Orthopaedics

Mackay Memorial Hospital ‘s Department of Orthopedics averages 11,000 outpatient visits and 600 surgeries a month, with a total of 141 inpatient beds.
In addition to General Orthopedics, we’re also equipped with a hyperbaric oxygen therapy center and a biomechanics Lab. The former provides treatments for chronic osteomyelitis, carbon monoxide poisoning, and bone necrosis caused by radiation therapy; the latter is currently working with the Institute of Biomedical Engineering of National Yang-Ming University on the research of artificial joint, biomechanics, and orthopedic diseases. In recent years, we’ve been dedicated to the development of sports medicine, arthroscopy, and minimally invasive spine surgery. With a view to the future, our department plans to set up a spinal trauma center to provide emergency treatment, surgeries, rehabilitation, and other services to patients with spinal injuries. With the introduction of advanced surgical navigation systems, we’re looking to benefit more patients.
Service Item

Knee replacement for patients with severe knee osteoarthritis.

Service Description
For severe knee osteoarthritis, after treatment of oral medication and injection fails, knee replacement surgery is a great choice for those who still suffer from pains and joint deformity.

Being the first hospital in Taiwan to practice Western medicine, Mackay Memorial Hospital has been treating severe knee osteoarthritis with artificial knee replacement surgery ever since the 1970s.

While early traditional surgery took care of the pains and deformaty, it left much to be desired when it came to functionality, as the patients still couldn’t fully bend their knees, squat, kneel, or exercise their joints.

In recent years, surgical procedures and approaches have continued to be improved upon, and new materials to be studied and developed. Our hospital adopts highly flexible and wear-proof artificial knee joint designed specifically for women. Our medical equipment is on a par with that of Europe and the US . It is adaptable to different symptoms and works well with minimally invasive surgical techniques to provide patients with safety, comfort, and the best quality of life!

Who needs it?
For patients with severe knee osteoarthritis who still suffer from pains and joint deformity after treatment of oral drugs and injection fails, knee replacement surgery is an excellent choice.

The average life span for an artificial knee joint is about ten to fifteen years. Not all patients need artificial joint replacement. Younger patients and those with mild symptoms will fully improve with medication, physical therapy, arthroscopic surgery, and high tibialosteotomy. Therefore, in order to reach the maximum therapeutic effect, appropriate treatments should be selected according to the different severity levels of arthritis.


Treatment Methods

The principle of artificial joint replacement is to rectify deformity, remove the damaged surface, and replace it with metal component with the help of UHMWPE pads between metal and the joint. Artificial joints are an effective replacement that can bend to an angle of 135 degrees. F or patients with severe joint degeneration, it helps them regain the ability to walk and to have a normal life.

Currently, different parts of the joint surface can be replaced in accordance with the scope and location of damage to the knee joint. Based on professional judgment, doctors will recommend the area of replacement to the patient.

1. Anterior Wear: PF Knee Replacement surgery for articular   surface of patella and femur removes the degenerative surface and replaces it with metal component. The reconstruction only involves part of the anterior surface of patella and femur, therefore the incision, bleeding, and post-operative pains would be kept to a minimum. As a result, complete recovery of functions can be expected much sooner.

°©¬ì.PDFX-rays before surgeries
°©¬ì.PDFX-rays after surgeries

2. Medial/Lateral Wear: Uniknee Replacement is reserved for patients who only have wear in one medial or lateral joint compartment of tibia or femur. The damaged articular surface will be replaced with metal component after excision.

°©¬ì.PDFX-rays before and after surgeries on medial compartments of tibia and femur.
°©¬ì.PDFX-rays before and after surgeries on lateral compartments of tibia and femur.

3. Anterior/Medial/Lateral Degeneration: Total Knee Replacement is necessary when the articular surface suffers from severe degeneration and deformity. Total knee replacement consists of UHMWPE components for patella, as well as components for femur and tibia. The patella component is entirely made of UHMWPE, and is anchored to the patella with bone cement. Metal components, aided with UHMWPE pads, are used for femoral and tibial joints and anchored to the tibial components.

Most of the pads are designed in the same shape as femoral articular surface in order to increase stability and reduce contact pressure from polyethylene material. As modern technologies advance, the UHMWPE pad has also greatly improved in both strength and wear-resistance.

°©¬ì.PDF °©¬ì.PDF

Potential Surgical Risks

All surgeries come with potential risks. Before operation, the anesthesiologist would evaluate the patient’s physical conditions, and consult with other doctors if necessary, so that the risk of surgery can be kept to a minimum. Patients with diabetes, hypertension, and heart disease aren’t necessarily prohibited from surgery. Careful evaluation and preoperative control treatment are the key. Infection is the most common and most damaging postoperative complication. It could happen within a few days or a few years after surgery.   Antibiotic treatment is required for milder cases. Removal of artificial joint and debridement of sequestrum are required for more serious cases. Only after infection is under control can a new artificial joint be implanted. Fortunately, the rate of occurrence is low. Take total knee replacement for example, our hospital has a rate of less than 0.5%. Infection may be effectively avoided by strict aseptic techniques and the postoperative use of antibiotics .

Surgical Benefits

  1. Long-term studies clearly show artificial joints have excellent durability, and can significantly improve patients’ quality of life.
  2. Current use of minimally invasive surgical techniques helps reduce the size of incision and the pains. Most of the patients undergoing total knee replacement can be discharged approximately in five days.

Surgical Complications and Possible Treatment

Although the success rate  of surgery is high and the chance of complications small, a few patients still might develop complications, such as poor wound healing, instability, damage to   nerves and blood vessels, infections, fractures, fat embolism, venous thrombosis, problems with stretching mechanism, and stiffness. With proper choice of incision position, recognition of risk factors, as well as appropriate and immediate treatment, skin problems can be effectively avoided. Attention to ligament balance and flexion-extension gap balancing can help maintain proper knee stability. Damage to nerves and blood vessels is rare. With our total knee replacement technology and experience, the rate of complications is extremely low.
Prevention of   venous thrombosis is necessary   because it   is the most likely of fatal complications. Current   methods   of prevention include   early -stage exercise s ,   mechanical assist devices,   and   the use of certain   drugs. With correct   surgical techniques   and   the right choice of components , such complications   can usually  be avoided.

Result


Surgery Code Cases
Shoulder hemiarthroplaty 81.81 11
Total elbow 81.84 4
Total wrist 81.73 0
Total finger 81.71 1
Total Hip 81.51 88
Hemi Hip 81.52 146
Total knee 81.54 231
Ankle 81.56 0
Note:The result was from95/8/1– 6/7/31