in one procedure, we can reconstruct the chondral damage. What has been seen, after a year, on an MRI, is that the chondral cartilage is as normal as normal cartilage. When we used to take cartilage from another place, it was not that differentiated; but when you take it from the side of the lesion, it is more differentiated and works much better, and the patient can get back to their sport.</p> <p><span class="dp-transcript-time">22:30</span> <strong>PRP (PLATELET-RICH PLASMA), EXPLAINED</strong></p> <p>A lot of patients have heard about PRP (platelet-rich plasma) therapy but do not really understand how it works. Can you explain it simply?</p> <p>We draw the patient's blood, prepare it in a centrifuge, and bring out the platelet-rich plasma. We place it in tendon injuries, like tennis elbow, or if somebody has Achilles tendinitis, or even rotator cuff injuries. It initiates growth in the normal tissue and helps in healing of the damaged tendons or tissues.</p> <p>But specifically, what are the different PRP injections, and how are they different from regular PRP shots?</p> <p>There are a lot of PRP variations now, like leukocyte-depleted or leukocyte-rich PRP injections. They are used in different conditions in orthopaedics, especially in sports injuries. Using them involves a lot of cost, as well as specific machines where we can prepare those injections. This is one of the latest things we have in orthopaedics. It is a minimally invasive technique to heal damaged tissues, especially sports injuries.</p> <p><span class="dp-transcript-time">24:48</span> <strong>CLOSING</strong></p> <p>Thank you so much for walking us through the entire OT and showing us the amazing technology available at Manipal Hospital. If you are planning your orthopaedic treatment, connect with Asar Care today and experience seamless medical travel with care you can trust.</p> <p>Thank you very much, and thank you so much for inviting us.</p> </div>