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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    Healthbase Collaborates with WellPoint to Bring Affordable Medical Tourism Solutions

    Healthbase collaborates with WellPoint to bring affordable healthcare benefits to Americans through an international medical tourism pilot program. Members will now have more choices regarding where to receive care and a greater involvement in the care they receive

    BOSTON, Jan. 5 /PRNewswire/ — Healthbase Online Inc., a Boston-based award-winning medical tourism facilitator, has collaborated on a pilot basis with WellPoint, Inc., an Indianapolis-based health benefits company to provide global health care coverage to members of WellPoint’s affiliated health plan in Wisconsin. Healthbase will handle all the medical travel logistics and arrangements for WellPoint members.

    According to Saroja Mohanasundaram, CEO of Healthbase (http://www.healthbase.com), “Healthbase is committed to providing high quality medical travel services at affordable cost. Healthbase will assist WellPoint members with coordination of the trip, medical appointment scheduling, digital medical records transfer, and concierge travel service.”

    Under this program, effective from January 2009, members who travel for certain non-emergency elective procedures like joint replacement and spinal fusion, will have access to Joint Commission International accredited healthcare providers in India. This will result to lower out-of-pocket costs for members translating into thousands of dollars in total savings. A hip replacement surgery, for example, costing over $60,000 in the US, costs less than $8,000 at an accredited hospital in India.

    “We are pleased to work collectively with Healthbase to deliver an international medical tourism pilot product to our clients who are interested in exploring a medical tourism solution,” said Dr. Razia Hashmi, vice president and medical director for WellPoint’s national accounts division. “Medical tourism is a promising option for improving access to affordable, quality health care. Working with Healthbase, our case managers will coordinate all steps of the medical tourism process for members interested in receiving care overseas.”

    About Healthbase:

    Healthbase is a one-stop source for global medical and dental choices, connecting patients to internationally accredited providers in 14 countries including India, Thailand, Singapore, South Korea, Turkey, Panama, Costa Rica and Mexico. Healthbase caters to individual consumers, self-funded businesses, insurers, benefit consultants, third party administrators and those using Consumer Directed Healthcare Plans (CDHPs) or voluntary benefit plans. More information at http://www.healthbase.com.

    About WellPoint, Inc.:

    WellPoint, Inc. is the largest health benefits company in terms of medical membership in the United States. WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at http://www.wellpoint.com.

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    Healthbase has helped an uninsured American patient get double hip resurfacing surgeries in India. The high cost of Birmingham hip resurfacing surgery in the United States plus the lack of expertise in this procedure in the country continues to drive scores of Americans to India.

    Nov. 21, 2008, Boston, MA. Healthbase Online Inc., an award-winning medical tourism facilitator based in Boston, Massachusetts, helps an Arizona-based former ballet dancer treat her hip osteoarthritis in India. 53-year old Katharine Frey who had arthritis in both her hips traveled to Apollo Hospitals, Chennai to have her hips resurfaced and availed of the 85% discount on the cost of the surgery.

    “I have appreciated everything we have experienced and received at the Apollo Hospitals . Everyone has been very kind, supportive and helpful,” says Katharine after her hip resurfacing surgery last winter. She was so happy with the quality of care she received at her overseas hospital that she went back a few months later to have her second hip resurfaced.

    Being uninsured, the $60,000 required to have a single hip resurfaced in the US seemed out of reach for Katharine. This led her into researching her other option – surgery overseas – and contacting Healthbase who coordinated both her surgeries in India for $8,000 each. The price included doctor’s fees, physical therapy and a week in the hospital.

    According to Saroja Mohanasundaram, CEO of Healthbase , “Our clients prefer going abroad for Birmingham hip resurfacing because it is a fairly new procedure in the US but has been in use, say, in India, for many years. Being a major procedure it demands years of practice on the surgeon’s part to gain proficiency. The fact that Katharine went back to have her other hip resurfaced in India speaks volumes about the high level of satisfaction with our service and that of our partner hospitals and surgeons.”

    Katharine Frey taking off on a paragliding flight just weeks after her hip resurfaicng surgery in India
    Katharine Frey taking off on a paragliding flight just weeks after her hip resurfacing surgery in India

    Katharine returned to work merely two and a half weeks post operation and to teaching ballet twenty days post operation. Katharine actively participates in swimming, yoga, hiking, paragliding, and cross-country road trips. “She has no pain in her hips and is moving and functioning like a normal human. I am so grateful and am enjoying watching Katharine return to life,” remarks Scott Martin, Katharine’s husband.

    Katharine was operated upon by Dr. Vijay Bose and his team. Dr. Bose, a specialist in Birmingham Hip Resurfacing, Joint Replacement and Sports Medicine, has over a thousand BHR surgeries under his belt.
    “Beyond the cost savings, the attention given was remarkable. Dr. Bose and his qualified staff will always be remembered for this,” adds Katharine.

    Impressed by the high quality of care in India, even Scott, who accompanied Katharine to India addressed some of his periodontal issues through dental scaling and crowns at Apollo Hospitals while Katharine recuperated after her second Birmingham hip resurfacing surgery.

    “It has been a positive life changing process for both of us. Thank you, Healthbase, for being so receptive, supportive and professional,” acknowledge Katharine and Scott.

    Healthbase connects patients from across the globe to health care facilities in India, Singapore, Thailand, Malaysia, South Korea, Philippines, Turkey, Belgium, Hungary, Costa Rica, Panama, Brazil, Mexico and United States. Healthbase has over 45 providers on its network.

    About Healthbase Online Inc.:

    Healthbase, an award-winning Boston-based medical tourism and dental tourism facilitator, is a one-stop source for global medical and dental choices, connecting patients to leading healthcare providers around the world. Healthbase coordinates over 200 procedures in various categories like orthopedic, spinal , cardiac, bariatric, urology , oncology , dental , cosmetic and general surgery . Some of the common procedures offered are Birmingham hip resurfacing , total hip replacement , knee replacement , ACL repair , rotator cuff surgery , spinal fusion , spinal disk replacement, heart bypass surgery , lap band , gastric bypass , cancer treatment , liposuction, dental implants, crowns, bridges, etc. for a fraction of the cost in the US with equal or superior outcomes. Healthbase’s partner healthcare facilities are located in Thailand, India, Singapore, Malaysia, Philippines, South Korea, Turkey, Belgium, Hungary, Costa Rica, Panama, Brazil, Mexico and USA, and are expanding to Canada, UK, Jordan, Taiwan, Argentina, New Zealand, Australia, El Salvador and Guatemala. To ensure that patients receive the best care possible, Healthbase works mainly with hospitals that have international accreditations like JCI, JCAHO and ISO. Healthbase caters to the needs of individual consumers, self-funded businesses, insurance carriers, benefit consultants, insurance agents, and third party administrators seeking affordable medical travel and dental travel options. To learn more, call 1-888-691-4584, email info.hb @ healthbase.com or visit http://www.healthbase.com.

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