Knee surgery can be frightening as patients often worry about curability and the inability to walk afterwards. To eliminate this anxiety, Hip and Knee Center at Bangkok International Hospital offers total knee replacement surgery that combines cutting-edge pain intervention techniques, such as adductor canal block and radiofrequency nerve ablation to minimize pain.
Knee and Hip Replacement
If you experience severe knee pain when moving, have knee deformities, or chronic knee inflammation, you might have osteoarthritis of the knee. Knee osteoarthritis can greatly impact one’s life, and although there is no cure, lifestyle changes can slow disease progression. However, if the damage is severe, total knee replacement surgery is one of the most effective ways of restoring the knee function, allowing for patients to enjoy life as normal. Other cutting-edge processes employed include the Nobel Prize Winning Biplane Imaging (EOS) system that provides full-body 3D skeleton imaging. Taking less than 20 seconds, it enables orthopedic surgeons to make an accurate diagnosis prior to surgery. Moreover, a Digital Template Computer Program allows surgeons to customize the size and determine the position of the prosthesis, subsequently reducing the possibility of traumatic damage to surrounding areas and prolonging the lifespan of the implants.
Thanks to an emphasis on fast rehabilitation, patients often start walking and restoring full muscle function within 24 hours of surgery. Over 90% of patients who receive total knee replacement surgery experience minimal pain and are able to return to daily activities within 1.5 to 3 months. Similarly, hip osteoarthritis often appears in people older than 40 with contributing factors including genetic abnormalities, autoimmune and SLE diseases, rheumatoid arthritis, and also the long-term steroid use. In its late stages, patients can experience hip pain that may radiate to the knee,
disrupted sleep and limited mobility, resulting in a poor quality of life.
In the past, traditional hip replacement surgery involved making a large incision (6 to 8 inches) on the side of the hip (lateral) or the back of the hip (posterior). Both require muscle and tendon detachment, which causes pain and prolongs the full recovery by months or years. If muscles fail to heal properly after surgery, the risk of dislocation and other unwanted postoperative outcomes also increases. Nowadays, advanced technology in orthopedic surgery allows for less invasive procedures with improved surgical results. For example, the Direct Anterior Approach (DAA) Cosmetic Incision Hip Replacement Surgery has become increasingly popular as it is a minimally invasive surgery involving a smaller bikini incision (3 to 4 inches) hidden at the groin.
The incision allows the joint to be on the natural tissue planes without detaching any tendons and muscles, resulting in less pain, less blood loss, lower post-operative complications, faster recovery, improved mobility
and additional cosmetic benefits. And patients often only spend 2 to 4 days in the hospital before returning home. Prior to the operation, digital template surgical planning is conducted to select a suitable artificial joint for each patient from a wide range, including cobalt chromium or ceramic, while new artificial stems are used to ensure that the prosthesis will not sink after surgery. This provides better accuracy in examining the length of a patient’s legs and location of the joints. We have successfully done more than 500 DAA cases at our hospital.
As a pioneer of DAA hip replacement in the Asia-Pacific region, the experienced team of surgeons at Hip and Knee Center, Bangkok International Hospital uses the latest hip prosthesis, Actis® stem, for ease-of-insertion and improved implant stability so patients restore mobility more quickly. In addition, JointPoint™ is a new non-invasive hip navigation system that provides surgeons with significant data on cup position, leg length, and stem position, thus minimizing complications.
Novel Pain Intervention Techniques
During and after surgery, inadequate postoperative analgesia can impair rehabilitation, prolong hospitalization and increase the risk of complications, such as myocardial ischemia, myocardial infarction, pulmonary dysfunction, paralytic ileus, urinary retention and thromboembolism. Therefore, acute pain management strategy is crucial. Previous options for postoperative pain control included narcotics, epidural anesthetics and spinal anesthetics.
However, despite the effectiveness of opioids, they also produced undesirable side effects, such as vomiting, constipation, confusion and respiratory depression. This has led to a shift in current pain management regimens. Multimodal analgesic regimen is a regimen where multiple drugs, which act at multiple pain receptors, are used in a lower dosage to reduce opioid side effects. As for knee surgery, an adductor canal block, which is conducted at the end of surgery by a well-trained anesthesiologist is a current gold standard for its pain control. During the procedure, a catheter is inserted into the mid-thigh with the assistance of ultrasound guidance technology, aiming for the saphenous nerve in the knee to be anesthetized. The adductor canal block in combination with multimodal pain protocols, such as anti-inflammatory agents and nonnarcotic medications can limit
the use of narcotics, hence reducing its undesirable side effects. With this intervention technique we can ensure that patients do not endure severe pain and are able to walk within 2 to 3 hours after the operation. The main advantage of this technique is preserving muscle strength in order to facilitate rehabilitation and exercise programs after knee surgery, leading
to a quick return to normalcy. Another pain intervention technique is radiofrequency nerve ablation. This minimally-invasive procedure uses conventional or cooled radiofrequency technology to reduce or eliminate chronic pain conditions. This method is often considered an effective option for patients with significant arthritis who are illegible for joint replacement surgery, those who prefer to delay their surgery and patients who are not fit for a major surgery.
During the procedure, with guidance from x-rays and ultrasounds, special radiofrequency needles are placed on nerves that are responsible for pain in the knee or hip. With needle tip placed on the specific area, radiofrequency is started and heats the nerve up to a certain degree. Ablated nerves will stop functioning for a duration of 4 to 6 months up to 2 years, thus pain will be improved. Side effects of this technique are considerably rare due to a precise needle placement technology.
In comparison to other techniques, cooled radiofrequency uses water-cooled technology to safely ablate the nerves that transmit pain signals with lower temperatures (45-60°C). This results in less damage to surrounding tissue and encourages faster recovery, so patients can return to their lives worry free.
Dr. Phonthakorn Panichkul
Joint Reconstruction and Arthroplasty Surgeon, Hip and Knee Center.
Bangkok International Hospital.
Dr. Sarit Hongvilai
Arthroplasty, Trauma and Orthopedic Surgery, Hip and Knee Center.
Bangkok International Hospital.
Dr. Marvin Thepsoparn
Pain Intervention Specialist and Anesthesiologist.