Shadowing a Total Knee Replacement at DHEE Hospitals in Bangalore, India

I stumbled forward as I was quickly ushered into an elevator. In the corner, Dr. Supraja Chandrasekar, Director of Pediatric Services at DHEE Hospitals in Bangalore, India, was talking to the hospitals' Orthopedic surgeons on the phone. Straining my ears, I tried to hear whether I would be watching a surgery today. Suddenly, Dr. Supraja hangs up and tells me there is a surgery happening right now and it will be a Total Knee Replacement (TKR). My brain falters for a second and I do not believe that I heard her correctly. Coming from the Bay Area post-Coronavirus, obtaining an opportunity to shadow in the outpatient clinic alone is a challenge. Also, the most intensive surgery I have seen so far is the excision of a Ganglion cyst on the right index finger, which was at the same hospital a day prior. After realizing that Dr. Supraja is serious, my surprise decreased and was replaced with excitement and nervousness. I had no idea what to expect.

She drops me off at the Operating Theatre to change into scrubs and find the operating room on my own. Luckily, since I had changed for a surgery the day before, I was able to find my way. As I was putting on my scrubs, my excitement and nervousness built. What even happens during a replacement surgery? Why is this patient receiving this surgery? How much will I be able to see? Is this even safe? My mind was buzzing with questions by the time I exited the changing rooms.

As I entered the operating room, I noticed the scrub nurses and anesthesiologist were hard at work prepping the patient and monitoring her as she slept. I found a corner with the best view, then waited patiently for the knee to be cleaned and the orthopedic surgeons to scrub in and lay out their tools. Half an hour later, the surgeons were standing on either side of the right knee, the anesthesiologist was by the patient's head, and the scrub nurse was patiently waiting next to the knee replacements, ready to help when called. After a few minutes, I started to grow impatient. Why were they not starting the surgery? The surgeons are here, right? Then, Dr. Chandrasekar Chikkamuniyappa, Senior Joint Replacement Surgeon, bursts in. Ah, they are waiting for the head surgeon.

Now that everyone had arrived and was ready, the scrub nurse verified the patient and procedure. And then it began. I kept my eyes glued to that right knee as Dr. Chandrasekar made the first incision. I was mesmerized by everything happening in that knee. They cut open the tissue until they reached the bone. Dr. Chandrasekar turns to me, “Can you see that there is no cartilage anymore?” My second question about the surgery was answered. The patient had osteoarthritis with inflammation in this knee.

I continue watching in awe as Dr. Chandrasekar starts sawing away at the patella, femur, and tibia bones like a carpenter sawing some wood. In that moment, I realized that this was the greatest moment of my life, and nothing I would see in healthcare afterwards could ever be as exciting as this. These may be dramatic and heavy statements, but the novelty combined with the surprise of being able to see something so intense overwhelmed me with elation.

I am shocked at the familiarity of this complex procedure for the surgeons. Everything looks like a calculated dance that they have perfected through repetition, which I know to be true. 

Dr. Chandrasekar tries a couple test knee replacements to get the correct fit. He repeatedly places it in, extends the knee to assess mobility, and removes it to saw off uneven parts of the bone. Once he obtains the correct measurements of the replacement that fits snug into the patient’s knee and provides feasible and optimal mobility, he gives the dimensions to the scrub nurse to pick out. The nurse finds it and shows it to the group of surgeons to approve. On the side, one of the surgeons prepares a paste, which I do not know the purpose of yet. Then, he hands it to Dr. Chandrasekar, who places it on the cut off tibia and femur and around the knee replacement. I realize that this is surgical cement used to hold the replacement steady to the bone, similar to how building cement is placed between bricks in houses.

After the knee has been replaced, Dr. Chandrasekar steps back and signals to the assistant surgeon to close up the incision. He steps off to the side as I shift my focus to the tight and precise stitches that are placed along the cut. As the tissue slowly closes up, I reflect back on what I had just seen. I never want to forget this once in a lifetime experience.

I do not know whether I want to be a surgeon and two surgeries are not enough to make that type of decision. However, as I walk out of the building, I still feel immensely grateful for this opportunity, and happy that I now know what happens during a Total Knee Replacement surgery.

Me the morning of the TKR.