"This is the first time we have performed 4 joint replacements on a single patient within one year", stated Doctor Le Dinh Khoa, head of the Joint Reconstruction Department at Tam Anh General Hospital, TP HCM.

San Samphors had previously sought treatment with medication at hospitals in Cambodia and Thailand, but her condition did not improve, and her pain recently worsened. X-ray results at Tam Anh General Hospital, TP HCM, revealed complete erosion and degeneration of the cartilage in both knee joints. Both hip joints showed severe degeneration, with the femoral heads dislocated from their normal positions and migrating into her abdomen. Doctor Khoa assessed this as a critical case, where surgery was the only method to relieve her pain and restore mobility.

X-ray results show both hip joints had broken through the pelvis and were gradually "migrating" into the abdomen. Photo: Tam Anh General Hospital

After consultation, doctors planned for San Samphors to undergo 4 artificial joint replacements within one year: the right knee, left knee, left hip, and right hip.

For the first joint replacement, doctors employed a muscle-sparing, minimally invasive surgical technique, which helped preserve the soft tissue system around the knee joint. The damaged section was removed, and an artificial knee joint, sized to match the natural anatomical structure, was implanted. Pain management involved a multimodal approach, combining various medications and anesthetic techniques to inhibit pain signal transmission and reduce side effects. After surgery, the patient experienced minimal pain, recovered quickly, and could walk on the first day. Two months later, Samphors underwent a left knee replacement using a similar technique and procedure.

Six months later, after sufficient recovery for the next major surgery, doctors replaced her left hip. According to Doctor Khoa, the greatest challenge was the patient's prolonged degenerative inflammation, which caused significant inward displacement of the femoral head and loss of the acetabular bone. Without precise calculations for bone grafting and artificial joint placement, there was a risk that the new joint could migrate directly into the abdomen, reducing its lifespan and leading to hip dislocation.

The medical team performed a 3D CT scan and utilized MediCAD 3D software for surgical planning, optimizing joint placement and the amount of bone needed to reconstruct the acetabular floor. The surgery was conducted using the ABMS muscle-sparing technique, which helped the patient avoid the risks of dislocation, nerve damage, and post-surgical paralysis. The artificial hip joint was precisely positioned as planned, resulting in a stable joint and a nearly restored range of motion. Both legs were equal in length, enabling the patient to perform complex movements like squatting and crossing her legs after the hip replacement. Three months later, Samphors returned to Vietnam for a right hip replacement, using a similar technique.

Doctor Khoa guides the patient in walking and preparing for discharge after the fourth surgery. Photo: Tam Anh General Hospital

Doctor Khoa explained that rheumatoid polyarthritis is a chronic autoimmune inflammatory arthritis that cannot be completely cured. If not well-controlled, patients face a risk of disability and damage to multiple organs, including the eyes, heart, lungs, skin, and blood vessels. Following surgery, Samphors will continue medication, physical therapy, and regular monitoring to prevent severe disease progression and maintain joint flexibility.

Doctors advise that for autoimmune musculoskeletal diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and lupus erythematosus, patients should undergo close monitoring from the outset to effectively manage the disease and prevent complications that destroy joint cartilage. If surgery is indicated, patients should seek hospital treatment promptly.

Phi Hong