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.

Related links

  • 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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    ROSE Procedure, a weight loss revision surgery

    Traditionally those who needed a revision bariatric surgery following a gastric bypass (also known as Roux-en-Y procedure) have had to resort to another open or laparoscopic gastric bypass surgery involving more cutting of the internals of the body. Such a revision obesity surgery is quite complicated and therefore surgeons and patients frequently avoided it for the high risks associated with it.

    Today patients have a better choice which not only involves NOT opening up the patient, as it is done edoscopically, but is also less complicated and has minimal risks.

    Need for the ROSE procedure

    The ROSE procedure is a weight loss surgery (WLS), needed as a revision for a gastric bypass surgery. So let’s first understand what a gastric bypass procedure does.

    The aim of a gastric bypass surgery is to make the stomach and stoma very small so that the stomach can now hold much less food and the feeling of satiety is achieved after the consumption of a very small amount of food. This makes the person eat less and thus lose weight.

    Most people lose their excess weight to a great extent following a gastric bypass procedure. However, the stomach pouch and the stoma may expand/stretch over time causing the capacity of the stomach to increase. So the stomach can now hold more food and the feeling of fullness is now achieved after consumption of a larger amount of food than before. This results in weight regain.

    A revision weight loss surgery is therefore required to once again reduce the size of the stomach pouch and the stoma. The ROSE (Restorative, Obesity Surgery, Endolumenal) procedure is a revision weight loss surgery for patients who have had gastric bypass surgery previously (at least 2 years ago) and lost 50% of excess weight but regained at least 15% of it back.

    In a ROSE procedure, the surgeon pleats/folds the stomach with sutures to reduce its size back to about the size at the time of the original gastric bypass surgery. This is achieved through an endoscope (a long narrow tube carrying a camera and surgical instruments) which the surgeon inserts into the patient’s stomach pouch through a natural opening in his body, in this case his mouth and down the esophagus. The surgical tools in the endoscope are then used to gather together sections of stomach tissue to create a pleat which is then sutured together. With this process, the stomach volume and stoma diameter can be reduced to increase restriction and help weight loss. The procedure takes about an hour to complete.

    Candidacy for the ROSE procedure

    In order to be eligible for the ROSE surgery you must have:

    • had the gastric bypass procedure at least 2 years ago,
    • lost 50% of your excess body weight following the surgery, and
    • regained 15% of it back.

    In some cases, a patient may also be a candidate if he underwent gastric bypass surgery but failed to lose weight.

    Advantages of the ROSE procedure

    • Incisionless i.e. no external incisions or cuts therefore lower risk of infection and associated complications, and also no scarring
    • Quick procedure (takes about an hour)
    • Causes little or no discomfort to the patient
    • Minimal post operative pain/symptoms (mild sore throat, hoarseness, swollen lip, and lip pain due to the endoscopic instruments that were inserted into the mouth)
    • Fast recovery time

    Cost of a ROSE procedure

    For a FREE estimate of the cost of ROSE procedure in the United States or cost of ROSE procedure abroad visit Healthbase.

    For more information about affordable surgery, read about international medical tourism and domestic medical tourism.

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    Medical Tourism is no longer restricted to outbound medical tourism i.e. Americans seeking care outside of the country. Domestic medical tourism is gathering pace as more and more Americans are now crossing state borders to take advantage of cheaper prices available for quality health care out-of-state. It’s amazing to know that the price differential on healthcare within the same country can be tremendous if only you take the trouble to shop for it.

    Recently Healthbase partnered with many health care providers in several states within the United States. The prices on major procedures that these providers offer to Healthbase clients are as low as 10% of the prevailing cost of those procedures in other typical hospitals within the country. Read more about this partnership.

    So how can some US providers offer such low rates?
    Patients can avail of such low rates if they choose the one-pay option. AARP Bulletin Today recently covered the story of Rodney Larson, an uninsured Minnesota resident and a Healthbase customer who had his triple bypass surgery at a heart care hospital in Kansas.

    According to the bulletin,

    As a father to nine daughters, electrician Rodney Larson always looks for ways to cut costs. So in 2008 when he was told he needed triple bypass surgery – totaling $80,000 or more – he shopped around.

    Rodney Larson traveled within the United States for heart surgery

    Rodney Larson traveled within the United States for heart surgery.

    Larson, 56, of Boyd, Minn., searched the Internet and found a hospital that would do the surgery for $13,200. The facility, Galichia Heart Hospital in Wichita, Kan., participates in a domestic medical tourism program run by Healthbase Online.

    Located in Boston, Healthbase is one of a handful of companies reaching out to U.S. hospitals to provide specialty surgeries at much lower costs than traditional providers. The company also offers international medical tourism – in which patients travel abroad for procedures – but is finding a market for U.S. specialty hospitals.

    Most patients who use medical tourism companies are uninsured and must pay upfront for procedures. Larson liked the one-pay option.

    “They saved me a lot of money, but the point is, it was excellent care,” he says.

    Source: AARP Bulletin Today

    Available procedures
    Most major procedures are available at discounted rates within the US through Healthbase. Procedures fall in the categories of cardiac, orthopedic, bariatric, spinal, etc.

    Want to know if the procedure you need is available and how much it costs?

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    By Victoria Knight, Dow Jones Newswires

    A post recently appeared in the Wall Street Journal Blog which talked about Healthbase, Healthbase’s customers and the latest trend in medical tourism or global healthcare – traveling from one state to another within the United States in search for cheaper prices for major surgeries. Healthbase is one company that has been helping American patients connect to affordable hospitals in the US for major surgeries. The author writes,

    Uninsured Americans also are shopping around for surgery in the U.S. in record numbers, and using new services such as Healthbase Online Inc. , a Boston-based medical brokerage that arranges treatments for patients at health-care facilities worldwide. Rodney Larson, a self-employed electrician from Minnesota, used Healthbase Online to arrange a triple heart bypass at Galichia Heart Hospital in Wichita, Kansas. He paid $13,000 flat fee for the surgery, about $90,000 dollars less than the rate for uninsured patients in Minnesota.

    The current economic conditions…

    Worsening economic conditions have made employers and workers more inventive in dealing with ever-rising health-care costs. Some are taking advantage of new health services that offer fixed rates for surgery to patients willing to travel to get care.

    The financial benefits of domestic and international medical tourism cannot be overlooked and some insurers have taken active steps to reduce the health care costs for their clients in this slowing economy by offering them medical tourism options. The author mentions about the forward thinking by some health insurers and writes,

    It’s a strategy that giving some insurers food for thought. WellPoint Inc., the nation’s largest health insurer, is currently evaluating programs and benefits where customers can “elect to seek certain services at designated facilities for a fixed per-case rate ,” according to a spokeswoman, Jill Becher.

    Others insurers aren’t sold on asking customers to travel for health care. Aetna Inc. says it already negotiates significant discounts with medical providers. Typically, it pays physicians within three days of submitting a claim, so up-front cash payments aren’t a strong incentive for achieving additional discounts, according to a company spokesperson.

    Request FREE quote for affordable major surgery within US or overseas

    More at: Wall Street Journal Blog

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    Healthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.Healthbase Logo

    Urinary diversion and reconstruction surgery

    Urinary diversion is a way of surgically rerouting or diverting urine flow from its normal pathway in order to treat the condition of diseased or defective ureters, bladder or urethra, either temporarily or permanently. Using the surgical method of urinary reconstruction and diversion a new way is created for the patient to pass urine.

    There are three main types of urinary diversion surgeries
    • Ileal Conduit Urinary Diversion
    • Indiana Pouch Reservoir
    • Neobladder to Urethra Diversion

    For all of these procedures, a portion of the small and/or large bowel is disconnected from the fecal stream and used for reconstruction.

    Ileal Conduit Urinary Diversion: The ileal conduit urinary diversion surgery is used in patients who have had their bladder removed and is usually used in conjunction with radical cystectomy in order to control invasive bladder cancer. In this procedure, the ureters are surgically unattached from the bladder and a ureteroenteric anastomosis is made in order to drain the urine into a detached section of ileum (a part of the small intestine). The end of the ileum is then brought out through an opening (a stoma) in the abdominal wall. The urine is collected through a bag that attaches on the outside of the body over the stoma. The bag must be periodically emptied of urine.

    Indiana Pouch Reservoir: The Indiana pouch surgery is used for patients who have had their urinary bladders removed as a result of bladder cancer, pelvic exenteration, bladder exstrophy or who are not continent due to a congenital, neurogenic bladder. In this procedure, a reservoir, or pouch, is created out of approximately two feet of the ascending colon and a portiom of the ileum (a part of the small intestine). The ureters are surgically removed from the bladder and repositioned to drain into the pouch. A piece of small intestine is brought out through a small opening in the abdominal wall called a stoma. Since a segment including the large and small intestines are utilized, also included is the ileal-ceceal valve. This is a one-way valve located between the small and large intestines which normally prevents the passage of bacteria and digested matter from re-entering the small intestine. After a period of several weeks, the body adjusts to the absence of this valve by absorbing more liquids and nutrients. Unlike other urinary diversion and reconstruction techniques, the Indiana pouch has the advantage of not using an external pouch adhered to the abdomen to store urine.

    Neobladder to Urethra Diversion: With the Neobladder to Urethra Diversion procedure, the intent is to create a new bladder that mimics the storage function of a normal urinary bladder. The surgery makes a reservoir or pouch by utilizing a small part of the small intestine and connects the pouch to the urethra. The ureters are repositioned to drain into this pouch. As in normal urinary system, urine is able to pass from the kidney, to the ureters, to the pouch, and through the urethra out of the body.

    For information about affordable urinary diversion and reconstruction surgery, check out Healthbase.

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    Healthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.Healthbase Logo

    ORTHOGNATHIC SURGERY

    Orthognathic surgery is surgery to reposition the maxilla (upper jaw or jawbone), the mandible (the lower jaw or jawbone), and the dentoalveolar segments (teeth and their sockets) to achieve facial and occlusal balance. One or more segments of the jaw(s) can be simultaneously repositioned to treat various types of malocclusions (bad bite) and jaw deformities. It is also used in treatment of congenital conditions like cleft palate. Bones can be cut and re-aligned, held in place with either screws or plates and screws.

    Relationship between the maxilla and mandible

    Orthognathic surgery is performed by an oral and maxillofacial surgeon almost always in collaboration with orthodontic treatment, often including braces before and after surgery, and retainers after the final removal of braces. Orthognathic surgery is often needed after reconstruction of cleft palate or other major craniofacial anomalies.

    Unless medical conditions necessitate that the surgery be performed earlier, orthognathic surgery is often delayed until after all of the permanent teeth have erupted. To improve the aesthetic results, orthognathic surgery can be combined with soft tissue contouring in adult patients.

    TYPES OF ORTHOGNATHIC PROCEDURES
    •  Mandibular Sagittal Split Osteotomy
    •  Maxillary osteotomy surgery or Le Fort Osteotomy (Le Fort I osteotomy, Le Fort II osteotomy and Le Fort III ostetomy)
    •  Genioplasty (chin surgery)

    DETAILS OF THE PROCEDURE
    Usually surgery is performed under general anaesthetic and using nasal tube for intubation. The surgery might involve one jaw or both the jaws during the same procedure. The modification is done by making cuts in the bones of the mandible and / or maxilla and repositioning the cut pieces in the desired alignment. The surgeon is often able to go through the inside of the mouth without having to cut the skin.

    Cutting the bone is called osteotomy and in case of performing the surgery on the two jaws at the same time it is called a bi-maxillary osteotomy (two jaws bone cutting) or a maxillomandibular advancement. The bone cutting is traditionally done using special electrical saws and burs, and manual chisels, and most recently by using ultra-sound waves (though not used on a wide scale). The maxilla can be adjusted using a ” Lefort I” level osteotomy. Sometimes the midface can be mobilised as well by using a Lefort II, or Lefort III osteotomy. These techniques are utilized extensively for children suffering from certain craniofacial abnormalities such as Crouzon syndrome.

    The jaws will be wired together (inter-maxillary fixation) using stainless steel wires during the surgery to insure the correct re-positioning of the bones. This in most cases is released before the patient wakes up after the surgery.

    COST OF ORTHOGNATHIC SURGERY
    Register to Healhtbase to request a FREE quote for affordable orthognathic surgery overseas.

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    Brought to you by Healthbase www.healthbase.com info.hb@healthbase.com 1-888-MY1-HLTH


    Healthbase is the trusted source for global medical choices, connecting patients to leading hospitals around the world, through secure and information-rich web portal. To learn more, visit: http://www.healthbase.com Login to get FREE quote. Access is free.Healthbase Logo

    TOP 10 REASONS WHY MEDICAL TOURISM IS POPULAR

    Medical Tourism dates back to the times when wealthy Europeans and Asians would travel within their continent or to other continents to seek health related treatments. But, of late, the trend has been popularized by Americans, Canadians, British and others who travel to far-off countries in search for low-cost high quality health care or for care that’s not readily available in their country.

    Following are the top 10 reasons why people travel to far-flung developing countries for medical care:

    1. Incredible Savings
    The top on the list is savings. Depending upon your destination country and the cost of the procedure back home, expect to save at least 50%.
    For example: A cardiac bypass surgery is estimated at well over $100,000 in the US. But in India, at a 5-star type hospital, you can have the same surgery for only about $10,000. That’s 90% savings even after you have paid for your travel, accommodation and vacation for yourself and a companion.

    2. No Wait-Lists
    Access to immediate service is what attracts those from countries that have public health care system towards medical tourism . A case at hand is that of a Canadian who suffered from chronic back pain for 16 years and was given medication to deal with it for all those years. Tired of the system and of the worsening pain, she went to India to get her spinal surgery. She now tells everyone how she got her life back by going to India .

    3. Excellent Quality
    To demonstrate their commitment to quality many international providers choose to be accredited by organizations such as JCI, JCAHO and ISO or by their local accrediting organizations. Read testimonials by medical tourists who vouch for the high quality treatment they have received overseas.

    4. World-Class Facilities
    International providers offer luxurious accommodation, private spacious rooms, and access to hospitality services 24 x 7. The facilities are immaculate and there are no infections that we so often hear about being present in UK hospitals.

    5. Access to Latest Technology
    The technology and equipments used by them are the latest and the greatest. It’s not uncommon to see surgeons working with billion dollar robotic machines in operating rooms.

    6. Surgeon Expertise
    Most surgeons catering to international patients have either been educated or have received professional training at top schools in the US, UK or in other countries in Europe. They have colleagues in the US, UK and elsewhere, so it should not come as a surprise if they know your local surgeon at home.

    7. Personalized Service
    Most medical traveleres vouch for the genuine and excellent service that they receive from surgeons, nurses and other medical staff alike. The staff to patient ratio is low making high level of personal care possible.

    8. Longer Hospital Stay
    One of the advantages of medical travel is you get to stay in the hospital for long without incurring hefty room charges. You can have a longer hospital stay than possible in your local hospital back home under the supervision of your surgeon and physical therapist.

    9. Great Convenience
    Given the ease of international travel combined with low airfares, your life-changing surgery is just a flight away. Another convenience that you get is not having to leave the comforts of your home until the surgery is due. You can research all you want on the Internet about hospitals and surgeons, share your medical records online with them, book and plan your itinerary on the web, etc.

    10. Travel Opportunities
    While the primary motivation for most customers is affordable surgery the opportunity to visit exotic destinations is an additional draw for some. You can choose to have a relaxing recovery in a resort setting or if your surgeon allows you can even enjoy outdoor tourist attractions.

    You can learn more about the growing trend of medical tourism , international healthcare facilities and surgeons and the details of the medical tourism process by logging on to http://www.healthbase.com. Healthbase.com is a medical tourism facilitator committed to providing low-cost high quality medical travel services to the global medical consumer.

    To learn more about medical tourism, read the medical tourism blog.

    For the latest news, interviews, videos, etc, about medical tourism, check out the surgical tourism blog.

    Before embarking on your medical travel trip, do read the overseas medical travel blog.

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