Sara Gezdari of My Medical Gateway talks to Professor Narūnas Porvaneckas, one of Lithuania’s most experienced orthopaedic surgeons, about what British patients should know when considering hip or knee replacement surgery abroad. Professor Porvaneckas, who is based at Meliva hospital in Vilnius, has worked in orthopaedic surgery for almost five decades and has performed several thousand hip and knee replacements. His specialist interests include primary and revision joint replacement, adult hip dysplasia and complex joint reconstruction.
Sara Gezdari: Professor Porvaneckas, when should someone with hip or knee pain begin to consider joint replacement?
Professor Porvaneckas: Joint replacement is normally considered when pain and loss of movement are substantially affecting everyday life and appropriate non-surgical treatments are no longer providing sufficient relief. The decision should not be based on an X-ray alone. We consider the patient’s symptoms, mobility, general health, examination findings and imaging together.
Sara: Can a patient be too young or too old for joint replacement?
Professor Porvaneckas: Age is only one factor. A younger patient may have severe joint damage that makes replacement appropriate, while an older patient may remain suitable if their health allows surgery to be performed safely. The important question is whether the expected improvement in pain and function justifies the individual risks.
Sara: What information do you need from a British patient before deciding whether surgery is suitable?
Professor Porvaneckas: We normally need recent imaging, a clear medical history, details of medication and information about previous treatment or surgery. We must also understand how the condition affects the patient’s daily life. Some patients may require additional tests or specialist clearance before a final decision can be made.
Sara: How do you decide between a partial and total knee replacement?
Professor Porvaneckas: A partial replacement may be suitable when damage is confined to one part of the knee and the remaining joint surfaces and ligaments are functioning well. A total replacement is generally more appropriate when arthritis affects several parts of the joint. The choice must be based on careful clinical and radiological assessment.
Sara: How do you select the right implant for a hip or knee replacement?
Professor Porvaneckas: Implant selection depends on the patient’s anatomy, bone quality, age, activity level and diagnosis. The surgeon should use a well-established implant system with appropriate evidence behind it. There is no single implant that is best for every patient, so selection should be individual rather than driven by a particular brand.
Sara: How long should a modern joint replacement last?
Professor Porvaneckas: Many modern hip and knee replacements function successfully for 15 to 20 years and often longer, but no surgeon can promise an exact lifespan. Implant longevity is influenced by positioning, bone quality, body weight, activity, infection and the way the joint is used over time.
Sara: What are the principal risks patients should understand?
Professor Porvaneckas: Important risks include infection, blood clots, bleeding, stiffness, nerve or blood-vessel injury and the possibility that pain may not disappear completely. Hip replacement also carries a risk of dislocation. Serious complications are uncommon, but patients must understand them and disclose their full medical history so that risks can be reduced wherever possible.
Sara: What happens immediately after surgery?
Professor Porvaneckas: Pain relief, circulation and the surgical wound are monitored closely. In most cases, mobilisation begins very early with assistance from the physiotherapy team. Early movement helps restore function and reduces the risks associated with remaining in bed, but progress must always be adapted to the individual patient.
Sara: Is recovery from knee replacement different from recovery after hip replacement?
Professor Porvaneckas: Both require commitment to rehabilitation. Knee replacement patients often experience more swelling and stiffness and may find the early exercises demanding. Hip patients may regain comfortable walking sooner, although this varies. Recovery is not a competition: steady, safe improvement is more important than trying to progress too quickly.
Sara: When is a patient normally fit to fly home?
Professor Porvaneckas: A patient should be medically stable, able to walk safely with the recommended support and have no sign of a developing complication. The wound, circulation and general recovery must be satisfactory. The timing depends on the procedure and the patient, so fitness to travel must be confirmed by the treating clinical team.
Sara: How is the risk of a blood clot managed when a patient must fly after surgery?
Professor Porvaneckas: Patients may receive anticoagulant medication and will be encouraged to walk and perform circulation exercises. During the journey they should follow the clinical team’s advice about movement, hydration and compression stockings where prescribed. Medication must be taken exactly as directed.
Sara: What should patients do after returning to Britain?
Professor Porvaneckas: They should continue the prescribed rehabilitation programme, take medication correctly and follow the wound-care instructions. They should also retain their discharge summary, operation report and implant information and share these with their GP or physiotherapist where appropriate.
Sara: Which symptoms require urgent medical attention?
Professor Porvaneckas: Increasing redness or discharge from the wound, fever, sudden severe pain, marked swelling, chest pain, shortness of breath or an unexpected loss of movement should never be ignored. A patient with urgent symptoms should seek immediate local medical assistance rather than waiting for a remote response.
Sara: Finally, what would you say to someone who is apprehensive about travelling abroad for joint replacement?
Professor Porvaneckas: Being cautious is sensible. Patients should understand who will perform the operation, what the package includes, how rehabilitation will be organised and what will happen if a concern arises after they return home. Good decisions are based on clear information, realistic expectations and open communication with the treating team.
Read more about Professor Narūnas Porvaneckas:
Considering a hip replacement?
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