Joint Replacement Surgery (Hip/Knee)

• Bone tumours around the joint, in selected cases where partial or total replacement is the best option.

Not every patient with joint pain is a candidate. Surgeons usually advise against replacement in the following situations.

• Active infection anywhere in the body, because bacteria can travel to the new joint.
• Severely weakened bones that cannot anchor the prosthesis securely.
• Very young, highly active patients where the prosthesis is likely to wear out before natural lifespan allows.
• Serious heart, lung, or kidney conditions that make general or spinal anaesthesia too risky.
• Obesity at a level that substantially raises surgical and healing risk, until weight is reduced.

• Leg-length difference after hip replacement, sometimes needing a shoe insert to correct.
• Dislocation of the hip prosthesis if the joint is moved into certain extreme positions too soon after surgery.
• Nerve or blood vessel injury near the joint during the operation.
• Reactions to anaesthesia, including nausea, allergy, or, rarely, more serious events.
• Wear of the prosthesis over time, leading to small particles that can cause local bone loss.

• Chest X-ray to assess the lungs and heart size.
• X-rays or MRI of the affected joint to plan the exact size and position of the implant.
• Urine test to rule out an undetected infection before surgery.
• Dental check, because bacteria from untreated dental disease can infect the new joint.

On the day of surgery, the typical sequence of events unfolds as follows.

• 1. You are admitted and change into a hospital gown. Nursing staff check your vital signs and confirm your allergy history and medication list.
• 2. An intravenous (IV) line is placed in your arm to deliver fluids and medication.
• 3. The anaesthetist meets you to discuss whether you will have general anaesthesia (fully asleep) or spinal anaesthesia (awake but numb from the waist down). Most knee replacements use spinal anaesthesia; hip replacements may use either.
• 4. You are moved to the operating theatre and positioned on the table. The skin over the joint is cleaned with antiseptic solution.
• 5. The surgeon makes an incision (cut) over the joint, moves muscles aside without cutting them where possible, and removes the damaged bone ends and cartilage.
• 6. The prosthetic components are fitted: a metal stem into the thigh bone (femur) and a cup into the pelvis for hip replacement, or shaped metal caps on both sides of the knee with a plastic spacer between them for knee replacement.
• 7. The surgeon checks the fit and range of motion, then closes the layers of tissue with sutures or staples and applies a sterile dressing.
• 8. You are moved to a recovery room where nurses monitor your blood pressure, pain level, and the returning feeling in your legs.

• Return to desk work may be possible after four to six weeks; physically demanding jobs take longer, often three to six months.
• High-impact activities such as running or jumping are usually discouraged long-term to protect the prosthesis from early wear.
• Follow-up X-rays are taken at regular intervals, often at six weeks, one year, and then every few years, to check the prosthesis is sitting correctly and showing no signs of loosening.
• Before any dental procedure or invasive medical test in the future, tell your doctor you have a joint prosthesis. Antibiotics are sometimes given in advance to prevent bacteria from reaching the implant.
• Lifestyle changes that protect the joint include maintaining a healthy body weight, strengthening the muscles around the joint, and avoiding falls.

• Anaesthesia type and duration: longer or more complex anaesthesia adds to the fee.
• Pre-operative tests and imaging: blood panels, X-rays, and MRI scans needed for planning are usually billed separately or itemised within a package.
• Post-operative medication: blood thinners, pain relief, and antibiotics prescribed after discharge add to the out-of-pocket cost.
• Rehabilitation: inpatient physiotherapy may be included in the hospital stay, but outpatient physiotherapy sessions after discharge are often an additional expense.

Hospital packages for joint replacement typically include the surgeon's fee, anaesthetist's fee, operating theatre time, the prosthesis itself, hospital accommodation, nursing care, and the first set of physiotherapy sessions. Items that are commonly billed separately include pre-admission tests run outside the hospital, any specialist consultations added during the stay, take-home medications, and outpatient rehabilitation after discharge.

For Indonesian patients, BPJS Kesehatan and most Indonesian private insurance policies do not cover treatment received abroad. Patients travelling overseas for joint replacement usually pay out of pocket or through an international private health insurance plan that explicitly includes overseas surgical cover. Before confirming travel plans, ask the hospital for a written cost estimate that itemises the prosthesis, stay, and rehabilitation separately. This makes it easier to compare options and prevents unexpected charges on arrival.