Simone Seymour
It is over four months since I had hip-replacement surgery in Malaysia. In NZ, it is up to a two-year wait for the public health service or five or so months to go privately. By contrast: after an arranged video-link with a surgeon, the request from the ALTY Orthopaedic Hospital in Kuala Lumpur [KL] was: how soon can you make travel arrangements to come?
My budget was $NZ30k, for the hospital, travel and accommodation. My daughter decided that a 70-something senior citizen couldn’t be trusted alone abroad, so some of that cost was for my caregiver/overseer. Said overseer made a few unilateral decisions about the trip home, so the budget blew out by at least an extra $NZ10k. Ouch. The credit-card recovery from that took as long as the physical recovery.
Now, I’m back walking without a stick for support and trying to rebuild the muscle tone and stamina lost while the hip joint degenerated and I spent too much time sitting. I now realise that I had waited too long before making the decision to go to KL to have the operation. Great thing, hindsight.
The hospital was a modern, pleasant place. A lasting memory is of an ambience of happiness and laughter coming from the nurses’ station in my ward. Studious attention from senior medical staff was also notable – even over the weekend. I was told that, from a young age, most of the local population are taught three languages at school: Malay, English and Mandarin Chinese. Therefore it was rare for there to be any communication problems, even if the accents were a bit of a challenge for older ears.
For someone unused to spicy foods, and despite marking the meal order sheets appropriately, the hospital meal offerings were a tad feisty – enough to be inedible in some cases. Asian porridge is not what we’re used to! But I wasn’t doing much except lie there, so little energy was being expended.
Two days post-op, a physiotherapist instructed me on the correct method of getting out of (and back into) bed, on to a commode chair, plus a number of bed exercises for my operated-on leg. After three days, and with the aid of a walking frame, I was up and making my way around the ward, under the eagle-eye of a physiotherapist. Somewhat to the amusement of the nurses, I was ‘encouraged’ thus: ‘head up – don’t look at your feet; don’t stoop – keep your back straight; don’t shuffle’.
Admitted on the afternoon of 12 June, operated on 13 June and discharged on 18 June. Six nights in the hospital. Before leaving KL, I had a final clearance check with the surgeon on 20 June. Getting in to a taxi was very difficult. After the first attempt, a larger car was ordered and I sat in the front seat. I had more than a few pills to take two or three times daily. I had no pain but that may have been the medication.
The sternest of the discharge plan instructions was to never sit such that the knee of the operated on hip/leg was above the horizontal hip line. Perhaps the sitting was not as much the problem as the bad pressure potential put on the freshly transplanted and unstable hip joint when attempting to move and especially to stand. When standing up, the operated leg had to be extended so that it was unusable. All the effort of raising the body was to be made by the non-operated-on leg and any available upper body support.
The surgeon’s choice of implant size gave me an unexpected bonus: my operated-on leg was lengthened by five millimetres. As a consequence of a long-ago vehicle accident, that leg was shorter than the other. That five millimetres enhancement should reduce the degree of limp in my gait.
Something I learned about while in KL was the three ‘approaches’ to hip replacement surgery: anterior, lateral and posterior (front, side, back). Unless there are serious medical reasons why not, the ALTY surgeons will only use the anterior approach. I believe the reason is that patient recovery/recuperation is much faster after an anterior procedure: eight to 12 weeks.
The patient’s recovery advantage is at a slight disadvantage to the surgeon and hospital. Apparently, it takes 50 per cent longer to perform the anterior approach operation, compared to posterior (which damages more muscle tissue and tendons). After a posterior approach operation, the recovery period is longer: 12 to 18 weeks. My pre-departure inquiries indicated that it is difficult to obtain an anterior procedure in NZ – especially outside the main centres.
Is the ALTY hospital anterior-approach preference one of patient-focussed recovery being a priority? Perhaps so. Maybe it is also influenced by the hospital ownership structure: apparently, the doctors who work there own the place. It may also be that reputation counts where there are more clinics for patients to choose from.
To avoid any doubt, I recommend the ALTY hospital to any fellow New Zealanders who need a hip transplant and can afford the cost.
