Orthopedic surgery | TOTAL HIP AND KNEE REPLACEMENT

CubaHeal Research Department: Cuba is at the forefront of orthopedic surgery, continuously evolving, creating new surgical techniques, designing medical devices, and improving patient’s quality of life. Hospitals in Cuba adhere to a strict conduit of hygiene, while also providing patient-center medical care. Due to the high standards of professionalism and efficiency that hospitals and medical staff uphold. Cuba attracts over 25 000 medical tourists each year.

Cuba has brought numerous innovations in the field of Orthopedics and Traumatology over the years, from which the entire world has benefited. Cuba has contributed to numerous advancements in joint replacement surgical techniques, As well as the development of more durable and efficient joint replacement prosthesis.

Total Hip Replacement Surgery

The primary indication for total hip replacement surgery is to relieve pain caused by severe osteoarthritis, inflammatory arthritis and avascular necrosis of the femoral head. Secondary indications include correction of significant deformities and post-traumatic reconstruction. Joint replacement is considered when the pain is disabling and significant or in cases in which joint dysfunction is causing significant reduction in the patient’s quality of life.

The surgery implies removing the damaged joint and replacing it with an artificial prosthesis. The artificial hip joint replacement has traditionally been made with cemented polyethylene cup implants.

However, Cuba has advanced to using “cementless” prostheses. These particular prostheses have microscopic pores which allow bony ingrowth from the normal femur into the prosthesis stem. This “cementless” hip is felt to have a longer duration and is considered especially for younger patients. The prosthesis can also be customized acording to the patient’s needs and anatomy.

Cuba has pioneered the surgical technique for cementless hip replacement surgery that is currently being used world-wide.  Although many varieties of these specialized prostheses now exist; the most used model in Cuba is a prosthesis made of metal and polyethylene covered with hydroxyapatite , which is the main mineral component of bone , obtained naturally from coral and also synthetically in the laboratory. It is produced at the National Scientific Research Center, part of the west Havana scientific complex.

Advances in hip replacement surgery have also allowed for a „minimal invasive” surgery technique to be developed. The classical hip replacement surgery technique implies making an 10 to 25 cm cut along the side of the hip. In the minimally-invasive approach, doctors make one to two cuts from 5 to 13 cm long. The same procedure is performed through these small incisions as with standard hip replacement surgery. The aim of the minimal invasive approach is to limit soft-tissue and bone dissection.

Specialized instruments and trained assistants are essential for the success of this technique. The instruments are designed to keep the assistant’s hands out of the operative field while generating less tension on the soft tissues. Robotic or computer guidance can be used to virtually visualize the minimally exposed anatomy.

The use of small incisions, coupled with minimal tissue damage has been shown  to lessen blood loss, ease pain following surgery, shorten hospital stays, reduce scar appearance, and speed healing. Moreover, 97% of patients attained standard physical therapy goals (transferring in and out of bed from standing, rising from a chair to standing, moving from standing to sitting, walking 100 feet, and negotiating a full flight of stairs) within 1 day of surgery. 

While the technique is certainly an advancement in hip replacement surgery; it is difficult and requires highly trained medical team. Smaller incisions mean poor visibility of the area. Surgeons need to have excellent understanding of the anatomy of the region and have access to specialized hands-on training by operating on cadavers and by visiting experienced surgeons.

Specialized instruments and trained assistants are also essential for the success of this technique. The instruments are designed to keep the assistant’s hands out of the operative field while generating less tension on the soft tissues.

Total Knee replacement surgery

The primary indication for total knee replacement surgery is relief of significant, disabling pain caused by severe arthritis. Generally, it is indicated in older patients with more modest activities. It is also clearly indicated in younger patients who have limited function because of systemic arthritis with multiple joint involvement.

Significant advances have occurred in the type and quality of the metals, polyethylene, and, more recently, ceramics used in the prosthesis manufacturing process, leading to improved longevity. As with most techniques in modern medicine, more and more patients are receiving the benefits of total knee arthroplasty. In Cuba, an average of 140 total and revision knee replacement surgeries per 100.000 population are performed annualy.

For total knee replacement surgery Cuba now uses the KALISTE prosthesis model, manufactured by the French company FHorthopedic. Kalisté Total Knee System  is a tricompartmental resurfacing prosthesis that allows the surgeons to begin the knee replacement surgery with either the tibial stage or the femoral stage. This prosthesis can be customized to the patient’s anatomy and has been designed to admit posterior cruciate ligaments PCLretaining or posterior stabilized PS Knee prosthesis.

The use of this knee replacement prosthesis coupled with the excellent surgical techniques that Cuban surgeons employ have led to excellent success rates. Statistics show that 91% of patients that have undergone the technique attained standard physical therapy goals within 2 day of surgery. 

In addition to providing excellent medical care, Cuba has extremely affordable prices for various orthopedic surgeries, including total hip and knee replacement. A standard that should be upheld all over the world as medical care is a right, and not a privilege.