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COVER
STORY: PM'S KNEE SURGERY
Operation
Vajpayee
The prime
minister's knee surgery will be the most watched medical event in Indian
history. A preview.
By
Supriya Bezbaruah
A
seemingly incongruous metal and plastic contraption is about to play a
star role in Indian politics. This week, this artificial joint will replace
76-year-old Atal Bihari Vajpayee's worn out left knee and put him out
of terrible pain. For all the discomfort, the prime minister can consider
himself a lucky man. Although a major medical operation, knee replacement
surgery has a tremendous success rate: 97 per cent. What's more, Vajpayee's
knee is being replaced by a world-renowned surgeon, Chitranjan S. Ranawat,
at Mumbai's Breach Candy Hospital.
 With
the political health of the country at stake, nothing is being left to
chance. The top floor of the seven-storeyed new wing of Breach Candy is
now SGP territory, out of bounds for the public. The 50-year-old hospital
is looking forward to its most high-profile patient since 1982 when Amitabh
Bachchan was admitted there following his life-threatening accident on
the sets of Coolie in Bangalore.
Every precaution
is being taken for the VIP patient. The average individual undergoes five
to seven pre-surgery tests to ensure all goes well. Vajpayee will have
more than 20. He requires knee surgery because he suffers from an advanced
stage of osteoarthritis. This is an age-related degenerative disease in
which the material cushioning the bones of the lower leg (tibia) and the
thigh (femur) get frayed and tattered. The bones then get rough and knock
against each other, making any kind of movement sheer agony. Vajpayee's
problem is so severe that his knee cap too has been affected.
An artificial knee covers the bones and protects them from being degraded.
It consists of two parts-a flat plate to sit over the tibia and a bracelet-like
frame that will cover the femur. Both parts are crafted from inert metals-stainless
steel for the femur and titanium for the tibia. These are substances the
body does not react to, explains S. Marya, a Delhi-based joint replacement
surgeon who has, worked with Ranawat in the US.
From the
RSS to BJP to NDA, Vajpayee has spent a lifetime flirting with abbreviations.
Even he will be hard put to pronounce UHMWPE-or Ultra High Molecular Weight
Polyethylene to give it its full form. A type of plastic, to use lay language,
UHMWPE will lie inside Vajpayee's body for the rest of his days. The plate
will form a cushioning material between the tibia plate and the femur
frame. A similar plastic implant will be fixed on the knee cap to fortify
it.
All this
will, of course, happen in the operation theatre, a room whose atmosphere
sometimes resembles a carpenter's shop, only more refined. The surgeon
will use sharp instruments to remove the debris and roughened portions
of the bone. He will then shape the bones so that the artificial knee
fits well. A thin slice of the tibia will be cut to make the lower leg's
bone surface flat enough for the artificial metal plate to sit comfortably.
Amid splattering of "bone dust"-almost like wood shavings, some
would say-a hole will be also drilled into Vajpayee's tibia to insert
and fix the artificial plate.
While the
steel frame of his inner bureaucracy paces outside the operation theatre,
Vajpayee will next keep his date with another steel frame-the one to fit
his femur. Three or four cuts will be made on the thigh bone to ensure
the metallic bracelet sits well. The titanium plate, the steel frame,
the UHMWPE piece will all have to be fixed to Vajpayee's tired bones.
Any gaps between the bone and the machine-crafted implants will be filled
with bone cement to ensure a good fit. Ranawat and his instruments will
literally press and hammer Vajpayee's knee into shape.
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