Arthroscopic Knee Surgery In Bkk: Alternatives To Bumrungrad?

[TerraplaneGuy]

Hi All,

I'm in BKK and went to Bumrungrad with knee pain. Diagnosed with torn meniscus. Dr. Tanuk, orthopedic surgeon, advised me to have it repaired by arthroscopic surgery. The estimate was THB 250,000-275,000 which I thought was very high. I'm looking for high-quality alternatives that would be cheaper and heard Siriraj would be a good choice. I don't speak Thai (although I have a Thai friend who might be available some of the time to interpret).

One doctor at Siriraj, Dr. Ba Vorn Rat, looks very experienced in this: http://www.siph.ecgates.com/doctor_detail.php?id=261&cat=18

I'd be grateful if anyone has any thoughts/experience about going to this guy or another at Siriraj for this procedure. Any other hospitals that would be good choices?

Thanks!

TG

[SteveReilly]

Hi I have had the same surgery at both St Louis and Bangkok Christian..St Louis was about 50k 6 years ago, and Bangkok Christian (Dr Somchai) was about the same or a little higher a few years later

Baumrungrad and Samitivej etc are all priced high. Two hospital groups own most of the hospitals which cater to farangs. Then there are some not-for-profit hospitals as well as thai govt hospitals. You should be aware that doctors rotate from hospital to hospital. Dr Somchai for example is a teacher at Chula Hospital, and also receives patients at both BNH and Bangkok Christian. When I met him at BNH for shoulder and mentioned the BNH price for arthro shoulder, I balked. He then used his connections to get me into Chula, huge savings and surprisingly a good hospital, and performed the same surgery on me there. The Chula wait list is long however, about a month or two.

[Sheryl]

I can't get that website to open and the only website I can open for Siriraj after hours seems still under construction.

There have long been plans to open up a private section of Siriraj with the same docs available after hours/weekends. If that is up and running now, then you can directly access the doctor of your choice, provided s/he has a private practice there. The cost may not be as low as you might expect, but it will be less than Bumrungrad.

If you are thinking of going in to the main (public) service of Siriraj, cost will be mush less but lots of red tape, you will nto be able to choose your doctor, and the surgery will likely be performed by residents in training (under the supervision of an attending, of course).

You might try one of these this doctors at Saint Louis, which will probably cost less than Siriraj/private but still more than Siriraj/public:

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=903 (Dr. Dr. Aree Tanavalee)

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=835 (Dr. Prachan Banlhasuek).

[SteveReilly]

I was curious so i checked my records for arthro knee at Bangkok Christian. Cost was 90,000 baht, about twice that of St Louis a few years before. Both of these were for torn meniscus.Dr Pongpun was my doctor at St Louis, assisted by Dr Sarunpong.

[pluto_manibo]

OP! I share your pain. I also have a couple tears and an ACL impingement which need surgery. I was treated in Bumrungrad last year for an ACL graft and meniscal tears( knee arthroscopy) and probably would go back there, if the insurance covers the costs for my current situtation. Do your research not all meniscal injuries need surgery....it all depends in which area of the meniscus, the size of the tear, your lifestyle, age, pain etc....Good luck! I was quoted same price for ACL graft(Hamstring) and meniscal trim, last year. As stated, unfortunately I need to go again for meniscal tears and some "clean up". Looking forward to Surfing in Bali for a week, then time to face the issue and go for surgery. Wherever you go, please do share your experience. Good recovery!

[TerraplaneGuy]

I can't get that website to open and the only website I can open for Siriraj after hours seems still under construction.

There have long been plans to open up a private section of Siriraj with the same docs available after hours/weekends. If that is up and running now, then you can directly access the doctor of your choice, provided s/he has a private practice there. The cost may not be as low as you might expect, but it will be less than Bumrungrad.

If you are thinking of going in to the main (public) service of Siriraj, cost will be mush less but lots of red tape, you will nto be able to choose your doctor, and the surgery will likely be performed by residents in training (under the supervision of an attending, of course).

You might try one of these this doctors at Saint Louis, which will probably cost less than Siriraj/private but still more than Siriraj/public:

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=903 (Dr. Dr. Aree Tanavalee)

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=835 (Dr. Prachan Banlhasuek).

Sheryl, thank you. Do you have thoughts on Lerdsin hospital? My Thai nurse friend (recent grad) suggested it for osteo.

[TerraplaneGuy]

OP! I share your pain. I also have a couple tears and an ACL impingement which need surgery....

Pluto, thanks, I'm curious about what they did with your tears. I'm told that sometimes they can repair them (some kind of stitching I believe) but more often they just trim them back, I assume to make them smooth and prevent further tearing. What did they do to you and how well did it work? Sounds like you have ongoing issues unfortunately.

[TerraplaneGuy]

I was curious so i checked my records for arthro knee at Bangkok Christian. Cost was 90,000 baht, about twice that of St Louis a few years before. Both of these were for torn meniscus.Dr Pongpun was my doctor at St Louis, assisted by Dr Sarunpong.

Steve, were both your operations for the same knee? I'm curious about whether these things tend to recur. Also, if your last surgery was just a few years ago, that's quite a difference in cost, between yours at THB 90K versus my Bumrungrad quote of THB 250-270K! (and I don't believe there is anything unusual about mine, it's a first, single tear).

[NeverSure]

I was curious so i checked my records for arthro knee at Bangkok Christian. Cost was 90,000 baht, about twice that of St Louis a few years before. Both of these were for torn meniscus.Dr Pongpun was my doctor at St Louis, assisted by Dr Sarunpong.

Steve, were both your operations for the same knee? I'm curious about whether these things tend to recur. Also, if your last surgery was just a few years ago, that's quite a difference in cost, between yours at THB 90K versus my Bumrungrad quote of THB 250-270K! (and I don't believe there is anything unusual about mine, it's a first, single tear).

First, good luck to you and I hope all goes well. There's not much worse than to have a hitch in your getalong. (Cowboy saying, LOL.)

That upper end price sounds outrageous to me. That's more like a Western price. I have a friend in the US, which has a reputation for being expensive. He just had it done for 320,000 baht (US$11,000,) beginning to end including initial consultation, tests, arthroscopic surgery, and some physical therapy. I just called him to verify that. That was a very good doctor and hospital.

Surely, Surely Thailand is cheaper than that? A lot cheaper?

Maybe you got a farang price? I like that 90k figure a lot better.

Good luck.

Mods, please don't hammer me for mentioning the **? It's a valid comparison, and useful information, when looking at a quoted Thai price?

[pluto_manibo]

OP! I share your pain. I also have a couple tears and an ACL impingement which need surgery....

Pluto, thanks, I'm curious about what they did with your tears. I'm told that sometimes they can repair them (some kind of stitching I believe) but more often they just trim them back, I assume to make them smooth and prevent further tearing. What did they do to you and how well did it work? Sounds like you have ongoing issues unfortunately.

Well, on top of the ACL graft,they trimmed the Meniscal tears. Unfortunately, there are new ones grade 2 and grade 3, I believe one will be trimmed and the other sewn back on. If they sew it back on, the recovery time is much longer but your knee function should be much better, if you have an active lifestyle. As, I said before, do your research because not all areas of the meniscus need trimming, some areas have higher blood supplies and can heal on their own. Proper muscle building and physical therapy(quads, hamstrings) can assist the knee in absorbing shock. Unfortunately, this is not my case but maybe yours.

[TerraplaneGuy]

Wow, get this: I just googled some more and there was a study published just a few weeks ago in the New England Journal of Medicine which found that physiotherapy was just as effective as surgery for meniscal tears. Here's a summary from NBC:

http://vitals.nbcnews.com/_news/2013/03/19/17371367-therapy-often-as-good-as-surgery-for-knees-study-finds?lite

Here's the NEJM article:

http://www.nejm.org/doi/full/10.1056/NEJMe1302696

This is important because major studies, also in NEJM, from 2002 and 2008 showed that surgery for knee osteoarthritis was ineffective, but those studies EXCLUDED meniscal tears, so people thought surgery was still good for them. This new study looked specifically at meniscal tears and concluded surgery is no better there either. This is really making me think twice!

[macleans]

The link in OP's post is the the private arm of siriraj. The facilities are first class, one of the very best in the country. Been there once and the combined fees for doc consultation + hospital fee together were slightly cheaper than Phyathai 2 and Vichaiyuth, my regular hospitals. However, the room rates are relatively more expensive, starting from 6,700 baht per night (inclusive of everything). So, I would assume that surgery would also cost as much as other private hospitals in the same class (e.g. 4 stars)

Anyway, I would say that SiPH is a good option for OP, and siriraj docs are renowed for excellence in Orthopaedics. Btw, I'm Thai, but personally believe farangs would be charged at the same rates as locals.

Being a Thai, I wouldn't go near Bamrungrad or BKK hospital since most famous doctors there (i.e. those who teach at medical schools) also have schedules at other private hospitals such as Phyathai 2, Vichaiyuth, st. louis, etc. which are much cheaper yet with good quality and services.

[Sheryl]

I can't get that website to open and the only website I can open for Siriraj after hours seems still under construction.

There have long been plans to open up a private section of Siriraj with the same docs available after hours/weekends. If that is up and running now, then you can directly access the doctor of your choice, provided s/he has a private practice there. The cost may not be as low as you might expect, but it will be less than Bumrungrad.

If you are thinking of going in to the main (public) service of Siriraj, cost will be mush less but lots of red tape, you will nto be able to choose your doctor, and the surgery will likely be performed by residents in training (under the supervision of an attending, of course).

You might try one of these this doctors at Saint Louis, which will probably cost less than Siriraj/private but still more than Siriraj/public:

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=903 (Dr. Dr. Aree Tanavalee)

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=835 (Dr. Prachan Banlhasuek).

Sheryl, thank you. Do you have thoughts on Lerdsin hospital? My Thai nurse friend (recent grad) suggested it for osteo.

Smae issue, it's a government hospital --> can't choose your doc, lots of red tape.

Personally if I were going to go to a govt hospital I'd opt for Chua or Siriraj. Or a military hospital, they tend to be quite strong in ortho.

[SteveReilly]

My 2 operations were for the same knee, about 2 years apart. Second one was at Bangkok Christian in late 2009. Have not been able to run since second operation because cartilage is so worn down. I can only do jump roping, cycling, elliptical and light squats. I will explore artificial meniscus as I am 51. Knee replacement is for much older patients. I agree with Macleans, get the bios of the doctors and find them when they are on duty at the cheaper hospitals e.g St Louis, Siriraj, Bangkok Christian

By the way, before I checked out of Bangkok Christian after the operation and before settling the bill, a customer service rep named Joy encouraged me to buy a membership card for 300 baht which gave me 10-30% reduction on certain charges, including room and nursing. The card was effective immediately when settling the bill.

[TerraplaneGuy]

The link in OP's post is the the private arm of siriraj. The facilities are first class, one of the very best in the country ...

Macleans, thanks. I see you're Thai, I'm not and the problem I'm having with the Siriraj site is that I don't see any English version. So I can't figure out how you get involved in this private arm. Do you have any info in English you can shoot me about where I'd go, whom I'd talk to, etc. to get registered there and try to see this Dr. Ba or another good orthopedic doctor? I don't want to go and stumble about the public arm aimlessly.

[macleans]

Not sure if I understood you correctly, but the link you posted is the link of the private arm. The public arm has another site. There is an English version of the website if you go to the main page. Anyhow, here it is http://www.siphhospital.com/en/index.html.

But the english site's not well constructed (yet), and there're no specific details on their medical centers and list of doctors. Nevertheless, I got you this. Click on each doctor and learn about his/ her qualifications. You can then indicate to me which doctors you're interested in and I'll tell you how you can pronounce their names. Then you can give the hospital a call. They have a staff who can speak English.

http://www.siphhospital.com/th/medical-services/find-doctor.php?dept_list=29

[TerraplaneGuy]

Not sure if I understood you correctly, but the link you posted is the link of the private arm. The public arm has another site. There is an English version of the website if you go to the main page. Anyhow, here it is http://www.siphhospital.com/en/index.html.

....

Macleans, thanks a lot. I didn't realize that link in my original posting was from the private arm. I'm going to try to call them after Songkran and see if I can get an appointment with Dr. Ba. My Thai friend translated his name for me and he seems well-qualified. I might take you up on your kind offer if he turns out not to be suitable or available. I'm hoping their fee is significantly lower than Bumrungrad's.

[macleans]

That's ok. The first name of your preferred doc is pronounced as "Bor-worn-raat" while his surname is pronounced as "Wa-na-du-rong-wan". You should state his first name in full or else the staff will get confused. Hope this helps.

[uhuh]

I can't get that website to open and the only website I can open for Siriraj after hours seems still under construction.

There have long been plans to open up a private section of Siriraj with the same docs available after hours/weekends. If that is up and running now, then you can directly access the doctor of your choice, provided s/he has a private practice there. The cost may not be as low as you might expect, but it will be less than Bumrungrad.

If you are thinking of going in to the main (public) service of Siriraj, cost will be mush less but lots of red tape, you will nto be able to choose your doctor, and the surgery will likely be performed by residents in training (under the supervision of an attending, of course).

You might try one of these this doctors at Saint Louis, which will probably cost less than Siriraj/private but still more than Siriraj/public:

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=903 (Dr. Dr. Aree Tanavalee)

http://www.saintlouis.or.th/clinic/doctor.php?dr_id=835 (Dr. Prachan Banlhasuek).

as Maclean said, the private arm of Siriraj has been open for a while now (about 2 years), but it is not that cheap.

Somewhat cheaper than Bumrungrad though.

The kind of medicine they do there is VERY different from Bumrungrad or Bangkok Hospital, it is much more Thai style Western medicine (do as little as possible, prescribe as little medication as possible, discharge the patient as soon as possible) than in the others (do as much as possible as long as insurance or patient pays, prescribe as much medication as possible, keep the patient as long in the hospital as someone pays for it).

Where in Siriraj they give u one medication and discharge u after 3 days, in Bumrungrad they give u 10 medications and keep u for a week.

[TerraplaneGuy]

Please bear with me as I'm trying to get clear on how these hospitals work (it's my first time). So Siriraj has two arms, public and private. Let's take this orthopedic fellow, Dr. Borwornraat (whom I called Dr. Ba). He's listed on the private website. But I understand he also does work at the public side because apparently he is available Tuesdays from 9-11 am (and only then) for a walk-in clinic (so says my Thai friend who called the main hospital switchboard a couple days ago). If so, I'm wondering whether I would save a lot of money trying to get him via the walk-in public clinic rather than book him through the private arm. I realize it would be more cumbersome and annoying and, from what Sheryl said above, maybe when it came to the surgery I couldn't be sure he would do it, maybe they'd substitute an entirely different doctor or have residents do it under his supervision. But still, presumably a much cheaper alternative to at least consider. Or am I getting this all wrong?

Any clarification much appreciated.

TG

[macleans]

I'm not sure if you'd be able to choose your Dr. if you follow the public route. Moreover, the queue for surgery can be very long and you'd end up using the old facilities at Siriraj puplic hospital (which are not bad). Suggest you ask your friend to call them to confirm.

Alternatively, you can try the afterhours clinic, which is also a public route. For the afterhours clinic, if memory serves me right the consultation fee is in the 300-400 baht region + a small hospital fee (haven't used the clinic for a long long time. again call to check). The expenditures on surgery and hospital stay should be about half of what a 4-star private hospital would normally charge you. By going through this route, however, you'd be able to choose your Dr. and I think Dr. Borwornrat may also have his schedule at the afterhours clinic. The red tape would be less and the queue would be much shorter than the walk-in clinic. My friend whose father once had a surgery through the afterhours clinic said he was satisfied with the treatment and patient care.

[CaptHaddock]

FYI. I had a meniscal tear about 10 years ago. I decided not to do the arthroscopic surgery. The pain and swelling went down on their own in a short time. I no longer run, but I do swim every day and I have had no problems with the knee since. YMMV.

[SteveReilly]

Hi why dont u just pay a thai student or unemployed friend 500 baht to translate for you and take a trip to Siriraj? that is what i did when i went to Chula a few years back in 2010 for should surgery...

[SteveReilly]

http://fitness.mercola.com/sites/fitness/archive/2013/04/05/unnecessary-knee-surgery.aspx

[TerraplaneGuy]

FYI. I had a meniscal tear about 10 years ago. I decided not to do the arthroscopic surgery. The pain and swelling went down on their own in a short time. I no longer run, but I do swim every day and I have had no problems with the knee since. YMMV.

Thanks - do you recall whether you had a large tear (or flap as they call it)? That's what they're saying I have.

[Sheryl]

with a large tear, surgery is usually unavoidable. Certainly no harm in getting 102 other pinions though, and in the process you may find some well qualified docs at hospitals less expensive than Bumrungrad.

Be sure to ask specifically how many of these procedures they have done. And in the case of hospitals where you can't review doctor CVs (e.g. govt hospitals, miliitary hospitals) if you don't have access to their CV ask about board certification and where they did their residency/fellowship.

[MaiChai]

All the hospitals pull in specialist as required. That's how it works here. Pra Ram 9 is a good hospital in the mid price range. Wife has had excellent treatment there. Highly recommended.

Sent from my i-mobile IQ 5.1 using Thaivisa Connect Thailand mobile app

[TerraplaneGuy]

with a large tear, surgery is usually unavoidable. ...

Sheryl, thanks. What the MRI report said was a horizontal tear with "large flap displacement". I don't want to sound paranoid but after my visit to Bumrungrad I wondered whether just possibly they were exaggerating the "large flap" bit. I doubt it, but the reason it came to mind is that the surgeon was so definite about operating and gave such a high fee estimate. What I wondered was whether maybe they are getting push-back from insurers since there are those studies questioning the efficacy of the surgery, and in order to make sure they get a green light they exaggerate the size of the problem. I hope not - unfortunately I can't make any sense myself of the MRI (I got the pictures) so I can't tell. I'll definitely get at least one more opinion (and estimate) from another hospital before deciding.

[Sheryl]

The fee quoted, while high, is standard for Bumrungrad these days, as well as other large private "international" hospitals.

The report you have is the radiologist's interpretation plus you were given the doctor's assessment. As most people in Thailand lack insurance I doubt that has anything to do with what you were told. But by all means get additional opinions, bringing the film with you.

I don't know what studies you refer to but arthroscopy is the standard treatment for this. In its absence the tear is likely to worsen. Note that surgery is best performed within 2 months of the tear.

[TerraplaneGuy]

.... I don't know what studies you refer to but arthroscopy is the standard treatment for this. ...

Sheryl, I think I posted a link to the NEJM studies above. If you can't get these links just google "2013 arthroscopy meniscal new england journal of medicine ''

Here's the recent one, just last month:

abc news summary: http://vitals.nbcnews.com/_news/2013/03/19/17371367-therapy-often-as-good-as-surgery-for-knees-study-finds?lite

the journal article:

http://www.nejm.org/doi/full/10.1056/NEJMe1302696

You'll see the journal refers to two earlier studies from 2002 and 2008 that found arthroscopic knee surgery was no more effective than placebo or physiotherapy. Those studies excluded meniscal tears but this new study specifically focused on them and found the same thing.