Yet several sufferers hesitate, worried about the long period of recovery following the operation, the hours of physical rehabilitation and the need for sticks and other walking aids until they feel safe back on their feet.

Now, thanks to a new minimally invasive joint replacement procedure developed in Europe by the Zimmer Institute and adopted by King Chulalongkorn Memorial Hospital in Bangkok, most hip replacement patients are able to walk the day after surgery and some have even returned to work three weeks later.

The minimally invasive anterolateral hip procedure was conceptualised by Heinz Rottinger, in Munich, Germany and further developed in collaboration with leading surgeons from around the world. It was introduced to the orthopaedic community early last year and hundreds of surgeons, among them Chulalongkorn Memorial Hospital's Pibul Itiravivong and Aree Tanavalee, have participated in training held at Germany's Zimmer Institute.

Rottinger recently travelled to Bangkok to explain the procedure to orthopaedic specialists in a lecture organised by Dr Pibul, head of Chulalongkorn Medical School's orthopaedics department, at the hospital's Chula-Zimmer Institute.

"Since I first began using this approach, I have found that my patients are able to return to activities of daily living without the traditional pain and rehabilitation time seen with other procedures," Rottinger says of the operation that spares the muscles and uses a metal and plastic prosthesis, usually implanted without cement, to replace the arthritic hip.

"This new single-incision approach is the next step in our drive to make minimally invasive joint replacement surgery accessible to a greater number of surgeons and patients. I believe it will appeal to surgeons around the globe as it addresses an expanded range of surgeon philosophies and preferences."

Compared to standard hip replacement surgery, potential benefits for patients include less tissue trauma; faster and less painful rehabilitation; a smaller incision (approximately seven centimetres) and less scarring.

In addition, patients only stay in hospital for two or three days as opposed to seven to 14 days for standard surgery, and some are able to go home within 24 hours.

"King Chulalongkorn Memorial Hospital has treated 27 cases. Most of the patients could walk on the next day and within three weeks they could drive, work and continue their normal daily activities," reports Dr Aree, an associate professor of orthopaedics at the hospital.

"Our research indicates that this small, single incision approach helps in providing excellent exposure without muscle damage and facilitates rapid rehabilitation.

"We are always looking to make surgery as minimally invasive to the patients as possible and this new technology is well known globally. It is a great opportunity to bring this technological advance to Thailand. This will bring significant advantages to our patients, and to the surgeons using this new kind of surgery."

Dr Pibul agrees. "Hip replacement is a solution for so many of those in severe pain, especially when it causes loss of mobility and stiffness. Painkillers can reduce the pain for a certain period but they cannot heal. And although physical therapy can help relieve the symptoms, it cannot help in long run.

"With the new technique and modern instruments, the surgeon removes only the old bone and replaces it with a new one. The   patient recovers within a few days. They are able to walk immediately because the pain has gone."

Providing all the procedures are correctly followed, the hip prosthesis can be used for 15 years. The cost at a government hospital should not exceed Bt100,000 including in-patient fees.

Osteoarthritis is a condition that should not be neglected. At the King Chulalongkorn Memorial Hospital alone, more than 3,000 patients come to the outpatients department seeking advice from orthopaedic specialists. Only 10 per cent can be treated. The only factor that cannot be controlled is the age: the older you get, the higher the risk of getting arthritis.

"Keep both the body and the mind as fit and healthy as you can. Control your weight to avoid burdening the hip and knees and avoid sharp movements that jolt the joints, such as jumping, sitting on sitting on your haunches or sitting down hard," advises the doctor.

A daily intake of calcium and vitamin D and regular exercise are still the key to maintaining healthy bones.

Juthamas Cholthavornpong

The Nation