Hip Replacement in Phuket, BKK, or Chiang Mai

[jerrymahoney]

1 hour ago, Ebumbu said:

Are you satisfied with your stability after four months? Where did you have your hip done? I'm reaching out to Bangkok Hospital and Bumrungrad. Getting X-rays today in Phuket. Then an MRI, I guess. Will try to get a cortisone injection before I'm wheelchair bound. Taking this very seriously now. Sudden decline. I did split squats and frog pose as rehab and it really tore me up.

 

Thanks. 

First off my surgery was result of hip fracture following fall, not degenerative. Stability fine after 4 months but still walked slow with a little side-to-side hip motion.

 

I walked out of the hospital very slowly after release with a cane, no walker or crutches with my 2-piece walking cane which I had brought with me.

 

As I noted on a previous post, after 2 moths I was able to climb the steps to a no-Jetway flight. Slowly but no need for wheelchair and truck lift onto the flight.

 

Phyathai2 Bangkok. 

Edited July 21, 2022 by jerrymahoney

[Ebumbu]

So, I got final confirmation today that my right hip is trashed. No surprise. Bangkok Phuket orthopedist said I'm at "final stage" hip disease, which means bone on bone. I saw the x-ray and there was no space where the cartilage should be. He spent a very long time with me and answered every question I had. We even went into specifics about the materials for the implant. 

We discussed the direct-anterior approach and Dr. Phonthakorn Panichkul. This is his friend and they graduated medical school together. So, Dr. P would come to Phuket to do my surgery and help train my doctor in the anterior approach. They'd work together. Fine. I can't walk through an airport with luggage at this point, and I want to sleep in my own bed, have my own food, etc. I could be released in 3 days post surgery or so. Quick recovery. 

 

Thank you to everyone's helpful advice. I'm fortunate that I have top-level resources here. I can do follow up checks in Phuket. I'm not in a hurry, but I'm getting "shocks" of pain to the bad hip, doing normal things like brushing my teeth. May need tramadol, unfortunately. Steroid injection aren't possible because they would delay surgery and increase risk of infection. OK, this is life. Moving ahead. 

Edited July 21, 2022 by Ebumbu

[DrJack54]

15 hours ago, Ebumbu said:

. OK, this is life. Moving ahead.

How much baht all up. 

[Ebumbu]

9 hours ago, DrJack54 said:

How much baht all up. 

For doctor P to come to Phuket from Bangkok and assist my Phuket physician doing Direct Anterior Approach, they want 490,000 baht (including 4 nights at hospital). I'm paying cash and will try to negotiate a little bit. I have not seen a formal contract or work order, but the quote seems to include the possibility for extra charges for all kinds of things including the pre-surgery health checks. I will do my best to nail them down and not get ripped off, but I realized the weakness of my position. 

 

I got a quote from Dr. Chanakarn in CM for posterior approach. 250,000 baht if I go to Rajavej hospital or 450,000 if I choose Bangkok Hospital in CM. I would prefer to avoid the posterior approach because it would lay me out for at least 6 weeks. I like what I am reading about direct anterior approach. 

 

I'm nearly certain I'll stay in Phuket and have Doctor Phonthakorn work with the Phuket surgeon to do my surgery (two surgeons). Need to keep stress low. 

 

Here's something I need to ask: how do you handle dental work after surgery? Do you have to take antibiotics before dental work forever? What happens if I get a small infection on my big toe or hand, etc? Let's say I accidentally get a cut on my hand. Do I take antibiotics?

 

I'm trying to deal with all my fears in advance so I can get at least some sleep at hospital. Good the the anterior approach lets you leave quickly and get back to your life. Doing my best to focus on new life of good mobility, including getting in really good shape at the gym. Thanks.

 

 

 

 

[Sheryl]

https://www.bangkokinternationalhospital.com/packages-promotions/hip-knee-surgery-packages

 

Bangkok Hospital in Bkk lists anterior approach hip replacement at under 400k. This does not however include pre op. labs & tests mor follow up consultation. Just the surgery .

[DrJack54]

8 hours ago, Ebumbu said:

For doctor P to come to Phuket from Bangkok and assist my Phuket physician doing Direct Anterior Approach, they want 490,000 baht (including 4 nights at hospital). I'm paying cash and will try to negotiate a little bit

Find some aspects of your post bit strange.

Re paying cash...has nothing to do with anything. 

You make it sound like paying a tradesman cash on a painting job with a discount for cash.

As for the "extra charges" in my case that was bit under 40k.

There is always the unknowns. For example in my case I required couple of rounds of blood transfusions.

You seem very settled on the anterior approach and that's fine.

Personally I wouldn't be thrilled with the expert coming to Phuket to give your doctor a chop out.

Anterior procedure (from reading) is very specialized surgery.

Your 10 yrs younger than myself and perhaps in good shape and indeed anterior may be best for you.

Either way you are having a significant procedure and recovery time is part of the gig.

You stated this in previous post.......

"Bangkok Phuket orthopedist said I'm at "final stage" hip disease, which means bone on bone"

 

Have they spoken about the condition of your "other hip"?

 

So I'm 6 weeks post op.

All my walking routines are now on one walking stick with arm rest.

As previously stated I have experienced Zero pain.

 

Best of luck with the procedure. 

 

Edited July 23, 2022 by DrJack54

[Ebumbu]

On 7/22/2022 at 12:39 PM, Sheryl said:

https://www.bangkokinternationalhospital.com/packages-promotions/hip-knee-surgery-packages

 

Bangkok Hospital in Bkk lists anterior approach hip replacement at under 400k. This does not however include pre op. labs & tests mor follow up consultation. Just the surgery .

Sheryl, do you think I'd get the same level of care bringing Dr P to Phuket, or should I travel to Bangkok to be sure? Phuket Hospital is saying they have all the same equipment and process. When I asked my Phuket orthopedist whether he would be wearing the "space suit" during surgery, the first thing he said was, "It's so hot." I didn't like that answer. I asked him twice more before I got a non-committal "yes." Maybe BKK will be more careful. I have no idea. 

I really can't walk now. Sucks. As much as I would want to come home immediately when done, I can't take risks with the surgery itself. Yes, I want the anterior for sure. Otherwise I'd get it done cheap. 

[Ebumbu]

On 7/22/2022 at 5:21 PM, DrJack54 said:

Find some aspects of your post bit strange.Re paying cash...has nothing to do with anything. 

 

Have they spoken about the condition of your "other hip"?

 

So I'm 6 weeks post op.

All my walking routines are now on one walking stick with arm rest.

As previously stated I have experienced Zero pain.

 

Best of luck with the procedure. 

 

Cash price: They charge more if I am paying with insurance. I was told this by the administrator. I get a discount for paying out of pocket for sure. 

 

Other hip is fine. I can put my left ankle behind my neck if I want. Zero problems. Strange, but true. It's normal. I saw the x-ray and it's totally different. 

 

Bringing surgeon to Phuket: They do this to train new surgeons. I think the famous dude would take the lead. I'm terrified of this entire thing and I don't want to add a plane flight when I can't walk, won't be able to sleep, and will be at my absolute worst. But, if I'm convinced I'll get better work done in BKK, I'll make arrangements for a wheelchair both ways. I'm in a bad way, as you said. Trying not to take opioids for pain now. Hip suddenly crashed when I tried to do some rehab exercises (split squats and frog pose). It's real bad. I am going to try stationery bike today. Unsure if I can do any exercise at all. 

[Sheryl]

Sent you a PM

[Ebumbu]

3 minutes ago, Sheryl said:

Sent you a PM

Thank you for all your extremely knowledgeable advice. You've helped me so much. Once I get through this thing, I will spend more time helping others. Paying it forward. 

[Ebumbu]

OK, so Bumrungrad's price seems ridiculous. Approximately double Bangkok Hospital. Right is cheaper than left. How bizarre. I guess they got the brand recognition and charge accordingly. 

 

Regarding your inquiries, the estimated costs of robotic assisted LEFT total hip replacement (MAKO THR) is 850,000 - 950,000 THB with 5 days hospital stay.

For robotic assisted RIGHT total hip replacement (MAKO THR) with 5 days hospital stay, the estimated costs is 820,000 - 900,000 THB.

 

Edited July 24, 2022 by Ebumbu

[Ebumbu]

Bangkok main hospital quote: 400k

 

Bangkok Phuket: 490k! 

 

Go figure. Maybe this is the charge for importing Doctor Phonthakorn on his day off. 

[crouchpeter]

On 7/20/2022 at 11:22 AM, Ebumbu said:

Hi Dr Jack. Thank for your PM. I may have some questions shortly. This hip thing has been a sudden crash. Now muscles are twitching, walking without one crutch isn't possible, and sleep is very difficult. Can't sleep on my right side (bad side). I'm out of time and feel overwhelmed. I will attempt to get a steroid shot in the joint to buy me some time. I've learned to look for the anterior approach for quicker recovery and less risk of dislocation. 550,000THB sounds too high, but not sure about traveling in this condition. So much effort to coordinate. 

 

Anyway, tomorrow I am getting to Bangkok Phuket hospital for evaluation. My top questions are about anterior approach and robot assisted surgery. Scary stuff for sure. I've never had surgery in my life. Never spent a night in a hospital. Aging is a challenge, eh? 

 

Also can't sleep on my back. I better start practicing I guess. Not sure if I can. 

 

Exactly my situation. I was jogging 5 kms. every day. Suddenly got infection in leg, (cellulitis), and 9 days in agony and hallucinating in Chantaburi Hospital. So in the space of about 1 month I was crippled. A couple of weeks later I could just walk with a Zimmer frame. I'm ready and desperate to get my hip done, but they're waiting until there's no infection or inflammation. (ESR blood test). They say, if you want an anterior surgical approach, the surgeon should have done at least 100 of these. Quicker recovery, but the same revision, (failure), rate. I'll l be using Prof. Wasin Vijitbreeda, (sic!), using lateral approach, non-cemented ceramic prosthesis, at the Police General Hospital, Bangkok. Total cost, under 200,000 baht.

For what it's worth, I wonder whether a private hospital would go ahead anyway, rather than waiting?

[Ebumbu]

34 minutes ago, crouchpeter said:

 

For what it's worth, I wonder whether a private hospital would go ahead anyway, rather than waiting?

Sorry to hear about all your sudden suffering. I can relate. 

An infection is the most serious potential complication because it could kill you. (Well, so could a blood clot.) We'll be on antibiotics for life for routine dental stuff like root canals. If your new hip gets infected, they have to take all the hardware out and leave you with nothing for 6 weeks while they try to sterilize the area. In some cases, the infection is so bad that they can never put the prosthesis back. So yeah, gotta wait until no infection for sure. I'm having all dental work done first. I need a root canal, some crowns, some cavities filled, and cleaning. 
 

34 minutes ago, crouchpeter said:

They say, if you want an anterior surgical approach, the surgeon should have done at least 100 of these.

 

My local Phuket surgeon said the same thing. He offered a lateral approach, but I'm going with the "top gun" for the anterior approach (in Bangkok). Dr. Phontakorn Panichkul trains other doctors in the anterior approach and studied in Canada and US. I feel good about this choice. I want to avoid potential for dislocation, all the movement restrictions, and I am encouraged by the quicker healing time. I need to get past this nightmare situation. 

 

 

Edited July 25, 2022 by Ebumbu

[crouchpeter]

On 7/22/2022 at 11:19 PM, Ebumbu said:

For doctor P to come to Phuket from Bangkok and assist my Phuket physician doing Direct Anterior Approach, they want 490,000 baht (including 4 nights at hospital). I'm paying cash and will try to negotiate a little bit. I have not seen a formal contract or work order, but the quote seems to include the possibility for extra charges for all kinds of things including the pre-surgery health checks. I will do my best to nail them down and not get ripped off, but I realized the weakness of my position. 

 

I got a quote from Dr. Chanakarn in CM for posterior approach. 250,000 baht if I go to Rajavej hospital or 450,000 if I choose Bangkok Hospital in CM. I would prefer to avoid the posterior approach because it would lay me out for at least 6 weeks. I like what I am reading about direct anterior approach. 

 

I'm nearly certain I'll stay in Phuket and have Doctor Phonthakorn work with the Phuket surgeon to do my surgery (two surgeons). Need to keep stress low. 

 

Here's something I need to ask: how do you handle dental work after surgery? Do you have to take antibiotics before dental work forever? What happens if I get a small infection on my big toe or hand, etc? Let's say I accidentally get a cut on my hand. Do I take antibiotics?

 

I'm trying to deal with all my fears in advance so I can get at least some sleep at hospital. Good the the anterior approach lets you leave quickly and get back to your life. Doing my best to focus on new life of good mobility, including getting in really good shape at the gym. Thanks.

 

 

 

 

Best to take Amoxycillin 3 gms., 1 hour before dental work for up to 3 months after op. Probably a good idea to take this prophylaxis whenever you have invasive dental work. These low grade infections are very hard to get rid of once they're entrenched Sometimes, they can't even culture any micro-organisms!

[Ebumbu]

12 minutes ago, crouchpeter said:

Best to take Amoxycillin 3 gms., 1 hour before dental work for up to 3 months after op. Probably a good idea to take this prophylaxis whenever you have invasive dental work. These low grade infections are very hard to get rid of once they're entrenched Sometimes, they can't even culture any micro-organisms!

 

Here's something nobody has been able to answer yet and I've been thinking about it: What about a sore throat infection (red throat with some yellow phlegm), a 2nd degree burn on hand with a little pus, conjunctivitis, sinus infection (some yellow phlegm), or a minor infection on my big toe from friction? What about skin rashes? Do you know the specific guidelines for when to take Amox? 3 grams is a lot. 

 

Thanks! I'm thinking everything through so I can deal with my anxiety. 

[nauseus]

32 minutes ago, Ebumbu said:

 

Here's something nobody has been able to answer yet and I've been thinking about it: What about a sore throat infection (red throat with some yellow phlegm), a 2nd degree burn on hand with a little pus, conjunctivitis, sinus infection (some yellow phlegm), or a minor infection on my big toe from friction? What about skin rashes? Do you know the specific guidelines for when to take Amox? 3 grams is a lot. 

 

Thanks! I'm thinking everything through so I can deal with my anxiety. 

I shared your pain.....until I finally got my right hip done late last year.

 

My doc is Dr. Mungkorn at Phayathai Hospital, Sri Racha. They often have hip/knee promotions - my hip basic price was 227k all inclusive of ICU recovery then private room up to 5 days - pre op medical and post op checks extra but reasonable as is post op physio. Anterior not suitable for me but I think he does them. I paid extra 20k for an upgraded ceramic socket. 

 

Good quick recovery. Highly recommended. 

 

Just in case you haven't finally decided yet.

 

For antibiotics best consult your surgeon/dentist.

Edited July 25, 2022 by nauseus

[crouchpeter]

1 hour ago, Ebumbu said:

 

Here's something nobody has been able to answer yet and I've been thinking about it: What about a sore throat infection (red throat with some yellow phlegm), a 2nd degree burn on hand with a little pus, conjunctivitis, sinus infection (some yellow phlegm), or a minor infection on my big toe from friction? What about skin rashes? Do you know the specific guidelines for when to take Amox? 3 grams is a lot. 

 

Thanks! I'm thinking everything through so I can deal with my anxiety. 

The 3 grammes Amoxycillin is prophylactic. ie. to stop infection from bacteria that enter the bloodstream during dental procedures. It's a powder you dissolve in water. Some say prophylactic and post-op. Ab cover is ineffective., and they could have a case! Any infections have to enter the bloodstream to affect a prosthesis. So keep clean and treat small wounds, especially wounds on toes or legs. Cellulitis can take hold very quickly!

[sanuk711]

2 hours ago, Ebumbu said:

Sorry to hear about all your sudden suffering. I can relate. 

I had a replacement last year--- 280K ...I notice you have not mentioned what you are replacing the hip joint with--it is important.

 

I went for the ceramic replacement, that's why mine was more expensive ----yes its Issan-- a different country from BKK.

[Sheryl]

3 hours ago, Ebumbu said:

 

Here's something nobody has been able to answer yet and I've been thinking about it: What about a sore throat infection (red throat with some yellow phlegm), a 2nd degree burn on hand with a little pus, conjunctivitis, sinus infection (some yellow phlegm), or a minor infection on my big toe from friction? What about skin rashes? Do you know the specific guidelines for when to take Amox? 3 grams is a lot. 

 

Thanks! I'm thinking everything through so I can deal with my anxiety. 

Most of what you mention would not be bacterial infection (rather, viral or fungal) and certainly not a systemic one.

 

Viruses, minor skin irritations etc are not a concern. Actual cellulitis would be.

 

In order to affect the prosthesis bacteria would need to enter the blood stream. Dental procedures are a common cause of transient bacteremia hence the need for prophylaxis. Heat rashes, chaffed skin, stubbed toes, superficial skin infections  etc are not.

 

As for sore throats, usually viral but if accompanied by fever or enlarged lymph nodes may indicate bacteria. 

 

Thd 3 Gm dose is a a prophylactic before an invasive  procedure which might briefly  introduce bacteria in the blood stream. For simple localized  bacterial infections of any sort it is usually advised yo  just test promptly with usual course of treatment.

[The Hammer2021]

I thought the best hip and knee doctors had received training  from that  British Birmingham  based doctor who invented the ' 'Birmingham hip'. Is there  an alternative  to hip replacement  based on coating the in chrome?

My friends went to  India for such hip  related treatment.

[Ebumbu]

16 hours ago, The Hammer2021 said:

I thought the best hip and knee doctors had received training  from that  British Birmingham  based doctor who invented the ' 'Birmingham hip'. Is there  an alternative  to hip replacement  based on coating the in chrome?

My friends went to  India for such hip  related treatment.

The Birmingham approach has fallen out of favor due to issues with metallosis, which means the metals get into the bloodstream or tissues and cause problems. They are still done for some very young, athletic patients (like the UFC star, Ben Askren). They don't tend to last as long as standard THRs now, which are projected to last 30+ years due to improved materials. 

I will be getting a ceramic implant and a plastic liner. The stem is titanium (which bends a little bit, like bone). No glue, because it breaks down and causes the stem to come loose. 

[Ebumbu]

17 hours ago, Sheryl said:

For simple localized  bacterial infections of any sort it is usually advised yo  just test promptly with usual course of treatment.

So, if I see a skin infection, I should have my blood tested at hospital? I was clear until this sentence. Thanks for your detailed answer. 

[The Hammer2021]

1 hour ago, Ebumbu said:

The Birmingham approach has fallen out of favor due to issues with metallosis, which means the metals get into the bloodstream or tissues and cause problems. They are still done for some very young, athletic patients (like the UFC star, Ben Askren). They don't tend to last as long as standard THRs now, which are projected to last 30+ years due to improved materials. 

I will be getting a ceramic implant and a plastic liner. The stem is titanium (which bends a little bit, like bone). No glue, because it breaks down and causes the stem to come loose. 

Thanks for the info

[Sheryl]

8 hours ago, Ebumbu said:

So, if I see a skin infection, I should have my blood tested at hospital? I was clear until this sentence. Thanks for your detailed answer. 

Usually no need for blood test. Just treat promptly if it looks like a bacterial infection. Be especially quick and aggressive to treat if any  signs of cellulitis (red area increasing in size and warm to the touch). 

[Ebumbu]

On 7/26/2022 at 9:40 AM, Sheryl said:

Usually no need for blood test. Just treat promptly if it looks like a bacterial infection. Be especially quick and aggressive to treat if any  signs of cellulitis (red area increasing in size and warm to the touch). 

Meaning 3 grams of Amoxicillin taken in one go? I've never had this thing, cellulitis. I'll Google what it looks like. Another great reason to never ride a scooter. 

 

Final quote from Bangkok: they want 505k baht. Even though the website promo says 347k baht, it doesn't include the actual implant device, which is about 150k. LOL. Bait and switch. How can you do the procedure without the implant? TIT. 

[Sheryl]

6 hours ago, Ebumbu said:

Meaning 3 grams of Amoxicillin taken in one go? I've never had this thing, cellulitis. I'll Google what it looks like. Another great reason to never ride a scooter. 

 

Final quote from Bangkok: they want 505k baht. Even though the website promo says 347k baht, it doesn't include the actual implant device, which is about 150k. LOL. Bait and switch. How can you do the procedure without the implant? TIT. 

1. No. The single 3 Gm dose of amoxicillin is a preventive measure before invasive procedures that might introduce bacteria into the blood stream. It us not how you would treat an actual infection of any kind.

 

Treat any actual infections exactly as indicated based on type of infection and underlying cause. Just be prompt about it.

 

You are overthinking this.

 

Risk is when infections get into the blood stream.  Most infections  are localized. Many people go their whole lives without ever having a systematic infection. You do need to take precautions before dental work and any invasive medical procedures.  Beyond that just manage illnesses and injuries as you normally would. Just don't be negligent in treating infections.

 

2. Bait and switch indeed. Wonder if quote you had in Phuket included the implant.