Spreading the Sunshine

A globally reputed joint replacement surgeon, examiner for FRCS/MRCS with the Royal College of Surgeons in Edinburgh, author, emcee, RJ and humorist – Dr. A.V. Gurava Reddy shuffles through multiple roles with comfort and passion. His humanistic approach and humorous insights put patients at ease and give him a lead-in to better understand them.
Having worked for about ten years in the UK, Dr. Reddy holds the record for the number of surgeries done in joint replacement a year in India – 4,000. He heads Sunshine Hospitals in Hyderabad with an expert team of orthopaedic surgeons, and always gives his patients first preference.
You & I spoke with Dr. Reddy to find out more about his life and work.
In a very short span of time, Sunshine has become synonymous with orthopaedic treatments in Hyderabad.
What’s the story behind the success?
It’s the patient-first philosophy behind Sunshine Hospitals. Though it sounds clichéd, it is the simple yet powerful mantra that steers our journey. We have devised our methods around this, to take care of the patient in a way that will make all the difference. For instance, you’ll always find beverages served in the outpatient department. We also don’t make patients stand in queues; instead, someone is assigned to help them with registrations. Some of the other patient-specific initiatives we have adopted include:

  •     In-home visits to patients for post-surgical physiotherapy
  •     Extensive, in-house counselling for patients who are recommended invasive as well as conservative treatments
  •     Patient coordinators available all over the hospital to attend to a patient as soon as he/she walks into the hospital
  •     A high-end, sophisticated video conference facility available in-house means international and outstation patients always have the facility to connect with doctors for opinions
  •     Regular health awareness camps and talks in various cities, to sensitise the community on different ailments, treatment options and surgical solutions
  •     The largest team of orthopaedic doctors under one roof who work like a family
  •     We also need to thank the patients who have given us the opportunity to serve them, which is the top reason for the growth that we have achieved to date.

Who else deserves credit for this prolific growth?
The entire team at Sunshine Hospital is the force behind our success. I’ve a big department and skilled team of doctors who are fully aware of what we stand for. In many organisations, the apex has a clear vision of its goals, but it doesn’t percolate to the bottom of the pyramid. At Sunshine, even the sweeper knows what Gurava Reddy’s goals are. We make sure every Monday morning, through our ‘Share My Dream’ programme, we reinforce that idea. We share videos and discuss a lot of things about patient care, and all our top administrators are doctors. They understand the patients’ problems much better.
When it comes to joint replacement, Sunshine has performed a record number of surgeries. How difficult has this been?
Performing a record number of surgeries is always a challenge, but thanks to the strong support team that we have at Sunshine – that includes doctors for screening, patient counsellors, nursing staff, anaesthetists, paramedical staff, critical care unit personnel, and physiotherapists – the whole task looks like a breeze.
Dr. A.V. Gurava Reddy 
Is surgery always required?
Surgery is in fact not always required when a patient suffers from joint pain. In fact, conservative treatments like medicine and physiotherapy can be adopted during the early stages of knee pain. It is only when pain progresses to advanced arthritis that surgery is typically recommended. We regularly run awareness programmes, where I (or one of my senior doctors)speak about the different stages of knee arthritis. We inform the patient community about which treatment methods are required at various stages. This has been effective in educating them about arthritis and its treatments.
How do you handle up to 20 knee replacement surgeries per day?
We start early in the morning. Of 14 surgery theatres, some five are earmarked for joint replacement, and I hop from one to the next. By the time I reach the first theatre, the patient’s knee is opened for the procedure. I only do the central part of the surgery, which takes roughly 20 minutes to finish. I then move to the next theatre. For the closing and opening of knees, I’ve a capable team who take 45 minutes to finish the entire process. We follow the Denton Cooley method.
Are people in India educated about joint replacement? How important are the roles of awareness and acceptance?
In India, awareness of joint replacement surgery is definitely on the rise. Fifteen years ago when I started my practice here, joint replacement surgery was a term one never heard. Today, about 120,000 such procedures take place in India each year. We still have a long way to go when compared to developed countries like the US and Germany, where more surgeries happen every year. The public-private partnership is one area where we need to work on making joint replacement reach the masses, as well as to make it more affordable.
What are the myths surrounding knee replacement?

  •     There is a high chance of failure in knee replacement.
  •     I may be bedridden and may not walk normally again.
  •     A minimum of three months of bed rest is required post-surgery. Post-surgery, it is not possible to climb stairs or sit on the floor.
  •     Knee replacement surgery is not advisable at age 70 or beyond.

In fact, what we educate the patient community to quash that myth is that the oldest patient I operated in India was 98, and in England was 103. Knee replacement surgery performed by specialist surgeons in a well-equipped hospital has found a success rate of 98%. This is one of the few procedures in the medical field with such a high success rate. The chances of a patient becoming bedridden are only 1-2 in 10,000. A patient who has undergone knee replacement will be able to walk on the first day after surgery. Ideally, no bed rest is required. Actually, the earlier the patient walks, the better the outcome. A doctor will suggest long periods of rest only if the bones are extremely weak or if the surgery had some issues.

Dr. A.V. Gurava Reddy with his Wife
There is no restriction on post-surgical activities. Though you can play golf and climb stairs, it is not advisable to do so regularly. The knee flexes a lot when one sits on the floor, so high-flex knees are recommended if one is habituated to doing so. Your surgeon is the best person to advise you on the level of activity you can engage in. This surgery can be performed beyond the age of 70. In fact, that is the age at which knee replacement surgery must be done if needed, so that the individual is not completely dependent on others for movement.
How important a role has marketing played?
Nowadays, one has to market oneself well. How good or ethical the pitch is, it’s more important. People should be aware of institutes that do 4,000 surgeries per year in India with such a success rate. We definitely need to propagate it. In fact, we have been ranked the seventh-best orthopaedic hospital in India by The Week magazine in a survey done by Nielsen. The six institutes ahead of us are 25 years old, and we are the youngest on the list.
You have also contributed to several innovations in the field of arthroplasty. Can you shed some light on them?
I’m the first surgeon in AP to do bilateral total knee replacement surgeries at the same time. People were scared to do it, but I started it as it’s convenient for the patient and his family. In one fell swoop, the entire thing is done. I have the maximum number of surgeries in the country in this regard. I also introduced oxinium ceramic knee surgery to the state for the first time. This alloy is made of biocompatible material; oxidised zirconium is called oxinium. These are better than the cobalt chrome implants and can be effective without replacement for more than 30 years. I also brought rotation platform knee replacement surgery to the city.
Is this because of your travels and your association with the UK?
Travel does make a difference. I’ve worked overseas and lectured in many countries as I love sharing knowledge. In fact, a lot of American and German surgeons have visited our facilities here and given their inputs. Recently, we operated on a lady on four joints: both knees and both hips. We had her walking within a week. We also have fellowships. People come to learn from the UK, Australia, Middle East, South Africa and many other countries and regions. We have 12 fellowships, and every six months, more people come to learn from us. I’m passionate about teaching, not the kind to hold back knowledge to avoid competition. The more you teach, the more proficient you become.
Why did you choose to pursue medicine? Did orthopaedics chose you, or was it the other way?
I come from a middle-class family. My father was a professor of agricultural science, and I didn’t have enough money to pay the donation at that time. I tried to get into medicine four times and always failed by a mark, but I got through the fourth time. I always wanted to be doctor. Through sheer hard work, I worked my way up, and going to England was the turning point. I practiced there for ten years and chose orthopaedics, as I thought there was not much competition here. I always say (jokingly) that my brain is in my knee, hence I chose orthopaedics!
Sunshine Hospital 
What was your first operation?
The removal of plates from bone in Pune was my first. My first joint replacement in India was 15 years ago at Apollo. I still remember I was operating on an IPS officer’s mother. I was quite nervous!
Managing director of Sunshine Hospitals, founder-director at KIMS, founder-member of the Indian Society for Hip and Knee Surgeons, actor, columnist and author – life has kept you pretty busy so far!
Don’t forget RJ and pianist! I’ve written books and emceed for my friends’ marriages as well. I wanted to do everything in life. The advantage is that I treat everyone with the utmost love and respect. I feel that there’s enormous love in this world, so where’s the time to hate?
How do you juggle your professional and personal lives?
I’ve a very supportive family and lovely children. We are a family of doctors. My wife Bhavani is a gynaecologist, my son Adarsh is also an orthopaedic surgeon who has just joined me, and my younger daughter Kavya has completed her MBBS and wants to be a cardiologist. Apart from this, I only work from Monday to Friday, but 18 hours per day. Saturday is my personal time for books, movies, music and other entertainment activities. Sundays are for family. We also take at least two or three holidays per year.

Dr. A.V. Gurava Reddy with his team
Doctors generally come across as very reserved and serious, but you’re easygoing and fun-loving!
My success mantra is humour. Within minutes, I can establish a rapport with anybody. I just go out and touch their hearts. I don’t have airs; I’m a commoner. Sometimes, I have to remind myself that I’m also a doctor and the managing director of a hospital. However, I feel that every doctor should be a humorist first and then a humanist.
How do you keep yourself so focused on and aligned to the nature of your work?
When I’m in hospital, I keep thinking about patients and patients alone. I multitask, delegate and supervise work. But at the end of the day, I don’t let anything override patient importance.
What are your expansion plans?
We established an exclusive, 150-bed heart institute headed by Dr. Anil Krishna, which within a short time has turned into one of the busiest cardiac units in the country. We opened a 250-bed, super-specialty institute in Madhapur recently, which was inaugurated by our honourable Chief Minister Shri K. Chandrasekhar Rao. I’ll be operating at this centre on Wednesdays and Saturdays. We are also going to open a centre of excellence in Bhubaneswar shortly.
Dr. A.V. Gurava Reddy with his Family 
Who are the people supporting you in running all these hospitals?
I’m blessed that I have excellent, dedicated people around me without whose help I could not have achieved these laurels. Dr. Anil Krishna is chief of our cardiac institute, who is second-in-command for the Sunshine Group. Dr. Nagaraju is the CEO and takes care of our Paradise centre and Bhubaneswar. Harikrishna is the CEO for the Madhapur centre and heart institute. Dr. Divakar is our vice-president, Dr. Vipin our medical director, Dr. Lily our medical superintendent, and Poornachandra our executive director. I’m honoured to have an excellent board of directors who are always there for me and guide me in every step. All these people add so much value to the group that I cannot imagine my existence without them.     

– as told to Rahul