Getting a New Knee or Hip? Do It Right the First Time

An informative article on joint replacement by Lesley Alderman appeared in the New York Times recently. It talks about the things that a patient should keep in mind if considering a joint replacement (hip replacement or knee replacement) surgery. Following is the article as it appeared on the NY Times website.

THERE is nothing like a new hip or knee to put the spring back in your step. Patients receiving joint implants often are able to resume many of the physical activities they love, even those as vigorous as tennis and hiking. No wonder, then, that joint replacement is growing in popularity.

In the United States in 2007, surgeons performed about 806,000 hip and knee implants (the joints most commonly replaced), double the number performed a decade earlier. Though these procedures have become routine, they are not fail-safe.

Implants must sometimes be replaced, said Dr. Henrik Malchau, an orthopedic surgeon at Massachusetts General Hospital in Boston. A study published in 2007 found that 7 percent of hips implanted in Medicare patients had to be replaced within seven and a half years.

The percentage may sound low, but the finding suggests that thousands of hip patients eventually require a second operation, said Dr. Malchau. Those patients must endure additional recoveries, often painful, and increased medical expenses.

The failure rate should be lower, many experts agree. Sweden, for instance, has a failure rate estimated to be a third of that in the United States.

Sweden also has a national joint replacement registry, a database of information from which surgeons can learn how and why certain procedures go awry. A registry also helps surgeons learn quickly whether a specific type of implant is particularly problematic. “Every country that has developed a registry has been able to reduce failure rates significantly,” said Dr. Daniel Berry, chief of orthopedic surgery at the Mayo Clinic in Rochester, Minn.

A newly formed American Joint Replacement Registry will begin gathering data from hospitals in the next 12 to 18 months.

Meanwhile, if you are considering replacing a deteriorating knee or hip, here are some ways to raise the chances of success and avoid a second operation.

EXPERIENCE COUNTS Choose – or request a referral to – an experienced surgeon at a busy hospital. “The most important variable is the technical job done by the surgeon,” said Dr. Donald C. Fithian, an orthopedic surgeon and the former director of Kaiser Permanente’s joint replacement registry.

Ask for recommendations from friends who have had successful implants and from doctors you know and trust. When you meet with the surgeon, ask how many replacements he or she does each year.

VOLUME MATTERS A study published in The Journal of Bone and Joint Surgery in 2004 found that patients receiving knee replacements from doctors who performed more than 50 of the procedures a year had fewer complications than patients whose surgeons did 12 procedures or fewer a year.

The researchers documented a similar trend when it came to hospital volume. Patients at hospitals that performed more than 200 knee replacements a year fared better than patients at hospitals that performed 25 or fewer.

ADJUST EXPECTATIONS Not everyone with joint pain will benefit from a joint replacement.

An implant can help reduce pain and improve mobility if the joint surface is damaged by arthritis, for instance. But a new joint will not help pain caused by inflammation of the surrounding soft tissue, said Dr. Berry, who is also vice president of the board of the American Academy of Orthopaedic Surgeons.

Some people with mildly arthritic joints, for instance, can manage well with the judicious use of medication. “Surgery comes with complications and risks, and should not be approached lightly,” Dr. Berry said.

Joint replacement is not a minor operation. If you have uncontrolled high blood pressure or another serious chronic condition, a joint operation may simply be too risky for you.

NARROW YOUR OPTIONS “There is no one best joint,” Dr. Berry said. “A successful replacement depends on selecting the right implant for the patient.”

A good surgeon will recommend an implant that makes sense for your age, activity level and the shape of your joint. Younger or very active people who place more physical demands on the implant, for instance, may benefit from newer hard-on-hard bearing surfaces, like those made of ceramic, said Dr. Joshua J. Jacobs, chair of orthopedic surgery at Rush University Medical Center in Chicago.

In general, be wary of the latest, most advanced new joint. There is little evidence to support the use of more expensive designs over basic ones, said Dr. Tony Rankin, a clinical professor of orthopedic surgery at Howard University. One recent study found that premium implants fared about as well as standard implants over a seven- to eight-year period.

Be skeptical, too, of advertising gimmicks. “I had a 78-year-old patient with a perfectly good knee replacement come in and ask if she should have gotten the ‘gender knee,’ which she had seen advertised on TV,” Dr. Rankin recalled. “She was doing well, but was swayed by the idea of a knee made just for women.”

GATHER THE DATA Once you have a recommendation or two from a surgeon, find out how well the joint has performed in others and if there are known complications. The newer metal-on-metal hip implants, for instance, are somewhat controversial and may cause tissue and bone damage in certain patients.

Ask if the hospital has a registry that tracks joint replacements. If so, ask to see the data on the implants you are considering.

It is also helpful to understand what the operation involves, including the materials that will be used and how the surgeon plans to fix the joint to the bone. You can learn more about your operation at the American Academy of Orthopaedic Surgeon’s patient information Web site, orthoinfo.org.

If you want to delve deeper, look at a large national registry from another country, like Australia. The annual report of Australia’s registry lists knee and hip implants that had a “higher than anticipated revision rate.”

A caveat: the information can be difficult to parse for a layperson. “A surgeon can provide perspective on information that, taken out of context, could be misleading,” Dr. Rankin said. So discuss it with your surgeon.

PLAN YOUR RECOVERY To avoid complications during your final stage of recuperation, discuss with your doctor in advance the support you will need when you return home, Dr. Berry advised.

Recovery takes a different course for each patient, depending on the type of procedure and implant. In general, expect mild to moderate pain for the first few weeks. Some patients are able to return to work in one to two weeks, but full recovery can take six to 12 months, Dr. Jacobs said.

Make sure you have the help you need in the initial stages of recuperation. Since you may have difficulty getting around and won’t be able to drive right away, you may want to have a friend or family member stay with you. You may even need to hire an aide or visiting nurse.

Follow your doctor’s orders, and don’t rush your recovery. You don’t want your new joint to fail because you couldn’t resist carrying loads of laundry up and down stairs, or felt compelled to rearrange the patio furniture.

If the new joint is given time to heal, you will find plenty of opportunities for all that in the future.

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  • Affordable joint replacement surgery overseas
  • Cost of knee replacement or hip replacement surgery
  • What joint replacement surgery patients are saying
  • Medical tourism
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    Chris Y from USA had a hip replacement surgery at Fortis Hospital, Mumbai, India facilitated by Healthbase. Following is his story about his experience with medical tourism abroad for hip replacement surgery.

    About 5 weeks ago I went from the USA (Raleigh, North Carolina) to Mumbai, India, for hip replacement surgery. I have been home for a while now and am happy to report I am making great progress toward total recovery.

    My hip problem was with me many years, but only showed itself during the past one year. In that year my gait went from normal to limping to a sort-of painful hop on only my good leg. Clearly I was in need. So I researched greatly many options both in the USA and abroad and found that more hip operations were successfully performed overseas, specifically in India. Through my research I connected with Moe, who is Healthbase’s Customer Support Manager. He patiently answered each of my questions, even when I would call again and ask new and different questions. Moe arranged for a 3-way conversation with the surgeon of my choice, who, also through my research, I chose to be the world-renowned hip resurfacing/joint replacement surgeon, Dr. Kaushal Malhan. After consideration, I realized that Healthbase, Dr. Malhan, and Fortis hospital were the right choices for me.

    About 3 months later I was ready to take a trip to Mumbai, India to become whole again. Being adventurous, I arranged for my own airfare, while Moe arranged for my hospital stay, and the date of my surgery. My stay in the hospital was for a total of 12 days and 12 nights, which went by very quickly.

    I hopped on the plane, (actually 3 planes), and was met at the airport (at 1 am) by Bharat, who is Fortis hospital’s International Patient Relations Manager. That same night I was brought to my room, where my check-in went fast and easy.

    Let me tell you about my room. It was spacious (it was actually called a suite). It was well lit and very clean. I had all the amenities I could want – a TV, a computer, a phone, a refrigerator (stocked with complementary juices), a large easy chair, hot water-maker for coffee, lots of pillows to lounge with, and a very big bathroom area. Every day during my stay the cleaning crew came to clean everything (even the bathroom) and to change my linens.

    The day after my arrival was devoted to surgery prep, which went like clockwork. It was obvious the staff had plenty of experience. I was scared, as I had never had surgery before, but was reassured at each step by every one of the staff member’s professional demeanor. The next day was my surgery, which apparently went very well. (In addition, I also needed bone grafting – this had been explained to me the day before the surgery). I felt well and strong almost immediately after the surgery. For a few days after the surgery I was given, it seems, just the right amount of pain medication, since I felt no pain, yet could easily read a newspaper, had a normal sleep pattern, and a good appetite.

    Doctors, nurses, and dieticians would stop by my room daily to ask how I was feeling, did I need anything, and would I like to have anything different foodwise. The meals were always very tasty, as I could choose daily from a menu book, which had a wide variety of Indian or Continental cuisine. I could specify anything I would like to eat for any meal. I did eat a large amount each day, and had fresh fruit plates at least twice a day. Also, the kitchen was just a phone call away, so I could ask for anything at any time, day or night.

    I am now moving about several hours each day without crutches or a cane. My gait is coming back, and I am exercising using the routine I was taught while in the hospital. I am completely free of medication, and foresee a time in the near future when I will be able to once again take up long-distance bicycling and walks on the beach. Dr. Malhan’s skill as a surgeon has made this possible, and his minimally-invasive techniques have definitely aided in the speed at which my recovery has progressed.

    So here is the bottom line. My being a patient in Fortis Hospital was a good decision, a smart financial decision, and from a surgical standpoint, a very wise decision. My room was big and clean, the care I received was very good, the food was absolutely great, and the physical therapy I received was specific to my needs, intense but not overbearing, to which I also attribute in large part my very rapid recovery (they claim the Physiotherapy Department as ‘World Class’ – I can attest their skills truly make them such).

    Anyone who is considering joint resurfacing or replacement should seriously consider the many advantages of having Healthbase as their medical tourism facilitator. In addition, I highly recommend the staff at Fortis Hospital in Mumbai, India, and especially Dr. Kaushal Malhan, whose world-renowned surgical expertise continues to create successful outcomes in patients such as myself.

    Thanks Healthbase!

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    Medical tourism, which is the practice of traveling from one place to another for medical care, is no longer limited to patients seeking conventional treatments such as hip resurfacing, spine fusion, knee replacement, heart bypass, lap band, cosmetic surgeries, or dental treatments. Today, many are going overseas to seek “unconventional” medical tourism treatments such as those for cancer.

    Cancer patients may be driven abroad by low prices but what remains the prime motivator is the easy accessibility to the latest technology at overseas cancer hospitals.

    COMPARING THE US AND ABROAD
    Without a doubt USA is the pioneer of the latest medical technologies and the country invests heavily in cancer researches. Such developments have provided remedies for previously irremediable diseases, thereby prolonging and improving the lives of the critically ill. However, these advancements remain beyond the means of those who lack health insurance, simply because of the price tag at which they come, in the US anyway.

    But, in India or Singapore or Turkey, for instance, not only are the same state-of-the-art technologies being used, the treatments are offered at a much lesser price making them accessible to a greater part of the populace. It is not uncommon, therefore, to see surgeons in Asia working behind the gamma knife or the CyberKnife or the da Vinci robotic surgical system, treating patients from all over the world and offering their services at a much discounted rate as compared with US rates.

    COMMON CANCERS AND THEIR TREATMENTS OVERSEAS
    Cancer hospitals abroad treat all types of cancers. Though most types of cancers are suitable for overseas treatment, a patient’s candidacy can only be decided on an individual basis. The more common ones that patients go abroad to cure are prostate cancer, breast cancer and thyroid cancer.

    There are several types of cancer therapies available today. Some of them are: surgery, radiotherapy (RT), chemotherapy, palliative therapy, etc. The specific treatment plan designed by the foreign doctor will depend on: (1) the type of cancer, (2) its stage, (3) whether it has metastasized to other parts of the body, (4) the patient’s overall physical health, and so on. The doctor may decide to give a combination of various types of therapies to increase the effectiveness of the treatment.

    Following are some examples of cancer treatments given abroad to remove the cancer from the body and to treat the symptoms of the disease:
    (1) Surgical resection of the affected organ followed by radiotherapy or chemotherapy to remove any remaining cancer cells.
    (2) Depending on distant metastases state and the pathology report, the doctor might use palliative or aggressive radiation therapy.
    (3) A high dose IMRT of primary and lymph nodes (LNs).

    ISSUES WITH SEEKING CANCER TREATMENT ABROAD
    As is well known, the quality of care offered abroad is on par with what is available in the United States. So the treatment quality is not a concern. But what might be of concern is the duration of the treatment.

    When you go overseas for a surgery such as a hip resurfacing or a heart surgery, you usually need to spend no more than 2 to 3 weeks in the host country. That’s true for most of the procedures you seek abroad. But in the case of cancer treatment, the duration of the treatment is a big concern. The treatment plan that the oncologist or the doctor designs can run over a period of several months. This means longer stays for the international patient and his companion which in turn translates to higher expenditure on accommodation. To resolve this and to generate more savings, Healthbase recommends seeking long-term accommodation in service apartments instead of hotels as the former cost much less.

    Even with higher expenses on accommodation factored into the cost, the resulting savings on treating cancer abroad can amount to approximately 40-80% when compared with the cost of treatment in the United States. For an accurate cost estimate and arrangement of cancer treatment abroad, check out the Healthbase website.

    Recent advancements in the field of organ transplantation have remarkably improved the success rates of transplant surgery. However, the cost of transplant operation still remains quite high in countries such as the United States. Patients without the means to pay for the high costs of transplant surgery are, therefore, increasingly looking towards affordable medical tourism in countries such as India, Singapore, Thailand and Turkey to meet their healthcare needs.

    Organ transplantation is the surgical replacement of one of your vital or non-vital body organs which has failed or is damaged as a result of injury or illness.

    Latest advancements in the field of transplantation and regenerative medicine (stem cell therapy) have greatly improved the success rates of transplant surgery. However, lack of available donor organs and tissues continue to result in increasing number of loss of lives of those needing transplants. Currently there are more than 100,000 patients in the United States alone waiting for an organ transplant. And, thousands more get added to the list each month.

    Organs that can be possibly transplanted are vital organs such as heart, intestine, kidney, pancreas, liver, lung, bone marrow, etc. or non-vital ones such as hair.

    TRANSPLANTATION TOURISM

    The high cost of transplant operation in the United States and several other countries is driving many patients to seek affordable care in more affordable countries such as India, Singapore, Thailand and Turkey where the price differential is remarkable.

    Medical tourism, also known as transplantation tourism in this case, is increasingly becoming popular with transplant patients who have been able to find a suitable donor like a relative. Transplant surgeries overseas in India or Singapore cost as low as 20% of what they cost in the US whereas quality wise they are on par with what is available in the United States.

    GUIDELINES FOR TRANSPLANTATION TOURISM

    When you have professionally established the need for an organ transplant and are considering a transplant surgery abroad, you must do your due diligence before setting your foot in the foreign land. Following are some of the guidelines that will help you.

    Provider related: Do proper research to ascertain that the provider you settle on offers top quality of care. Thus, consider the transplant hospital‘s quality data and statistics such as success rate, quality measures, patient rating, etc. A hospital’s quality standards, such as being accredited by Joint Commission International, ensure that the quality of care offered will be top notch. Also, if possible, make sure that the facilities, equipments, technology, etc. being used by the provider are cutting edge.

    Surgeon related: Make sure that your foreign transplant surgeon and his team are highly qualified and experienced in the specific kind of organ transplantation that you are seeking. A look at the surgeon’s resume or profile should give you a pretty good idea of his qualifications.

    Aftercare related: Aftercare of an organ transplantation surgery is as important as the operation itself. Therefore, you must find out what support your foreign provider will give after you have returned to your home country. You must keep your local provider informed about your decision of going abroad to seek care.

    Law related: Last but not the least, the legal aspect of organ transplantation plays an important role when seeking a transplant surgery. Every country – home or foreign – has some or the other organ transplant laws in order to protect its citizens from potential exploitation, organ trafficking, and other such illegal acts. As such, different countries have different policies as to who is allowed to donate to whom. So, learn about the transplant policies that apply in the host country where you are seeking treatment.

    Seeking organ transplantation surgery overseas is not a simple process. However, by working with a specialized medical tourism facilitator you are relieved of the complications involved. For an accurate transplant surgery cost estimate and arrangement of organ transplant surgery abroad, check out Healthbase.com.

    OTTAWA, Feb. 3, 2010 – Accreditation Canada International partners with the Environment and Quality Assurance International Certification Center (EQAICC). The EQAICC is an international certification body with head offices in South Korea and Japan, and branch offices in China, Taiwan, and the United Kingdom.

    This new partnership will permit the EQAICC to implement Accreditation Canada’s international accreditation program in health care organizations in South Korea.

    “We are pleased to bring Accreditation Canada International to Korea,” says Dr. Jason Moon, CEO of EQAICC. “The high quality of Accreditation Canada’s services will be welcomed in Korea. These services will soon be expanded to Japan and China.”

    Accreditation Canada International will provide education and training to EQAICC professionals and their extensive network of surveyors. In partnership with EQAICC, several pilot projects with South Korean hospitals will be carried out to identify areas of the program that must be tailored to the South Korean health care system and environment. The hospitals will receive an accreditation recognition decision from Accreditation Canada.

    More on the story here

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    (Ottawa, Canada – January 27, 2010) As part of its expanding role in the global marketplace, Accreditation Canada International has launched Qmentum International, a new accreditation product tailored to its international clients. The Qmentum International program builds on more than 50 years of Canadian accreditation expertise. This rigorous program will challenge performance-oriented, client-focused health services organizations at all levels, while recognizing their achievements at different stages of their quality journey.

    Qmentum International focuses on quality improvement, patient safety, risk assessment and mitigation, performance measurement, and accountability. It provides a sustainable quality improvement approach through step-by-step implementation, based on ongoing support and capacity-building within the organization.

    The program is founded on Accreditation Canada’s widely recognized national accreditation program, as well as the successes of previous international programs. Fulfilling the requirements of the International Society for Quality in Health Care (ISQua), the development was guided and supported by the expertise of an international advisory committee, with members representing the Middle East, the Caribbean, Europe, and South America.

    More on the story here.

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    A doctor told FOX 2’s Chris Edwards he needed a common medical screening – colonoscopy – which he could have done at dozens of places around Metro Detroit for about $7,000.

    Instead, he chose to have it done thousands of miles from home with help from Healthbase, a medical tourism agency that offered a Cost Rica medical travel package that included a colonoscopy, extensive dental work, and some fun activities as part of recuperation.

    The colonoscopy procedure itself cost him only $350.

    Check out the report by Fox 2’s Deena Centofanti, who tagged along with Chris for a coverage of his experience of Costa Rica’s health care services.

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