Hip and Knee Joint Resurfacing/ Replacement

HIP PROBLEMS:  Total Solutions

Hip Arthritis

Arthritis of the hip is a disease that wears away the cartilage in the ball-and-socket joint at the top of your leg bone (femur) and pelvis. This wear causes the two bones to scrape against each other, raw bone on raw bone. When this happens, the joint becomes pitted, eroded, and uneven resulting in pain, stiffness, and instability. In some cases, motion of the leg may be greatly restricted.

Two surgical procedures that address this problem are hip replacement and hip resurfacing.
 

Hip Resurfacing VS Hip Replacement

 

 

HIP REPLACEMENT SURGERY

Conventional Total Hip Replacement (Hip Arthroplasty) is a long-established procedure for the treatment of Hip Arthritis. The purpose of total hip replacement is to remove the two damaged and worn parts of the hip joint- the hip socket (acetabulum) and the ball (femoral head) – and replace them with smooth, artificial implants called prostheses, which help make the hip strong, stable, and flexible again.

For younger, more active people needing a hip replacement there is a high chance that a traditional hip replacement will wear out during their lifetime and need to be replaced again.

A second replacement (called a revision) is much more difficult. Hip Resurfacing offers an option.

 

How is it done?
Hip replacement generally takes one to two hours. It may be performed under a general or spinal anesthesia.  During the procedure the surgeon will remove the damaged or diseased portion of the hipbone replacing it with an artificial hip joint).  You will return from surgery with a large dressing on the hip area.  You may be required to wear “anti-embolism” stockings to reduce the risk of developing blood clots. A small drainage tube will be placed during surgery to help drain excess fluids from the joint area. Rehabilitation and physical therapy are started immediately following surgery and continue throughout hospitalization and at home for one year after surgery.


Why is it done?
Relief from pain is the greatest benefit and the major reason for hip replacement surgery.  Reasons for replacing all or part of the hip joint include:  severe pain from arthritis or injury in the hip that limits an individual’s ability to do the things they want to do, fractures in the elderly of the neck of the femur, and the occurrence of hip joint tumors.

Risks & complications
There are possible risks and complications associated with anesthesia, including respiratory or cardiac malfunction.
Other complications include:

  • Infection requiring antibiotics and in some cases hospitalization.  Infection can sometimes occur around the hip joint years after the surgery.
  • Blood clots in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolism).
  • Injury to nerves or blood vessels.
  • Fracture or dislocation of the new hip joint may necessitate additional surgeries.
  • Stiffness or instability of the joint caused by extra bone growth.
  • Retention of urine and bladder infection.
  • Blood thinning medications create the possible complication of having blood that is too thin. These side-effects of anticoagulation medications include bleeding around the incision, or internal bleeding, such as a stomach ulcer or stroke. Risks of bleeding are small, but need to be balanced against the possibility of developing a blood clot.

With time - sometimes as long as 20 years - the artificial joint will loosen and revision surgery will become necessary.

Risks can be reduced by following the surgeon's instructions before and after surgery.

Candidate eligibility
You will receive an extensive pre-operative evaluation to determine if you are a good candidate for hip replacement. Candidates for Hip Arthroplasty will be valuated to assess the degree of disability, impact on your lifestyle and pre-existing medical conditions. The surgeon will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient.  Commitment to a rehabilitation program is important since improvement of the new hip joint is largely determined by the patient’s effort.

Why hip replacement surgery in Thailand?

  • TMTT can refer you to medical providers who are recognized for their excellence for orthopaedic surgery.
  • The Orthopaedic Surgeons in Thailand have performed thousands of hip replacement surgeries during the past 25 years.
  • As with other surgical procedures performed in Thailand, the risk of post-surgical infection is much lower in Thailand than in the U.S. and most other countries.

HIP RESURFACING SURGERY

Hip resurfacing is surgery to resurface the head of the femur and the hip socket with metal-on- metal bearing surface prostheses.

How is it done?
Hip resurfacing may be performed under a general or spinal anesthesia. During the procedure the surgeon removes the femoral head from the hip socket. The femoral head is fitted with a spherical metal shell and the hip socket is lined with a concave metal shell. The hip is placed back in its normal position.  A small drainage tube is placed during surgery to help drain excess fluids from the joint area. Rehabilitation and physical therapy start after surgery and continue throughout hospitalization.

Why is it done?
Relief from pain caused by the wearing down of the hip joint is the greatest benefit and the major reason for hip resurfacing surgery.

Risks & complications
There are possible risks and complications associated with anesthesia, including respiratory or cardiac malfunction. Other complications include the possibility of:

  • Infection requiring antibiotics and in some cases hospitalization
  • Infection around the hip joint years after the surgery
  • Blood clots in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolism)
  • Injury to nerves or blood vessels
  • Fracture or dislocation necessitating additional surgeries
  • Stiffness or instability of the joint caused by extra bone growth
  • Retention of urine and bladder infection

Risks can be reduced by following the surgeon's instructions before and after surgery.

Candidate eligibility
You will receive an extensive pre-operative evaluation to determine if you are a good candidate for hip resurfacing. Hip resurfacing is generally suited to younger patients (less than 65 in men and 60 in women) who wish to maintain an active lifestyle. Patients with severe hip deformity, small women with osteoporotic or cystic bone, women who intend to become pregnant or patients with reduced renal function may be better off with other treatments. The surgeon will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient.  Commitment to a rehabilitation program is important since improvement is largely determined by the patient’s effort.

 

TOTAL KNEE REPLACEMENT SURGERY

Total Knee Replacement is surgery to replace diseased or damaged joint surfaces of the knee with metal and plastic prosthetic devices.

How is it done?
Surgery may be performed under a general or spinal anesthesia. During the procedure the surgeon shaves the joint cartilage at the ends of the femur and tibia (sometimes the cartilage of knee cap) and fits them with prosthetic caps. These are then re-attached to the remaining bone with specialized cement. You will return from surgery with a large dressing on the knee. A drainage tube will be in place to help drain excess fluids from the joint in the days following surgery. You will be required to wear pressure stockings immediately after surgery to prevent blood clotting.

Why is it done?
Most knee replacements are performed to relieve severe pain from arthritis or injury in the knee that limits an individual’s ability to do the things they want to do. It might also be performed to remove tumors of the knee.

Risks & complications
There are possible risks and complications associated with anesthesia, including respiratory or cardiac malfunction. Other complications include the possibility of:

  • Infection requiring antibiotics and in some cases hospitalization
  • Infection occurring around the joint years after the surgery
  • Blood clots in the legs (deep vein thrombosis), which can dislodge and move to the lungs (pulmonary embolism)
  • Injury to nerves or blood vessels
  • Loosening or dislocation of the prosthetic devices
  • Joint stiffness
  • Blood thinning medications create the possible complication of having blood that is too thin. These side-effects of anticoagulation medications include bleeding around the incision, or internal bleeding, such as a stomach ulcer or stroke. Risks of bleeding are small, but need to be balanced against the possibility of developing a blood clot.

Risks can be reduced by following the surgeon's instructions before and after surgery.

Alternatives
The surgeon may discuss alternative approaches to the total knee replacement procedure, including:

Non-Surgical Alternatives:

  • Walking aids such as a walking stick or cane or fitting with specialized braces
  • An exercise program to strengthen the muscles around the knee joint to improve positioning and relieve pain
  • Non-steroidal anti-inflammatory drugs like aspirin, ibuprofen and celebrex to relieve pain
  • Corticosteroids such as prednisone or cortisone can reduce joint inflammation
  • Herbal supplements like glucosamine and chondroitin

Surgical Alternatives:

  • Arthroscopic surgery
  • Osteotomy
  • Cartilage transplant
  • Knee fusion

Candidate eligibility
Candidates for total knee replacement should be free of infection.  You will receive an extensive pre-operative evaluation to determine if you are a good candidate for the total knee replacement procedure. The surgeon will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient. Post-operative progress is determined largely by patient effort.