Best Doctors in India for Birmingham Hip Resurfacing Surgery
- Orthopedic Surgeon, Gurugram, India
- Over 30 years’ experience
- Medanta-The Medicity, Gurgaon
Profile Highlights:
- Dr. Ashok Rajgopal is one of the finest Orthopedic Surgeons in India, who is currently serving as the Group Chairman of Orthopedics at Medanta Hospital in Gurugram.
- He was awarded the Padma Shri by the President of India in 2014 for his impeccable service to Orthopedics in India.
- He is a highly knowledgeable and skilled orthopedic surgeon with more than 39,000 Total Knee Replacement surgeries to his name. He also holds the credit for more than 3200 joint replacement surgeries, over 60,000 arthroscopic surgeries, and 28,000 arthroplasties.
- He holds a unique stint of performing 28 Total Knee Replacement surgeries in less than 12 hours and has achieved several other milestones in his career.
- With an experience of more than 3 decades, Dr. Ashok has revolutionized Orthopedics and Knee replacement procedures in India.
- Orthopedic Surgeon, Gurugram, India
- Over 25 years’ experience
- Artemis Hospital, Gurgaon
Profile Highlights:
- Dr. I.P.S. Oberoi is a leading Orthopedic and Joint Replacement Surgeon in India with over 25 years of experience.
- He has a 97% success rate in performing more than 7000 joint replacements.
- He was the first and one of the only few surgeons to perform Key Hole Surgery (Arthroscopy) for Shoulder, Knee, Elbow, Hip, and Ankle Injuries.
- He is the youngest arthroscopy surgeon to be elected as the President of the Indian Arthroscopy Society twice.
- Dr. I.P.S. Oberoi is the first Indian to have served as secretary of the Asian Arthroscopy Congress and is the only surgeon to have been chosen secretary of the Indian Arthroscopy Society twice.
- Top Orthopedic Surgeon | Apollo Hospital, New Delhi, India
- 30+ Years Experience
- Indraprastha Apollo Hospital, New Delhi
Profile Highlights:
- (Prof) Raju Vaishya is a well-known Orthopedic Surgeon in India with expertise in arthroscopic surgery (hip and knee) and joint replacement procedures.
- He has been in the field of joint replacement and arthroscopy for more than 30 years and is highly skilled at the management of chronic arthritis and performing joint replacement surgeries for hip, knee, elbow, shoulder, and finger joints.
- Dr. Raju Vaishya is among the first orthopedic surgeons to introduce shoulder arthroscopy in India and is the best surgeon for knee and hip arthroplasty in the country.
- His interest also lies in cartilage regeneration and restoration along with management and treatment of ligament injuries.
- Currently, Dr. Raju Vaishya is one of the lead orthopedic surgeons in Indraprastha Apollo Hospital and is also a Professor in the department. He is part of a highly efficient team of orthopedic doctors and surgeons in the hospital which makes it one of the best orthopedic centers in India.
- He runs a fellowship training program in orthopedic surgery under Indraprastha Apollo Hospital and has trained over 300 national and international orthopedic surgeons.
- Dr. Vaishya is known to have introduced the personalized knee surgery plan that uses a customized patient-centric approach for arthroplasty.
- Dr. Raju Vaishya regularly attends national and international scientific meetings and gets invited to speak and deliver talks at such conferences and seminars. He has chaired various orthopedic and arthroscopic sessions and delivered presentations.
- He has done a large number of research on the different aspects of Arthroscopy and joint replacement procedures. His work has been published in renowned peer-reviewed journals and holds the credit for over 175 publications in national and international journals and medical textbooks.
- Dr. Raju Vaishya’s name has been featured in the Limca Book of Records four times for his contributions towards orthopedics.
- An esteemed member of numerous medical associations and organizations, Dr. Vaishya is a well known name in orthopedic surgery of the world.
- Top Orthopedic Surgeon | Kokilaben Hospital, Mumbai, India
- 22+ Years Experience
- Kokilaben Dhirubhai Ambani Hospital
Profile Highlights:
- Dr. Dinshaw Pardiwala is an Orthopedic Surgeon par excellence specializing in shoulder replacement and sports injuries surgeries.
- Specializing in arthroscopy of the knee, shoulder, hip, ankle, and elbow, Dr. Pardiwala is at the forefront of his field.
- He is renowned for complex arthroscopic procedures such as ACL & PCL reconstructions of the knee, shoulder dislocation repairs, and rotator cuff repairs.
- Currently, Dr. Pardiwala serves as the Head of the Centre for Sports Medicine and Director of Arthroscopy & Shoulder Service at Kokilaben Dhirubhai Ambani Hospital, Mumbai. His influence extends globally as a member of the medical advisory committee of the International Cricket Council (ICC) and on the medical boards of numerous national sports associations.
- Top Orthopedic Surgeon | Max Hospital, Saket, New Delhi, India
- 20+ Years Experience
- Max Super Specialty Hospital, Saket, New Delhi
Profile Highlights:
- Dr. Ramneek Mahajan is a well-known name in the field of Orthopedics and Joint Replacement surgery in India.
- He has an extensive experience of 20+ years and is currently serving as the Senior Director and Head of the Joint Reconstruction Unit (Knee & Hip) at Max Institute of Musculoskeletal Sciences, Max Smart Super Speciality Hospital in Saket, New Delhi.
- His expertise lies in Primary and Revision Joint replacement surgeries and Arthroscopy. He has performed over 32,000 orthopedic surgeries to date and also holds the credit for more than 15,000 joint replacement surgeries, ranging from primary procedures to complex revisions. His commitment to restoring his patients’ physical well-being is unparalleled.
- Orthopedic Surgeon, Gurugram, India
- 22+ years’ experience
- Fortis Memorial Research Institute
Profile Highlights:
- Dr. Subhash Jangid is a distinguished leader in the field of orthopaedics, currently serving as the Senior Director and Unit Head of Orthopaedics at Fortis Memorial Research Institute, Gurgaon.
- With over 22 years of extensive experience in orthopaedics, Dr. Jangid has established himself as a leading authority in joint replacement and robotic-assisted joint reconstruction.
- Dr. Jangid specializes in knee, hip, and shoulder joint surgeries, including advanced joint replacement procedures. His expertise extends to robotic and computer-navigated joint reconstruction, areas in which he has made significant contributions.
- Orthopedic Surgeon, Gurugram, India
- 33 years’ experience
- Medanta-The Medicity, Gurgaon
Profile Highlights:
- Dr. Raman Kant Aggarwal is a leading Orthopedic Surgeon with expertise in the management and treatment of shoulders and sports injuries.
- He has been performing orthopedic surgeries for the shoulder and sports injuries for more than 33 years and has experience in performing all kinds of replacement and reconstruction surgeries of the shoulders and upper limbs.
- He holds the credit for performing the highest number of total shoulder replacement surgery and shoulder arthroscopy in Delhi and NCR.
- Orthopaedic Surgeon, Chennai, India
- Over 25 years’ experience
- Apollo Hospitals Greams Road
Profile Highlights:
- Dr. Madan Mohan Reddy is one of India’s most acclaimed Orthopedic Surgeons, currently serving as a senior orthopedic surgeon at Apollo Hospital, Chennai.
- Having practiced medicine for almost two decades in India and the UK, he specializes in treating various orthopedic conditions.
- When it comes to difficult foot and ankle patients, hip replacements, knee replacements, and lower extremity trauma, Dr. Reddy has an excellent track record.
- Throughout his medical career, he has also devoted a large portion of his time to improving the techniques for orthopedic procedures such as knee replacements, shoulder surgeries, and other procedures.
- Orthopedic surgeon, Gurugram, India
- Over 25 years’ experience
- Medanta-The Medicity, Gurgaon
Profile Highlights:
- Dr. Attique Vasdev is a renowned Orthopedic surgeon specializing in Knee surgeries.
- Currently he is the Director of Knee Unit at Bone and Joint Institute of Medanta- The Medicity and has been instrumental in starting the unit as well.
- Along with performing surgeries for all kinds of knee related diseases and disorders, he is also trained to perform sports injury surgeries.
- His principal area of interest lies in Knee replacement, Arthroscopic surgery, ligament reconstruction surgeries and Knee Osteotomy.
- Dr. Vasdev holds an immense experience of more than 25 years in knee surgeries and knee procedures. He is among the very few orthopedic surgeons in India focusing primarily in knee-related disorders.
- He organizes workshops and takes part in various CMEs and seminars where he gives live demonstration on various knee surgeries.
- He has been an invitee to various orthopedic conferences and meetings both in the national and international forum.
- Top Orthopedic Surgeon | Apollo Hospital, New Delhi, India
- 35+ Years Experience
- Indraprastha Apollo Hospital, New Delhi
Profile Highlights:
- Dr. Yash Gulati is a leading Orthopedic Surgeon and one of the best hip and knee replacement surgeons in India.
- For his contributions towards orthopedics in India, he was awarded the Padma Shri in 2009 and is the youngest orthopedic surgeon to receive the honor.
- Dr. Yash Gulati is an expert in all types of hip, knee, and spine joint replacement surgeries and holds the credit for performing the highest number of total knee replacements with the I-Assist Navigation technique in India. He also performed the largest number of total hip replacement surgeries for Sickle Cell disease.
- With several firsts to his name, Dr. Gulati performed the first-ever total hip replacement surgery on the youngest patient in India. He pioneered the Gyroscope-based Computer Navigation Knee Replacement surgery in India and is the best in the procedure.
- He holds more than 3 decades of experience in primary and revision total hip and knee replacement surgeries and has performed a large number of complex surgeries with excellent outcomes.
Best Hospitals in India for Birmingham Hip Resurfacing Surgery
- City: Gurugram, India
Hospital Highlights:
- One of India’s best and largest multi-specialty hospitals, Medanta was built with the aim to bring India to the highest standards of medical care. The hospital has been providing the best medical services to its patients, since its inception, with care, commitment, and compassion.
- Equipped with 1250 beds, the hospital was founded by Dr. Naresh Trehan in the year 2009 with an aim to provide the best medical care at affordable costs. The hospital is spread across 43 acres and includes 45 operation theatres and 350 beds dedicated solely to ICU. The hospital includes over 800 doctors, and more than 22 specialty departments and has a dedicated floor for individual specialty in order to offer the best services under one roof.
- The hospital is considered one of the premier institutes in India for Cardiac Care and includes staffs and members of high caliber. The hospital has 6 distinct centers of excellence.
- City: Gurugram, India
Hospital Highlights:
- Artemis Hospital, established in 2007 in Gurugram, India, is a leading multi-specialty institution known for its excellence in patient care and advanced medical technology, offering comprehensive services across specialties like Cardiology, Oncology, Neurology, Orthopedics etc.
- Renowned for its patient-focused care, Artemis Hospital combines state-of-the-art infrastructure with a team of internationally trained doctors and surgeons, ensuring the highest standards of medical treatment.
- Accredited by JCI and NABH, Artemis Hospital meets global healthcare quality and safety standards, reflecting its commitment to providing compassionate, personalized care.
- The hospital is recognized for utilizing cutting-edge diagnostic and ther*peutic techniques, ensuring patients receive accurate diagnoses and effective treatments tailored to their needs.
- City: Chennai, India
Hospital Highlights:
- The Apollo Proton Cancer Centre in Chennai is the most sought-after private cancer hospital in India. It is an integrated facility that provides cutting-edge, all inclusive cancer treatment to patients all over the globe.
- The hospital is a part of the renowned Apollo Group which has a large network of over 74 hospitals in India and across the globe. Out of the 74 hospitals, 21 of them are cancer centres. However, Apollo Proton Cancer Centre is the only cancer hospital to have JCI accreditation.
- The Centre, which was established on the principles of excellence and expertise, unites a formidable medical staff led by some of the most illustrious figures in cancer treatment.
- The hospital follows the global ASTRO Model Policy. It is the same global policy which is followed by countries like USA, UK, and Europe.
- Apollo Proton Cancer Centre is among the very few hospitals in India to receive patients from First World countries such as USA, Canada, New Zealand, Australia, Singapore, Thailand, etc.
- Apart from that, it is also the first hospital in Chennai to receive patients from several countries like Uzbekistan, Kazakhstan, Turkmenistan, Georgia, Armenia, Azerbaijan, SAARC countries (Bangladesh, Nepal, Sri Lanka, Maldives, Bhutan, Afghanistan, and Pakistan), South Africa, Turkey, Egypt, etc.
- In fact, there is a dedicated team at the Apollo Proton Cancer Centre that serves only international patients. Thus, on a monthly basis, the Centre receives patients from across 32 countries.
- Moreover, there are certain treatments in Apollo Proton Cancer Centre that are not available in any other centre. APCC addresses all types of possible cancers that are usually not covered by any other centre.
- City: New Delhi, India
Hospital Highlights:
- Over the last 33 years, the Fortis Escorts Heart Institute has set new standards in cardiac treatment with groundbreaking research. It is now known around the world as a centre of expertise for Cardiac Bypass Surgery, Interventional Cardiology, Non-invasive Cardiology, Paediatric Cardiology, and Paediatric Cardiac Surgery.
- The hospital has cutting-edge laboratories that perform a wide range of diagnostic tests in Nuclear Medicine, Radiology, Biochemistry, Haematology, Transfusion Medicine, and Microbiology.
- Fortis Escorts Heart Institute boasts a diverse group of bright and experienced doctors who are backed up by a team of highly qualified, experienced, and devoted support professionals as well as cutting-edge equipment such as the recently installed Dual CT Scan.
- Approximately 200 cardiac doctors and 1600 personnel currently collaborate to manage over 14,500 admissions and 7,200 emergency situations each year. The hospital now has a 310-bed infrastructure, as well as five cath labs and a slew of other world-class amenities.
- City: Gurugram, India
Hospital Highlights:
- Fortis Memorial Research Institute (FMRI) is a premier multi-super-specialty, quaternary care hospital, known for its exceptional international faculty, top-tier clinicians, super-sub-specialists, and specialized nurses, all supported by cutting-edge technology.
- It is the flaship hospital of Fortis Healthcare Limited, part of IHH Healthcare Berhad, a leading integrated healthcare services provider in India. As one of the country’s largest healthcare organizations, Fortis operates 28 healthcare facilities with over 4,500 operational beds (including O&M facilities) and more than 400 diagnostic centers (including joint ventures).
- Recognized as one of the top hospitals in India, FMRI serves as a leading referral center and aspires to be the ‘Mecca of Healthcare’ for India and beyond. Its 11-acre campus is a testament to its commitment to providing world-class healthcare.
- Accredited by JCI and NABH, FMRI is dedicated to maintaining the highest standards of healthcare quality and safety, ensuring that every patient receives the best possible care. The hospital’s reputation is further enhanced by its state-of-the-art facilities and innovative medical practices.
- City: New Delhi, India
Hospital Highlights:
- The Indian Spinal Injuries Center (ISIC), provides state-of-the-art facilities for the management of all types of spinal ailments.
- Staffed with internationally trained, acclaimed, and dedicated spine surgeons, the hospital provides cutting-edge medical & surgical technology. The hospital provides comprehensive management of spinal injury, back pain, spinal deformities, tumors, osteoporosis, etc.
- The hospital performs motion-preserving spine surgeries including disc replacement and dynamic fixation, and minimally invasive spine surgeries such as endoscopic disc excision.
- The orthopedic service of the hospital covers all orthopedic ailments including trauma, joint diseases & replacements, oncology, pediatric orthopedics & upper limb ailment.
- City: Faridabad
Hospital Highlights:
In the sprawling city of Faridabad, where healthcare needs are diverse and ever-evolving, one institution has consistently stood out as a beacon of excellence in the field of medicine—Marengo Asia Hospital. Established with a vision to provide world-class healthcare services to the community it serves, Marengo Asia Hospital has emerged as a trusted name synonymous with quality, compassion, and innovation in healthcare.
- City: New Delhi, India
Hospital Highlights:
- Indraprastha Apollo Hospital is a 700-bedded multispecialty hospital in the heart of the capital of India. It is a part of Apollo Hospital group, one of India’s most reputed healthcare chains. Indraprastha Apollo Hospital has been accredited by Joint Commission International, making it the first internationally accredited hospital in the country in 2005.
- There are 52 specialties in the hospital with one of the best cardiology centers in the country. The hospital is also equipped with State of the art infrastructure facilities with the largest Sleep Lab in Asia and the largest number of ICU bed facilities in India.
- The latest and highly advanced technologies that are installed in the hospital include Da Vinci Robotic Surgery System, PET-MR, PET-CT, Cobalt-based HDR, Brain Lab Navigation System, Tilting MRI, Portable CT scanner, 3 Tesla MRI, 128 Slice CT scanner, DSA Lab, Endosonography, Hyperbaric Chamber and Fibro scan.
- City: New Delhi, India
Hospital Highlights:
- One of the well-regarded providers in India committed to the highest standards of clinical excellence and patient care, Max Super Specialty Hospital is a part of Max Healthcare, which is the second-largest healthcare chain in India. Regarded as one of the most well-regarded healthcare providers in the country, Max Super Specialty Hospital is committed to the highest standards of clinical excellence as well as patient care. The hospital is also equipped with the latest technology as well as cutting-edge research. The hospital is known to deliver and ensure the highest level of patient care.
- The hospital has more than 500 beds and offers treatment for over 35 specialties. The hospital also holds the credit of having installed the first Brain Suite in Asia. This is a highly advanced Neurosurgical machine that allows MRI to be taken while surgery is ongoing.
- Other advanced and latest technologies are also installed in the hospital such as the 1.5 Tesla MRI machine, 64 Slice CT Angiography, 4D ECHO, LINAC, and 3.5T MRI machine.
- City: Kolkata, India
Hospital Highlights:
- Founded in 2017, the HCG EKO Cancer Centre is a committed, all-inclusive cancer care facility in Kolkata.
- The hospital was collaboratively established by India’s leading cancer care provider HCG (HealthCare Global Enterprises Ltd.), and EKO Diagnostic Pvt. Ltd., a top diagnostic and imaging chain in Eastern India.
- With 88 beds, the hospital provides a full spectrum of services including diagnosis, prevention, screening, second opinions, treatment, rehabilitation, follow-up, and palliative care.
- Additionally, the hospital contains a day-care chemotherapy ward, Neutropenic ward, medical ICU, pharmacy, blood bank, and an IPD wing.
- At HCG EKO Cancer Centre Kolkata, a large team of cancer experts with experience in medical oncology, surgical oncology, radiation oncology, hemato oncology, BMT, and nuclear medicine collaborate to offer a variety of treatment options under one roof.
- Furthermore, the hospital is also known for employing the most advanced radiation technology such as, the Radixact, a next-generation TomoTherapy equipment that provides greater radiation delivery precision.
Birmingham Hip Resurfacing
The Birmingham Hip Resurfacing Surgery is a surgical procedure first introduced in the United Kingdom by manufacturer Smith & Nephew in 1997 and is currently implemented in over 26 countries as a medical alternative to Total Hip Replacement. The surgical procedure is recommended for patients who suffer from bad or worn out hip problems as the procedure aims to relieve intense hip pain and stiffness by ‘resurfacing’ a portion of the damaged hip bone.
What is Hip Resurfacing and how is it Different from Hip Replacement?
The Birmingham Hip Resurfacing surgery (BHR) is an alternative medical option to Total Hip Replacement (THR) where doctors place a mushroom-top cap over the head of the femur bone and another matching metal mushroom cap on the pelvis socket. Before the metal caps are inserted, a small part of the damaged bone is shaved or ‘resurfaced’. On movement of the hip bone, the joints produce a synovial fluid that acts as lubrication between the two metal surfaces and this pain from bone friction or stiffness is eliminated.
This procedure differs from the traditional hip replacement method where the entire hip joint is replaced completely leading to maximum bone loss, a situation that might not be favorable for younger patients. However, the hip resurfacing surgery needs to be done under an experienced medical team since it involves careful alignment of the metal caps in order to avoid future complications after the surgery.
When does a doctor recommend BHR?
Hip damage can be caused by different arthritis types such as osteoarthritis or rheumatoid arthritis, trauma etc. Conditions like bone tumour, avascular necrosis or dysplasia too can cause hip bone damage. Conditions like these affecting young patients can cause permanent hip bone damage but medical treatments like a total hip replacement surgery can prevent any possible future surgery options in young patients. Doctors hence recommends hip resurfacing surgery which preserves future surgical treatment options.
Birmingham Hip Resurfacing benefits
- The hip resurfacing surgery allows maximum bone conservation and is considered an apt medical treatment, especially for younger male patients ( less than 50-60 years old).
- The BHR success rate worldwide has been 90.2% to 98.6% making this medical procedure one of the most recommended treatment technique.
- Effect of the hip resurfacing surgery is known to last much longer than hip replacement method which makes it apt for long-term results.
- This medical procedure has the fastest recovery rate with documents revealing how some patients could go back to normal leg functioning within just 4 hours of the surgery. The usual time for complete recovery is 2-3 weeks within which the patient can go back to their normal life.
- This medical procedure also reduces hip dislocation complications significantly.
Common Diagnostic Tests Before Hip Resurfacing Surgery
Before recommending the surgery, your doctor or medical team might run a few clinical exams to diagnose the exact cause of the underlying condition and to determine whether hip resurfacing surgery is the best medical option for your condition or not. Usual tests may include physical tests or movement tests to determine the exact location or intensity of the pain. Doctors may ask about your medical history or possible bone or hip complication of the past and may ask for MRI or ECG results to determine whether the condition is merely related to the bones or does it have neurological complications involved. Doctors may also prescribe other necessary clinical exams if needed to understand the condition better.
Birmingham Hip Resurfacing Surgery Process
Preparation
There are no exclusive preparations needed for this procedure. Patients should inform the medical team of any past or present medical condition including intake of any daily medicine like antibiotics, blood thinners, pain killers, herbal or vitamin supplements, homeopathy doses, etc. You can ask your doctor for a detailed dietary chart to follow before the surgery. Doctors usually recommend no eating or consuming alcohol 12 to 10 hours before the surgery.
Procedure
The detailed procedure for this surgery may vary from patient to patient based on their surgical condition. Generally, an orthopaedic surgeon conducts the surgery with the help of a medical team and the entire procedure takes about 2-3 hours in total. This is a two-part surgery.
Step 1
Step 1 starts with the patient undergoing local or full anaesthesia to avoid any pain or discomfort during the procedure. The surgeon will then make a small incision in the patient’s thigh, preferably in the back to reveal the femoral bone once it’s been taken out of the hip joint socket. The top of the femoral bone is then trimmed or shaved with the help of surgical instruments and the doctor fits a metal cap over the head. This concludes the first part.
Step 2
Step 2 of the procedure starts with shaving or trimming the damaged bone or cartilage lining the pelvic socket before another metal cap is fitted into the socket. The surgeon now places the femoral bone back into the socket and aligns the metal-to-metal implant. The procedure ends with the surgeon closing the incision.
The Hip Resurfacing Surgery is Not Appropriate on these conditions:
- If the patient is pregnant
- If the patient’s bone health is weak or filled with multiple cavities
- If the patient has a kidney disorder
- If the patient is sensitive to metal
- If the patient is overweight or obese
- If the patient has chronic blood or bone infection
- If the patient has an immunity disorder due to diseases such as AIDS.
Risk Factors of Birmingham Hip Resurfacing Surgery
- Blood Clot
- Bone infection
- Bleeding Disorder
- Injured Nerves in and around the operation area
- Femoral fracture
Birmingham Hip Resurfacing Surgery Precaution & Care
Pain or soreness in the muscle or hip joint is normal after the surgery. The pain or soreness might be prominent near the incision area including chances of fluid leaking in and around the incision. While doctors prescribe pain medications for the soreness, fluids yellow or white in colour should be reported to the doctor immediately, especially, if the fluid draining is accompanied by redness or swelling. However, minimum fluid leakage is actually normal for this treatment.
There are no special diet regulations but it’s always better to check in with the medical team regarding diet to avoid interaction with medications prescribed. Based on your recovery rate, the medical team may ask for imaging scans or will advise you for physical therapy. A cane or a crutch for the initial recovery days might also be prescribed. Doctors will also determine when the patient can start applying pressure or go back to their normal lifestyle.
FAQs
How long do I have to stay in the hospital after a hip resurfacing surgery?
About 4-5 days hospital stay is needed.
How fast can I recover from the hip resurfacing surgery?
Usually, patients can start walking after 4 hours of the surgery, but that is completely based on the patient’s recovery rate. Doctors usually keep 2-4 weeks as the general recovery period.
Do I have to undergo hip resurfacing a second time?
Taking wear and tear into account, patients after 10-20 years might have to reappear for a resurfacing or total replacement surgery based on their condition.
Is this surgical procedure safe?
This surgery was approved by FDA in 2016 and so far 3000+ hip resurfacing surgeries with successful results have been performed.
Can I run after my hip resurfacing surgery?
Clinical documentations say running is possible after this surgery. However, long-term effects such as wear and tear are not calculated in this documentation. Your doctor will be able to guide you better on this.