Hip Joint Replacement

[DrJack54]

Yes a common topic and I did read past threads.

Being a very common operation for us elderly, I was hoping for feedback from anyone with first hand experience.

Today went to Phyathai 1 hospital with the typical symptoms.

In my case it came upon me very quickly and had never had any pain etc in the past. 

So the prognosis is hip joint replacement.

 

At this point don't have much idea of cost, however guessing 350k baht a ballpark figure.

 

[Sheryl]

Seems odd to recommend a hip replacement for someone whose pain is new and without trying more conservative measures first (e.g. antiinflamatories and physical therapy, assuming Xraty confirms arthritis as the cause and it is nto something else altogether) . Definitely get another opinion on this first.

 

Cost of hip replacement depends on  whether one side or 2 sides and the hospital where done. 1 side usually 300-350, 2 sides >500k. (those are for for-profit private hospitals). Non-profit private hospital just a bit less. Government hospital, much less.

 

As it sounds like you are self-pay, I suggest you consult Prof.Aree Tanavalee  either at St Louis Hospital on Sathorn or at the Chulalongkorn Univ Hospital after hours clinic (13 th floor OPD building).

https://saintlouis.or.th/en/FindDoctor

 

 

 

 

[DrJack54]

1 minute ago, Sheryl said:

Cost of hip replacement depends on  whether one side or 2 sides and the hospital where done

First up thanks for all your help in the various forums.

Yes it's the left side only.

In my thinking the x-ray was quite clear. 

Yes I am self funded.

As many would confirm ...it's a very painful gift.

Currently can only walk very short distance in a hobbled state. 

Pain significant.

I appreciate your suggestion of a second opinion. However given my situation not simple. 

 

I personally have added consideration that the doctor only touched on briefly.

At the same hospital I have been seen to for 2 DVT and  pulmonary embolism over last 4-5 years

As a result on anticoagulant.

 

The doctor had a guesstimate of 350k. 

If anyone reads this and can advise on their personal recovery steps, that would be appreciated.

Thanks Sheryl.

 

[worgeordie]

13 hours ago, DrJack54 said:

In my case it came upon me very quickly and had never had any pain etc in the past. 

I don't think the need for a hip replacement happens like that,

I suspect it happens over years , suffering pain ,until it cannot

be stood any more and only a hip replacement is the solution.

 

I have been suffering a pain in my hip for a few weeks now ,

trying to control it with Paracetamol , then my wife was recommended

a tablet by a friend who had suffered hip pain, i's called

Celebrex 400 grm , within a hour of taking the tablet the pain was gone.

they re not cheap 800 THB for 20 capsules, I suspect my problem is

sciatic nerve  , good luck.

regards Worgeordie

[DrJack54]

58 minutes ago, worgeordie said:

, I suspect my problem is

sciatic nerve  , good luck.

regards Worgeordie

Thankyou for your advice.

I agree normally would come on over time .

I certainly did not strain it in any way. No small fall nothing.

The x-ray showed clearly spurs on the left side. 

The pain has gone down to more of a discomfort level, however pretty annoying.

Walking (baby steps) to the toilet is about the extent of my mobility. Even that is in hunched position and life left leg with arms to shuffle.

 

Old age is such a joyous reward.

Ha. 

Edited June 3, 2022 by DrJack54

[spidermike007]

The first thing I would try is mega dosing MSM and Glucosamine. Forget the condroitin, which seems to be less effective. Start with 3,000 grams a day of each. Takes at least a month to start having an effect. I know many who have had great results from it. Worth a try. 

[Sheryl]

5 hours ago, DrJack54 said:

Thankyou for your advice.

I agree normally would come on over time .

I certainly did not strain it in any way. No small fall nothing.

The x-ray showed clearly spurs on the left side. 

The pain has gone down to more of a discomfort level, however pretty annoying.

Walking (baby steps) to the toilet is about the extent of my mobility. Even that is in hunched position and life left leg with arms to shuffle.

 

Old age is such a joyous reward.

Ha. 

 

You hardly need a hip replacement just for bone spurs, if that s what is causing the pain. Conservative management (anti-inflamatories, PT, maybe cortisone injection) would be the first line of treatment. If insufficient, then simple arthroscopy to remove the spurs could be undertaken

 

Hip replacement is indicated only if there is severe degeneration of the whole hip joint and pain does nto respond to conservative treatment

 

Of course it all depends on the overall condition of the joint, but  it is most unusual for a surgeon to have jumped straight to recommending joint replacement at the first occurrence of pain.

 

As I said before, you should get a second opinion.

 

 

[DrJack54]

5 minutes ago, Sheryl said:

 

As I said before, you should get a second opinion.

I think you are correct.

 

Things have happened quickly.

As it stands now I'm booked in for operation next Thurs.

Stopped warfarin today.

Have check up and covid check Tuesday which is not easy trip to hospital. 

The package with all the add ons will be 400k. That covers 5 night stay. 

I'm trusting the doctors judgement which is perhaps foolish. 

[Sheryl]

Just now, DrJack54 said:

I think you are correct.

 

Things have happened quickly.

As it stands now I'm booked in for operation next Thurs.

Stopped warfarin today.

Have check up and covid check Tuesday which is not easy trip to hospital. 

The package with all the add ons will be 400k. That covers 5 night stay. 

I'm trusting the doctors judgement which is perhaps foolish. 

 

I can only tell you that immediately recommending a hip replacement for first time new onset of hip pain without first trying other approaches is  most unusual and not in accordance with usual  medical practice.

 

Personally I would certainly not undergo such an extensive procedure -- which does include insertion of prosthetic material into your joint -- without a second opinion, especially given the short duration of your pain.

 

 

 

 

[scubascuba3]

My mum had 3 hip replacements, first one she was in pain for a year or two, left it too long to have the op

[Lorry]

On 6/2/2022 at 7:53 PM, DrJack54 said:

If anyone reads this and can advise on their personal recovery steps, that would be appreciated.

Lots and lots of physical therapy. This was just as important as the operation. Started slowly immediately after operation,  and then in earnest about 2 weeks post op. 4 weeks inpatient in a rehab hospital (doesn't exist here), then in an outpatient setting. 

 

Rehab means 3 things:

1. physical therapy one-on-one (I recommend Bumrungrad 2000 B per session or St Louis 1000B per session, both are equally good; i do not recommend Samitivej, BNH or Bangkok Hospital), after 2 or 3 months i needed less of this

2. Training with machines or exercise by yourself,  you need someone to teach you (couple of days) and supervise you in the beginning, i don't know any good place for this in Bangkok

3. ergotherapy, and teaching how to handle everyday life situations. I found this extremely useful. Here,  the internet was helpful too (eg how and when to have sex after hip replacement is not something a female 25y.o. physical therapist is going to discuss with you)

A friend of mine told me about her own experience: don't believe all these people who  say it's over in months - expect 2 years.  She was right.

 

Disclaimer: another friend cut down considerably on rehab. He is doing fine. But it took 2 years, too.

 

NB yes, it can happen very suddenly (with me, within days). I still did like Sheryl said, got a second opinion, tried conservative treatment for 3 or 4 months. I think you proceed wayyyyyy too fast.

 

 

Edited June 3, 2022 by Lorry

[The Hammer2021]

My friend  had this problem and diligently researched his condition  and medical  solutions. He went to  India where the surgeon had trained in Birmingham, England. I believe innovative work has been done there. I'm not sure  he got replacements but got a titanium  coating on both  hips. My friend  concluded that treatment  in India  was better and  cheaper than Thailand. This information  might be worth  considering.

[The Hammer2021]

18 hours ago, worgeordie said:

I don't think the need for a hip replacement happens like that,

I suspect it happens over years , suffering pain ,until it cannot

be stood any more and only a hip replacement is the solution.

 

I have been suffering a pain in my hip for a few weeks now ,

trying to control it with Paracetamol , then my wife was recommended

a tablet by a friend who had suffered hip pain, i's called

Celebrex 400 grm , within a hour of taking the tablet the pain was gone.

they re not cheap 800 THB for 20 capsules, I suspect my problem is

sciatic nerve  , good luck.

regards Worgeordie

Celebrex is only  recommended  for short term use I believe. When I mentioned  it to  my NHS doctor he actually winced and made a very derogatory  comment about how  dangerous  it was.

[DrJack54]

7 hours ago, Lorry said:

NB yes, it can happen very suddenly (with me, within days). I still did like Sheryl said, got a second opinion, tried conservative treatment for 3 or 4 months. I think you proceed wayyyyyy too fast.

Thanks for all that information even though the rehab sounds scary.

So to be clear ...after you tried conservative treatment for few months, you ended up having the hip joint replacement? 

[Sheryl]

11 hours ago, The Hammer2021 said:

Celebrex is only  recommended  for short term use I believe. When I mentioned  it to  my NHS doctor he actually winced and made a very derogatory  comment about how  dangerous  it was.

There is an increased  risk of cardiovascular events (heart attack, stroke)  with long term use of this class of NSAIDs (COX-2 inhibitor) especially in the elderly and in the West doctors will often prefer a short course of steroids instead (emphasis on short).

 

For hip of course, steroid injection can be given into the joint  and this will often relieve pain for up to 6 months in some cases.

 

However Thai doctors seem not to have gotten the memo, and continue to widely dispense NSAIDs including the COX-2s and even to the elderly. Conversely many of them seem terrified to use steroids, even briefly. Not true of those trained in the west, but seems  true of those trained only in Thailand.

[Sheryl]

5 hours ago, DrJack54 said:

Thanks for all that information even though the rehab sounds scary.

So to be clear ...after you tried conservative treatment for few months, you ended up having the hip joint replacement? 

 

You need to understand that all cases are not alike...even cases of identical pain felt in the same place.

 

The likelihood of your being able to avoid a hips replacement (or at least defer it for years) depends on the extent of degeneration of the hip joint. Inflammation, bone spurs etc can all be managed without such radical surgery.

 

"Total hip arthroplasty (THA) is indicated for patients who have failed conservative or previous surgical treatment options for a deteriorated hip joint and who continue to have persistent, debilitating pain and a significant decrease in the activities of daily living. "

https://www.uptodate.com/contents/total-hip-arthroplasty

 

Also relevant is the strength of the muscles which stabilize and move your hip and whether you are able/willing to engage in a program of targeted exercises to strengthen these.

https://www.health.harvard.edu/pain/avoiding-knee-or-hip-surgery

 

I cannot guarantee that conservative treatment would work in your case (no one can) but it is normal medical practice to try this first and it can avert or delay the need for surgery in many cases. There may also be options for much less extensive surgery, depending on what is causing the pain.

 

Your other medical conditions make surgery more of a risk for you than would otherwise be the case.

Again I urge a second opinion before rushing into this.

 

[The Hammer2021]

2 minutes ago, Sheryl said:

There is an increased  risk of cardiovascular events (heart attack, stroke)  with long term use of this class of NSAIDs (COX-2 inhibitor) especially in the elderly and in the West doctors will often prefer a short course of steroids instead (emphasis on short).

 

For hip of course, steroid injection can be given into the joint  and this will often relieve pain for up to 6 months in some cases.

 

However Thai doctors seem not to have gotten the memo, and continue to widely dispense NSAIDs including the COX-2s and even to the elderly. Conversely many of them seem terrified to use steroids, even briefly. Not true of those trained in the west, but seems  true of those trained only in Thailand.

I was first given Celebrex nearly  10 years ago at Bumrungrad for  suspected gout. When I researched it I discovered  it was relatively  and it hadn't been passed  for  use in UK or USA - I felt it was almost 'experimental'.

It was years later my NHS doctor mentioned Celebrex in a negative  way when I mentioned I had used it under care of a doctor in the Middle  East.

 

[Lorry]

14 hours ago, DrJack54 said:

.after you tried conservative treatment for few months, you ended up having the hip joint replacement? 

Yes.

I had had mild symptoms for years,  which I and my orthopedic doctor ignored. The deterioration was sudden,  swift (couple of weeks max) and brutal.

X-ray: radiologist: "grisly", orthopedic doctor (another one): "the hip is gone"

I tried 3 months physical therapy anyway. The head of the rehab department where i did that saw the x-rays. He advised to give it a try, but told me i would most probably need a hip replacement. 

Edited June 4, 2022 by Lorry

[DrJack54]

6 minutes ago, Lorry said:

Yes.

I had had mild symptoms for years,  which I and my orthopedic doctor ignored. The deterioration was sudden,  swift (couple of weeks max) and brutal.

X-ray: radiologist: "grisly", orthopedic doctor (another one): "the hip is gone"

I tried 3 months physical therapy anyway. The head of the rehab department where i did that saw the x-rays. He advised to give it a try, but told me i would most probably need a hip replacement. 

Thankyou for sharing.

I also really appreciate Sheryl replies above and believe that is most sensible option.

However (and I'm typing this for others) seeking more opinions is far from easy.

I can make it to the toilet and that's about it. 

In other threads I have often recommended folk to have affairs in order.

I'm referring to Will etc.

Currently I have no way of being able to make it to my bank to shift funds from a FD account into savings with card so that my partner could milk it if required.

Yes all a bit melodramatic but we all need to cover our bases.

Tuesday having "pre check" prior to admission on Thurs.

The plan is to have consultation with doctor to discuss alternative course of action. 

Thanks for every reply.

Most likely bump this thread ongoing to give insight into the recovery process.

Cheers

[it is what it is]

On 6/2/2022 at 1:40 PM, Sheryl said:

Seems odd to recommend a hip replacement for someone whose pain is new and without trying more conservative measures first (e.g. antiinflamatories and physical therapy, assuming Xraty confirms arthritis as the cause and it is nto something else altogether) . Definitely get another opinion on this first.

 

Cost of hip replacement depends on  whether one side or 2 sides and the hospital where done. 1 side usually 300-350, 2 sides >500k. (those are for for-profit private hospitals). Non-profit private hospital just a bit less. Government hospital, much less.

 

As it sounds like you are self-pay, I suggest you consult Prof.Aree Tanavalee  either at St Louis Hospital on Sathorn or at the Chulalongkorn Univ Hospital after hours clinic (13 th floor OPD building).

https://saintlouis.or.th/en/FindDoctor

 

 

 

 

 

it's an elective surgery, and generally, if the patient is elderly, it is not uncommon for prompt replacement. cost wise; in the uk, free on the nhs but with wait list 2 - 12 months dependent on your local, or 12,000 GBP - 15,000 GBP, private, so 350K sounds about right.

Edited June 4, 2022 by it is what it is

[DrJack54]

18 minutes ago, it is what it is said:

it's an elective surgery, and generally, if the patient is elderly, it is not uncommon for prompt replacement

One of my personal considerations is that being 68 , I would rather than face it now rather that years later. 

True it's been sudden onset however anti inflammatory meds have done little. 

 

[cdemundo]

I will belabor the obvious and don't mean to underestimate intelligence here.

 

There are now several procedures for total hip replacement, I have not had a THR but I am a physical therapist and I see patients for post-surgical rehab.

Be sure to look into the "anterior approach" surgeries as they involve less cutting of muscles and are easier and faster to rehab.

I work with patients in post-surgery rehab and there is a big difference in recovery time and post-surgical pain between anterior and posterior approach.

Many anterior approach patients require almost no time or assistance to return to normal function.

Orthopedic surgeons in my city predict that soon anterior approach hip replacements will be done on an outpatient basis.

For younger patients this is nearly the case now as many only spend one night in the hospital.

Here in LA there are still surgeons using both techniques but I think that soon there will be no more posterior approach THRs.

I am not sure about methods used in Thailand but factor the approach into the cost of surgery.

[cdemundo]

Here is a discussion that might be helpful of the methods of hip replacement surgery.

It appears that availability is a question:

Referring to the anterior approach surgery:

"“Currently, this technique is widely utilized with a high percentage of success in the United States, Canada, and Europe. However in Thailand, with the exception of our team at the Bangkok Hip and Knee Center, this procedure is not as yet readily available."

 

I don't mean to complicate your decision but there is a significant difference between the anterior and posterior approach methods.

 

 

https://www.nationthailand.com/life/30404357

 

Direct Anterior Approach Overview

The surgical approach (sometimes called the surgical technique) is the way the surgeon makes their incision so that they can operate on the bones that make up the joint. Most surgeons use what is called the traditional approach, but more are starting to use the Anterior Approach.

Direct Anterior Approach is a relatively new technique in the Southeast Asia region and requires extensive training and expertise. Dr.Phonthakorn Panichkul of the Hip and Knee Center indicates that “Currently, this technique is widely utilized with a high percentage of success in the United States, Canada, and Europe. However in Thailand, with the exception of our team at the Bangkok Hip and Knee Center, this procedure is not as yet readily available. We expect the Direct Anterior Approach to become the standard for hip replacement surgery in the near future”.

Edited June 4, 2022 by cdemundo

[cdemundo]

17 hours ago, DrJack54 said:

Thanks for all that information even though the rehab sounds scary.

So to be clear ...after you tried conservative treatment for few months, you ended up having the hip joint replacement? 

I believe you can expect considerably less time and effort in rehab than what Larry describes with the newer surgical method, the "anterior approach" as it is called here.

Probably he had a posterior approach surgery (of course I don't know this for sure) and the rehab is substantial.

I would say the difference in the rehab between the two approaches is like night and day.

Be sure to raise this question in consultations with a surgeon.

I am not a sales person for the "anterior THR" but I have seen the changes in the amount and duration of rehab required with patients having the newer surgical technique and it is much easier on a person.

Best of luck to you DrJack.

[Lorry]

8 hours ago, cdemundo said:

I believe you can expect considerably less time and effort in rehab than what Larry describes with the newer surgical method, the "anterior approach" as it is called here.

Probably he had a posterior approach surgery (of course I don't know this for sure) and the rehab is substantial.

I had an anterolateral approach (Roettinger, OCM) as it was done in Europe. Anterior approach (AMIS) is propagated in the Anglo-Saxon world. Both are called "minimal invasive" which means less muscle is destroyed than by the conventional approach..

Posterior approach is out of fashion in the industrialized countries. It is easier to do but requires more rehab.

Bumrungrad offers minimal invasive techniques but still says on their website "Rehabilitation and physical therapy are started immediately following surgery and continue throughout hospitalization and at home for one year after surgery."

 I fully agree.

 

But as I said before,  a friend of mine skipped quite a lot of the rehab.  One year post op., his results were much worse than mine were 1 year post op.  2 years post op., they were about the same as mine . 

 

BTW I forgot to mention that I also tried steroid injection, done at a big hospital under fluorescence. It was a miracle cure,  alas, it didn't last.

Time between radiological diagnosis and operation was about 5 months. 

 

Edited June 5, 2022 by Lorry

[DrJack54]

13 minutes ago, Lorry said:

Time between radiological diagnosis and operation was about 5 months.

Thanks for all your posts.

It's good when you can hear from a "been there done that" perspective.

 

As I've mentioned in earlier posts, I'm pretty much locked in.

On Tuesday I will discuss exactly what process is planned. 

Thinking that will be posterior.

 

Appreciate the comments and info from @cdemundo.

 

If younger I may have considered alternative treatment. 

The rehab aspect is scary and comments that a full on effort is required seems very sound advice. 

 

For the benefit of others I plan to make some posts of the procedure on Thursday with feedback of the following 5 days in hospital. 

 

[Doctor Tom]

On 6/2/2022 at 7:53 PM, DrJack54 said:

First up thanks for all your help in the various forums.

Yes it's the left side only.

In my thinking the x-ray was quite clear. 

Yes I am self funded.

As many would confirm ...it's a very painful gift.

Currently can only walk very short distance in a hobbled state. 

Pain significant.

I appreciate your suggestion of a second opinion. However given my situation not simple. 

 

I personally have added consideration that the doctor only touched on briefly.

At the same hospital I have been seen to for 2 DVT and  pulmonary embolism over last 4-5 years

As a result on anticoagulant.

 

The doctor had a guesstimate of 350k. 

If anyone reads this and can advise on their personal recovery steps, that would be appreciated.

Thanks Sheryl.

 

I would be highly suspicious of such a swift diagnosis. I was given such a diagnosis about 15 years ago.  I started a weight loss and fitness programme, concentrating on my back and leg muscles.  I have had no real symptoms since that time.  Its not a routine procedure that does not carry risks and a  replacement guarantees nothing if there are other issues.  get a least one or two other opinions, take medication as Sheryl advises and do your research before submitting to the operation.  You can take your time. 

Edited June 5, 2022 by Doctor Tom

[DrJack54]

Update.

Had the hip replacement last Thursday.

The stay in hospital is 5 nights. 

The hard work is ahead.

Had first walk with a frame today.

Zero pain however on pain killers so not banking on simple recovery.

Wonderful hospital so happy with that. 

Mods can close this thread if wish to.

[DrJack54]

Short update on self funded hip joint replacement.

So the "package" which includes operation and 5 nights in flash private room with all the bells and whistles was 350k baht.

Not included is post op daily visits (checks) by your Doctors.

In my case 2 separate issues.

One obviously for the hip and one due to past DVT and PE issues.

This all added up to another 40k.

So 390k all up.

Regardless if you are self funded or using insurance I suggest you do a lot of planning ahead. 

The assistance from a partner or carer is imo almost essential.

 

With the flash room and sleeping facilities along with all the extras etc for my partner that was a godsend.

 

I live in a condo and while it's large it is a studio.

As a result it is extremely easy to move about the room.

 

Also a bonus is the hallways from the room which enables easy access to walking with frame. 

 

We have a townhouse and if we were living there I would seriously have rented a condo as described above.

 

I won't sugar coat it....The recovery is not pleasant. Guess also depends on your size. 

At 180 and 95kg the rest of my joints and muscles are complaining about the added work load. 

 

On the + side the area of hip and operation has no pain at all. 

 

If anyone has tip or two about recovery that would be good.

Couple of earlier posts re rehab were very helpful.

 

 

 

Edited June 17, 2022 by DrJack54

[Lorry]

Try to get away from the walker asap, use forearm crutches, they are available in Thailand but still not so common.

Get a physical therapist to teach you how to use them (walk with alternating steps, similar to natural walking).

 

Get a foreigner to criticize your gait and your movements.  Thai's won't criticize enough.