Osteoarthritis Surgery in India and UAE | Complete Patient Guide

• Confirmed KL Grade III or IV osteoarthritis on weight-bearing anteroposterior (AP), lateral, and skyline (patellofemoral) radiographs

• Persistent moderate-to-severe pain and functional limitation (WOMAC pain subscale ≥40/100 or Oxford Knee/Hip Score ≤26/48) despite ≥6 months of structured non-operative care

• Age generally 50 years or older for total joint replacement, though high-demand younger patients with post-traumatic or dysplastic OA may be considered for joint-preserving procedures (osteotomy, unicompartmental replacement)

• BMI ≤40 kg/m² preferred; BMI >40 kg/m² requires dedicated risk discussion and may necessitate prior weight optimisation

• Medically stable cardiovascular, pulmonary, and metabolic status confirmed by pre-operative assessment

Required Diagnostic Workup Prior to Travel:

• Weight-bearing plain radiographs of the affected joint (AP, lateral, and joint-specific views)

• MRI of the affected joint (to assess soft tissue structures, cartilage mapping, and rule out concurrent meniscal or ligamentous pathology)

• Full blood count (FBC), comprehensive metabolic panel (CMP), coagulation screen (PT/INR, APTT), HbA1c (if diabetic), serum albumin (nutritional status)

• 12-lead ECG; echocardiogram and/or stress testing if RCRI ≥2 or symptomatic cardiac history

• Chest X-ray

• DEXA scan (bone mineral density) for patients >60 years or those with risk factors for osteoporosis, to guide implant fixation strategy (cemented vs. cementless)

• Urine culture to exclude occult urinary tract infection (a common source of haematogenous joint infection)

• Dental clearance recommended pre-operatively for elective joint replacement

Contraindications (Absolute or Relative):

• Active local or systemic infection (absolute contraindication to joint replacement)

• Severe peripheral vascular disease or inadequate soft-tissue coverage at the operative site

• Active inflammatory arthropathy not adequately controlled (relative; liaise with rheumatologist)

• Severe, uncorrectable coagulopathy

• Significant medical co-morbidities conferring unacceptably high anaesthetic risk (ASA Grade IV–V)

• Active malignancy with bone involvement at the planned surgical site

• Severe neurological deficit affecting the limb (may preclude rehabilitation)

• Dementia or psychiatric conditions significantly impairing ability to participate in post-operative rehabilitation

Surgical management of osteoarthritis is stratified by joint compartment involved, disease severity, patient age, activity demands, and bone quality. The following techniques are deployed at GAF Healthcare's partner institutions:

1. ARTHROSCOPIC DEBRIDEMENT & LAVAGE

Indicated for KL Grade I–II with mechanical symptoms (loose bodies, meniscal tears, focal chondral defects). Performed under spinal or general anaesthesia through 2–3 portals. The surgeon uses a motorised shaver and radiofrequency ablation probe to remove unstable cartilage flaps, osteophytes, and inflamed synovium, and irrigates the joint. Evidence base for pure OA (without mechanical pathology) is limited; best outcomes occur in patients with concurrent meniscal pathology. Day-case or 23-hour admission.

2. HIGH TIBIAL OSTEOTOMY (HTO) / DISTAL FEMORAL OSTEOTOMY (DFO)

Joint-preserving surgery for younger, active patients (<60 years) with unicompartmental OA and correctable varus or valgus malalignment. HTO realigns the mechanical axis of the lower limb to offload the diseased compartment, delaying or avoiding total knee replacement. Performed using opening-wedge technique with locking plate fixation (Tomofix or equivalent), guided by digital planning tools (e.g., TraumaCad, Surgimap). Full weight-bearing typically achieved at 6–8 weeks. Survivorship of 80–85% at 10 years in well-selected patients.

3. UNICOMPARTMENTAL KNEE ARTHROPLASTY (UKA)

Resurfaces only the medial or lateral compartment of the knee, preserving the anterior cruciate ligament (ACL), contralateral compartment, and patellofemoral joint. Indicated for isolated single-compartment disease with intact ACL and correctable deformity <15°. Robotic-assisted UKA (Mako SmartRobotics, Navio) provides intraoperative real-time ligament balancing and bone preparation accuracy within 1° and 1 mm, reducing implant outliers and improving early functional outcomes. Implant survivorship 85–92% at 15 years.

4. TOTAL KNEE ARTHROPLASTY (TKA)

The gold-standard intervention for tricompartmental or bicompartmental KL Grade III–IV OA. The distal femur, proximal tibia, and patellar surface are resected and replaced with metal alloy (cobalt-chromium or oxidised zirconium) and UHMWPE bearing components. Key technical approaches include:

• Conventional instrumented TKA: measured resection or gap-balancing technique

• Computer-navigated TKA: optical or electromagnetic navigation reduces coronal alignment outliers by 50% compared to conventional instruments

• Robotic-assisted TKA (Mako, ROSA, Cori): image-based or image-free platforms with haptic boundary control; meta-analyses demonstrate superior coronal alignment, component positioning, and patient-reported outcomes at 1–2 years

• Patient-Specific Instrumentation (PSI): custom cutting blocks fabricated from pre-operative MRI/CT scans

• Kinematically aligned TKA (KA-TKA): restores the patient's pre-arthritic joint anatomy rather than mechanical alignment; growing evidence for superior early kinematics and proprioception

Implant survivorship >95% at 10 years with modern cemented implants. Cementless fixation (porous titanium ingrowth) is an option for younger, higher-demand patients with good bone stock.

5. TOTAL HIP ARTHROPLASTY (THA)

For KL Grade III–IV hip OA. Femoral head and acetabulum are replaced with a modular implant system. Surgical approaches include posterior, direct lateral, anterolateral, and the increasingly popular direct anterior approach (DAA), which is truly muscle-sparing, allows intraoperative fluoroscopic or robotic cup positioning, and is associated with faster early recovery and lower dislocation risk. Bearing surface options: ceramic-on-ceramic (CoC), ceramic-on-HXLPE, or metal-on-HXLPE. Dual-mobility cups are used in high dislocation-risk patients. Implant survivorship >95–98% at 10–15 years.

6. TOTAL SHOULDER ARTHROPLASTY (TSA) / REVERSE TOTAL SHOULDER ARTHROPLASTY (RTSA)

For glenohumeral OA with intact rotator cuff, anatomic TSA (stemmed or stemless) is preferred. RTSA is indicated when OA is combined with massive rotator cuff tear arthropathy. Both techniques can be performed arthroscopically-assisted or through a standard deltopectoral approach.

7. ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOLS

All partner hospitals deploy ERAS pathways including: multimodal analgesia (periarticular infiltration, adductor canal blocks, systemic paracetamol/NSAIDs, minimised opioids), tranexamic acid (IV and topical) to reduce blood loss, early mobilisation within 4–6 hours of surgery, and accelerated physiotherapy, reducing average hospital stay for TKA/THA to 2–4 days.

PRE-OPERATIVE PHASE (4–8 Weeks Before Departure or Upon Arrival):

• Remote consultation with GAF Healthcare's orthopedic specialist to review imaging, reports, and determine candidacy

• GAF Healthcare assists with e-Medical Visa application (India) or UAE entry documentation

• Prehabilitation programme provided: home-based quadriceps, gluteal, and core strengthening exercises

• Medical optimisation: HbA1c <8% for diabetics; blood pressure controlled; anticoagulants bridged or stopped per protocol; dental clearance obtained

• Pre-admission testing completed at partner hospital on Day 1 of arrival: blood panel, ECG, anaesthesia assessment, surgical consent

DAY OF SURGERY:

• Nil by mouth per anaesthesia protocol (typically 6 hours for solids, 2 hours for clear fluids)

• Spinal anaesthesia (preferred for lower limb procedures — reduces blood loss, DVT risk, and early confusion vs. general anaesthesia) with sedation, or general anaesthesia based on patient-specific factors

• Adductor canal nerve block (knee) or femoral nerve/PENG block (hip) placed pre-operatively for multimodal analgesia

• Operative time: Arthroscopy 45–60 min; UKA 60–90 min; TKA/THA 90–150 min; robotic-assisted procedures add 15–30 min of setup time

• Periarticular cocktail injection (ropivacaine, ketorolac, epinephrine, morphine) administered intraoperatively

• Tranexamic acid administered (IV 1g pre-incision + 1g at 3 hours, and/or topical intra-articular 3g in 100mL saline)

• Wound closure with barbed sutures and waterproof dressing; no drain in most ERAS protocols

DAY 1 POST-OPERATIVE:

• Patient mobilised out of bed within 4–6 hours with physiotherapist; partial to full weight-bearing with walker (TKA/THA)

• Oral multimodal analgesia: paracetamol 1g QID, celecoxib 200mg BD, pregabalin 75mg BD; opioids (oxycodone/tramadol) as rescue only

• DVT prophylaxis initiated: rivaroxaban 10mg OD or enoxaparin 40mg SC OD, continued for 5 weeks post-discharge for joint replacement

• Cryotherapy and limb elevation for swelling management

• Physiotherapy twice daily: active knee flexion/extension, straight leg raises, bed-to-chair transfers, stairs

DAYS 2–4 (HOSPITAL DISCHARGE):

• Target range of motion milestones: knee flexion ≥90° by Day 3 (TKA); hip precautions education (THA posterior approach)

• Wound check; haemoglobin monitored; oral iron supplementation if indicated

• Discharge criteria: independently mobile with walking aid, adequate pain control on oral medications, no wound concerns, afebrile

WEEKS 2–6 (IN-COUNTRY REHABILITATION — Serviced Accommodation Near Partner Hospital):

• Outpatient physiotherapy 5 days/week at partner hospital or affiliated rehabilitation centre

• Week 2: Suture/staple removal; wound review; gait training without walking frame (crutches or walking stick)

• Week 3: TKA flexion target ≥110°; hip abductor strengthening (THA); low-impact cycling on stationary ergometer

• Week 4–6: Surgeon review with repeat X-rays confirming implant position and bone healing; stair ascent and descent without aid; short-haul flight clearance typically issued at Week 3–4; long-haul flight clearance at Week 5–6 with compression stockings and in-flight exercises

• DVT prophylaxis completed at Week 5

MONTHS 3–12 (HOME REHABILITATION):

• GAF Healthcare provides tele-physiotherapy coordination with patient's home physiotherapist

• Month 3: Return to driving (right-sided TKA/THA after neuromuscular function restored, typically 6–8 weeks)

• Month 6: Return to low-impact activities (swimming, cycling, golf, doubles tennis)

• Month 12: Final functional assessment; WOMAC/Oxford Score recorded; implant survivorship baseline X-ray