Hip and knee joint replacement surgery and successful endoscopic gallstone removal for a 105-year-old patient
The Ho Chi Minh City University of Medicine and Pharmacy Hospital (BV ĐHYD TPHCM) has just successfully performed knee joint replacement, endoscopic removal of gallstones, and hip joint replacement for a 105-year-old patient. This is a rare case; the elderly patient suffered a fractured femoral neck and multiple accompanying internal medical conditions, requiring multidisciplinary collaboration in diagnosis and treatment to help the patient walk again and avoid dangerous complications after a fall. Thanks to good coordination among specialties, despite the advanced age and frail condition, the patient underwent three major surgeries smoothly, recovered well, and experienced no adverse events or complications during treatment.
Elderly patient with multiple internal diseases
This is the case of patient V.T.S. (105 years old, residing in Ho Chi Minh City). Previously, Mrs. S. suffered from knee osteoarthritis, making walking difficult. On one occasion while moving around the house, she slipped and fell, causing her buttocks and back to hit the floor. After the fall, she felt pain and could not move. Family members took her to the emergency department at the University of Medicine and Pharmacy Hospital, Ho Chi Minh City. After examination and X‑ray, doctors said she had a fracture of the left femoral neck on the background of knee osteoarthritis that made walking difficult, leading to the fall. Mrs. S. also suffers from many chronic diseases such as localized myocardial ischemia, hypertension, atherosclerosis, hyponatremia, pulmonary fibrosis, and pulmonary hypertension.
Associate Professor Dr. Bùi Hồng Thiên Khanh – Head of the Orthopedic Trauma Department, Hospital of Ho Chi Minh City, says that if joint replacement is not performed, the patient will have to stay in place due to pain and inability to turn, causing restrictions in eating, drinking, urination, defecation and difficulties for caregivers. This easily leads to respiratory, circulatory and renal complications such as lung infection, urinary infection, pressure ulcer in the sacral area… leading to death. In response to the family's wish for Mrs. S. to be able to move again, the Orthopedic Trauma Department planned a partial left hip replacement and knee replacement for her. However, for effective treatment, interdisciplinary cooperation is needed to properly control underlying medical conditions and minimize possible complications during the surgery.
Interdisciplinary collaboration in diagnosis and treatment
Given the condition of elderly patients with multiple accompanying internal medical diseases, specialists in Orthopedic Trauma, Cardiology, Hepatobiliary - Pancreas, Thoracic Vascular, Endocrinology, Respiratory,Elderly – Palliative care, Anesthesia - Intensive Care, Advanced intensive care, Rehabilitation – Physiotherapy… quickly convened, discussed to propose the most suitable treatment method for the patient.
Prof. Dr. Phan Ton Ngoc Vu – Head of Anesthesia – Intensive Care Department, Ho Chi Minh City University Hospital shares: “To ensure the safety of the patient,
At the beginning of August 2020, doctors performed a partial hip replacement for the patient, combined with continuous spinal and epidural anesthesia. The operation proceeded smoothly. On the first day after surgery, the patient was able to sit up and turn independently. Two weeks after the first surgery, the patient was undergoing physical therapy, preparing for knee replacement surgery, when suddenly symptoms of right flank pain, high fever, and jaundice appeared. After tests, ultrasound and abdominal CT, doctors discovered the patient had complicated biliary stones. If not intervened promptly, the patient is at risk of severe infection and could die.
After that, the doctors perform low-dose general anesthesia to conduct retrograde endoscopy to remove gallstones for the patient. This is a minimally invasive procedure that helps the patient recover quickly and avoids dangerous complications. After successfully performing the gallstone removal procedure, about a week later, the patient continues to undergo knee replacement surgery in a stable health condition.
X-ray image of the patient\'s knee joint after surgery
Safe and effective treatment methods for elderly patients
After surgery, the patient quickly begins physical therapy – rehabilitation and uses medication to treat underlying conditions. After 4 weeks, the patient can walk again, with stable health condition. Before discharge, the patient and family are instructed on simple exercises to continue maintaining physical therapy at home. The follow-up examination in October 2020 showed the patient recovered well, able to walk independently and live normally.
The patient was discharged in stable health condition
According to Associate Professor Dr. Bùi Hồng Thiên Khanh, this is one of the oldest patients in Vietnam to undergo both hip and knee joint replacement surgery. Previously, such major surgeries were often contraindicated for elderly people because of the risk of many complications and adverse events during the operation. However, with the development of medicine, anesthesia and intensive care methods together with coordination among specialties within the same medical facility have helped elderly patients, who have many internal medical conditions diagnosed and treated early, also undergo surgeries safely and effectively. As a result, patients have a better quality of life, avoiding dangerous complications that could occur.
Assoc. Prof. Dr. Bùi Hồng Thiên Khanh examines the patient after surgery
Assoc. Prof. Dr. Bùi Hồng Thiên Khanh recommends that falls are one of the leading causes of death among the elderly. When falling, older people are very prone to fractures due to aging and low bone density. Therefore, calcium should be supplemented in the diet for older adults, increase sports training and undergo regular health examinations to prevent osteoporosis risk. In case an elderly person suffers a fracture, the broken area should be promptly immobilized and taken to a medical facility with an orthopedics–trauma surgery department for timely diagnosis and treatment.