Joint pain can make your life miserable. In its early stage, doctors may prescribe pain-killer medicines or recommend physical therapy. But when the hip or knee pain affects your quality of life or tests show advanced arthritis or significant joint damage, your orthopaedist will recommend joint replacement.
Dr. Siripong Ratanachai, Director of Bumrungrad Joint Replacement Center, explains the signals to watch for that tell you when you need knee or hip surgery.
“You’ll know when you have a significant pain that keeps you awake at night despite the use of medications; a pain that keeps you from being able to walk or bend over; a pain that isn’t relieved by rest; or a pain that isn’t resolved by non-surgical approaches.”
“Osteoarthritis is a very common condition that can affect any joints in the body,” the doctor continues. “Major causes of knee and hip osteoarthritis include normal wear and tear on the joints, with greater occurrence among senior citizens, along with inappropriate surgeries that lead to infection of the joint, and also unsuitable arthritis treatments.”
Depending on bone condition, knee and hip replacements can be done partially or totally, using minimally invasive surgical procedures which require preoperative planning, specialised tools and highly experienced surgeons.
“In partial knee replacement, only the damaged part of the knee cartilage is replaced with a prosthesis. On the other hand, total knee replacement uses metal and plastic parts to cap the ends of the bones that form the knee joint and kneecap.”
“Partial hip replacement, or “hip hemiarthroplasty”, is a procedure to replace only the femoral head of the diseased joint. In total hip replacement, the damaged bone and cartilage are removed and replaced with prosthetic components. The damaged femoral head is removed and replaced with a metal stem and metal or ceramic hip ball that is placed into the hollow centre of the femur.”
GAME-CHANGING MAKOPLASTY
To reduce human error while implementing the surgical procedure, Bumrungrad Joint Replacement Center employs robotic assisted surgery and robotic technology (MAKOplasty).
“During the surgical procedure, even a minor error may have significant consequences. To avoid this, we utilise modern technology and equipment that support the surgeons while they implement the process.”
“MAKOplasty is another important assisting tool for partial knee and total hip replacements. After establishing bone resection areas and boundaries for cutting, the surgeon uses the robotic arm with force-controlled tip to remove the defected bone. The active, tactile-and-auditory feedback mechanism of the robot ensures that cutting occurs only in the pre-specified areas, so incorrect cutting can be avoided.”
Since the procedure involves such advanced technologies, has the doctor’s role become less important?
DOCTORS STILL INDISPENSABLE
“The doctor still has the leading role in the procedure,” explains Dr. Siripong. “The various technologies take on supporting roles.”
He emphasises that surgery isn’t a starting point for treating damaged joints.
“Doctors specialising in orthopaedics begin helping patients well before any surgical procedures might be recommended. Doctors must determine the right time for replacement surgery after concluding the procedure will not endanger the patient’s health nor greatly increase the patient’s risk level.”
A successful surgery is one that offers a high degree of safety and matches with patient’s expectation.
And that requires doctors.
“Doctors must first make a proper determination that the patient is a good candidate and meets the health guidelines specific to the procedure. That’s followed by the doctor’s surgical capabilities, especially his or her ability to correctly align the joint while keeping damage to surrounding tissue minimal. The doctor’s experience and expertise are also tested when choosing the specific artificial device to ensure it delivers the optimal fit.”
GOOD TO GO …AND GO
The lifespans of artificial knees and hips depend on several factors, including the surgeon’s ability to accurately align the new joint, the quality of the artificial joint, and the patients’ lifestyle.
On average, an artificial joint has a lifespan of 15 to 20 years. It’s an orthopaedist’s responsibility to choose high-quality artificial joints that best suit each individual patients’ requirements.”
When it’s done right the first time, there’s less of a chance the patient will need a second surgery but not no chance.
The technology has reduced the chance of needing to come back. Dr. Siripong says that about 20 per cent of the patients who had the earlier generation joint replacement surgery return for a second surgery.
“Sometimes this is due to the device reaching the natural end of its lifespan while other patients’ replacement joints have worn out early due to the previous surgery being less accurate, causing the artificial joint to wear out faster.”
And the main reason for return visits is the patient’s own negligence: in other words it’s very avoidable.
Post-op patients are recommended to visit their doctor once a year. “That way any parts of the artificial joint that start to wear out can be repaired easily with minimal effort, and without requiring replacement of the entire artificial joint.”
KICKING OFF RECOVERY
Meanwhile, on-line applications are available to allow patients in foreign countries and upcountry to access their follow-ups. Bumrungrad network hospitals across the country ensure the most convenience for upcountry patients.
“On more thing to be considered,” counsels Dr. Siripong, “is that patients with an artificial joint need regular exercise to build muscle around the joint area. In general, low-impact exercise that doesn’t involve rushing is recommended. It is important to take things slowly and gradually build up to a comprehensive exercise routine.”
“Since our patients are mostly senior citizens, safety is our highest priority. Bumrungrad Joint Replacement Center employs four highly experienced hip and knee replacement surgeons fulltime. We also have a multidisciplinary team of professionals available 24 hours for backup in urgent cases.”
“Importantly, Bumrungrad patients are considered as family members which is why the Joint Replacement Center combines very high international standard services with traditionally caring Thai hospitality.”
