BHR

Birmingham Hip Resurfacing:
Regaining the Ability to Walk

By Joyce A. Reed

[2]

Like many Americans in their 50’s, I suffer from various forms of osteoarthritis. For the past two years, the arthritis pain in my right hip gradually increased. One day in January 2007, I woke up in the morning and stepped out of bed placing my normal weight on my right leg. A sharp pain shot from my right foot to my hip, and I sat back down quickly.

I made an immediate appointment with my orthopedist, and he discovered that the cartilage in my right hip joint was gone! The joint surface was literally “bone-on-bone”. He told me that I needed hip replacement surgery. I tried to discuss other options with him, but he retorted, “You are not going to get out of this one!” I needed the surgery.

Knowing nothing about hip replacement surgery, I researched the surgery on the Internet and in issues of Arthritis Today© for answers to my many questions. I discovered a recently approved FDA surgery originally developed in Europe, Birmingham Hip Resurfacing.

Birmingham Hip Resurfacing [1] can be compared to capping your teeth instead of pulling your whole tooth and replacing it with an implant. The actual device is all metal consisting of chromium steel. It is simplistic in design being a socket and ball with an attached stem. Unlike the former hip replacement devices, the Birmingham does not have plastic parts that can easily fail. The Birmingham procedure has been used in Europe for a few decades, and one marathon runner reportedly is successfully running/walking on his/her Birmingham hip replacement for 10 after the surgery. S/he has placed 35 life-cycle-years of use on his/her hip. A life-cycle-year is how far a normal person walks in one year.

On the internet, I found Dr. Stephen Raterman of Tampa, Florida. Dr. Raterman was the closest orthopedic surgeon using the Birmingham system to my home. I called and made an appointment. While I waited for the appointment, I started using a cane to walk since the pain of placing any weight on my right leg became unbearable.

During my first appointment, Dr. Raterman and his staff were attentive, professional and friendly. They x-rayed my hip and found that the ball section of my right hip joint had completely collapsed. Dr. Raterman carefully explained the details of the surgery to my husband and me. He told us that he would try to perform the Birmingham Hip Resurfacing on me by grafting bone to buildup my collapsed socket. Once the surgery began, if he discovered that he could not graft enough bone to do the resurfacing then he would do a Birmingham Hip Replacement. The Hip Replacement uses the same device as is used in the Hip Resurfacing, but the stem on the ball is longer to give the Replacement the stability it needs to operate correctly. When I left his office, I was very comfortable about my upcoming surgery.

In early May 2007, I checked into the University Community Hospital at Fletcher in Tampa, Florida. The hospital staffs were friendly and helpful. They quickly and easily prepared me for my surgery. My husband remained with me until I was moved into surgery.

My surgery lasted about two hours. My husband was impressed with the electronic patient status monitor in the waiting room. The board gave detailed information about me to him concerning pre-operation, operation and post-operation status. I woke in the Recovery Room with only a mild sore feeling in my hip. While everyone was very concerned about my pain levels, I never really had any pain. The surgical scar was only about 12 inches long and very thin. If I regained my ability to walk, it was a small sacrifice to make. My husband joined me in the Recovery Room, and I was quickly moved to my hospital room.

The hospital nursing and therapy staff provided excellent and friendly care. The day following the surgery, my therapist got me out of bed and up on my feet. The pain in my right leg was gone! I continued therapy and was released two days after my surgery.

I walked with a walker while in the hospital and for approximately ten days after leaving the hospital. I then went directly to walking with a slight limp for another week. The limp gradually improved until I walked normally again!

I did have one obvious post-operative problem. How could I pass through Homeland Security checkpoints at airports if I had a large metal object inside of my leg? Dr. Raterman’s office solved this problem by issuing me a medical security card listing my name, date of operation and an illustration of the device. Homeland Security accepts the card in conjunction with my normal picture identification.

I believe that writers overuse the word miracle, but miracle is the only word that fits my Birmingham Hip Resurfacing experience. The surgery changed my life bringing me from someone who could barely walk with a cane to normal walking. I can now completely enjoy my life.

I cannot find the words to thank my doctors, especially Dr. Raterman, for performing this miracle. I also want to thank Arthritis Today© for publishing informative articles that led to my discovering the Birmingham Hip Resurfacing.

For further information concerning this new procedure, see www.birminghamHipResurfacing.com .

[1] Picture courtesy of Dr. Stephen Raterman

[2] Picture courtesy of Worley (Lee) Reed, Author’s Husband

DOWN THE LINE Mike DiGiovanna July 29, 2007

 

Shuey gets hip to a comeback

 

What seemed like a routine save, 1 1/3 scoreless innings to close a 6-3 victory over the Angels on June 30, was anything but for Orioles reliever Paul Shuey, who in the five years since his previous save had three hip surgeries, including a hip-replacement procedure that has not yet been approved in the U.S., three full seasons away from the big leagues and one retirement.

 

"You go through all the effort to get back, and then to get an opportunity like that … " said Shuey, the 36-year-old right-hander who last saved a game for the Dodgers in a 6-2 win over Florida on Aug. 22, 2002. "It was really nice."

 

Shuey, a pennant-drive acquisition from Cleveland in 2002, went 11-6 with a 3.43 earned-run average in 90 games for the Dodgers despite right hip pain — stemming from a 1999 injury and arthroscopic surgery — that grew severe by the end of 2003.

 

He had surgery to reattach the labrum in his hip and grind down several bone spurs that winter, but his condition worsened the following spring, and Shuey, one of the game's hardest throwers in Cleveland from 1994 to 2002, lost his velocity.

 

"If it's excruciating and you can throw 96 mph, that's one thing," Shuey said. "When the pain is that bad and you're throwing 87-90 mph and you're ineffective, you're not going to get away with much."

 

Shuey underwent another surgery to fill a hole in a bone where a large spur had been removed, and he missed the entire 2004 season. He went to spring training with the Indians in the spring of 2005, and his velocity — if that's what you want to call it — topped out at 82 mph.

 

"The big man upstairs," Shuey said, "was telling me I had to shut it down."

 

After a brief stint with Cleveland's double-A team, Shuey retired and considered a hip replacement.

 

His doctor advised a less-invasive procedure called hip resurfacing, in which a metal ball joint, socket and pelvis are inserted. "I basically have a big ball bearing in there instead of a hip joint," he said.

 

As soon as he got off crutches, Shuey began throwing without pain. He found his proper stride and mechanics. His fastball returned to the 91-mph range, and after working out for scouts, he landed a contract with the Orioles.

 

Shuey opened 2007 at triple-A Norfolk but was called up in June and is 0-1 with a 4.80 ERA in 15 games.

 

He sets off all sorts of bells and whistles when he goes through airport security, "but the arm is good," Shuey said. "I wouldn't be surprised to play a few more years."

 

READ COMPLETE ARTICLE

What Items Will I Need At Home After Surgery?

 

Everyone has slightly different needs.  There are some basic items almost everyone needs and then there are things that some people want and others just don’t need.

 

Must Haves:

 

Crutches  - Normally crutches are supplied by the hospital.  I used elbow crutches and they are much easier to use than normal under the arm crutches.  Overseas hospitals use elbow crutches while US hospital still normally use old fashioned under the arm crutches.  If you have to be on crutches for a long time, I would suggest getting a pair of elbow crutches or at least a pair of the more modern underarm crutches available from many internet shopping stores.

 

Walker – some people that have bi-lateral surgery or special hip problems are required to use a walker.  Whether you use crutches or a walker is up to your orthopedic surgeon.

 

Cane – Canes are often used after a crutch is no longer needed.  A cane is a handy method of still having support if required.  People often get tired on long walks and find it easy to carry a cane with them to offer assistance.  A cane offers much less assistance than a crutch, but it does take weight off the operated leg. It is estimated that a cane will take almost 60% of the weight off the operated leg when used properly. A cane is used on the opposite side of the operated leg, is moved forward with the operated leg as it takes a step and planted about the same position in front of your body as your step.

 

 

Toilet Riser – a toilet riser or potty chair with arms is a must after hip resurfacing surgery.  Most patients are required to follow the 90 degree rule and sitting or rising from a normal height toilet seat will break the rule.   Inexpensive toilet risers that look like big life savers are available at any drug store or discount store for about $20.  Fancier versions or the potty chair with arms are much more expensive.  The one problem with the plastic, inexpensive risers is they are not very big.  A large man sitting on a toilet riser does not have much room to do his business.  The inner diameter of the toilet risers is very small. They are fine for women, but often a problem for men.  Men should check out their options before surgery to make sure they can comfortable use the toilet adapter.

 

Reacher - Many people like to have one or two reachers in case they need to pick something up from the floor.  If you have a helper at home, you might not need one.  You can also bend down and pick something up from the floor by placing your operated leg behind you and bending the other leg.  I did that quite often when I had to feed dogs or pick anything up.  Of course, you need to be careful not to lose your balance. The reason you need to place your leg in back of you when bending is to prevent yourself from breaking the 90

 degree rule.

Grabber	Sock Putter On-er	Grab Bars	Tub Grab Bar

 

 

Sock Putter On-er – Some people find the sock putter on-er a great help.  If you have a helper, you can probably get away without one. If you don’t go sockless and don’t have a helper, you will find the sock helper useful because again you are not to break the 90 degree rule.  It is impossible to reach down to your feet to put socks on without breaking the 90 degree rule.

 

Grab Bar By Toilet – I had my husband install a grab bar on the wall next to my toilet.  I found it to be a great help in getting on and off the toilet. This is not required, but I am glad to have it installed.  I have back problems and it helps to have a nice grab bar by the toilet.

 

Grab Bar by Shower or Tub – I found myself to be very unsteady for a few weeks after surgery. Getting in and out of the shower without help was a problem. I was 61 and not a spry as a younger person, but felt I needed to be very careful not to fall. A Grab Bar by the shower or tub would be a great help for most people, even if they have not recently experienced surgery.

 

Raised Bed – If you have a low bed, you will want to consider a way to raise your bed.  Many of the newer beds and mattresses are fairly high and you can get in and out of bed without breaking the 90 degree rule. If your bed is low, raising your bed with special risers or just bricks or wood blocks, help getting in and out of the bed without breaking the 90 degree rule. Be careful that your risers are secure and your bed won’t slip off of them.  Test them out before your surgery.

 

Silky Sheets – These are certainly not required, but some ladies like to use them because they are slippery and it makes sliding on and off the bed much easier. Some ladies just wear silky PJs to allow them to rotate easily when getting in and out of bed. Men sometimes like to wear nylon warm up pants so they can rotate or slide in and out of bed easily.

 

Ice Packs	Foam Mattress Pad	TEDS

 

Ice Packs – Ice packs are often used by many hip surgery patients. Ice helps reduce swelling and also pain. There are many varieties of commercial ice packs available that you can freeze in your freezer.  Some people just use ice cubes in a plastic bag while others have used frozen bags of peas since they conform to your hip. The peas can be frozen over and over – Just don’t eat them after they have been thawed and frozen too many times!

 

Plastic Garbage Bags – Sitting on a plastic garbage bag when getting in and out of the car or bed makes it easier to rotate you body after surgery. It is often difficult to move your operated leg and body shortly after surgery.

 

Lazy Boy Type Recliner-Lounge Chair – Most people have a difficult time sleeping after hip surgery. Many people need to lie on their backs and it is often difficult to sleep in that position for days at a time. Many people find sleeping or napping in a nice recliner is a great help after surgery. I slept many nights in my Lazy Boy and took many naps in my favorite chair after surgery.  Many people like the La Fuma recliner chairs after surgery.  It is a personal choice as to which chair works best, but having some type of recliner is a definite help to most people.

 

Slip on Shoes – Many people find it much easier to use slip on shoes after surgery. You don’t have to worry about getting a helper to put them on and tie them for you.

 

Stool Softener– A stool softener or similar product is a must after surgery.  Many people start to take them just before surgery. The anesthesia and narcotic based pain meds often cause severe constipation.

 

Nice To Have Items

 

Pillows – Extra pillows to put under your legs while you are lying in bed. Extra pillows under your legs make lying on your back feel much better.  Also many doctors suggest you keep your legs elevated while laying down to help circulation and prevent blood clots. Dr. De Smet always suggests “toes above your nose when lying down.”

 

TEDS – An extra pair of TEDS comes in handy if you doctor suggests you wear them.  An extra pair allows you to wash one pair while you are wearing the other pair. You definitely need a helper to put TEDS on. Some people are able to use the sock putter oner to put them on, but I have heard it is quite a struggle.

 

Foam Mattress Pad – Foam mattress pads on top of your mattress help make lying on your operated side and even your back much more comfortable.  The closed cell foam tends to be too hot for many people, while others like the neoprene type egg carton foam.

READ COMPLETE ARTICLE

How To Select a Surgeon for Hip Resurfacing by Patricia Walter

 

Selection of a surgeon is a personal choice. It is a choice that makes you feel confident that your surgery will go well, that your surgeon has a good bedside manner and you can ask questions anytime you need answers.

 

When buying real estate the old saying about what is important is "Location, Location and Location." In many people's minds the most important factor in choosing a surgeon for hip resurfacing is "Experience, Experience and Experience." I realize that every hip resurfacing surgeon has to start somewhere to do his first operation, but I feel, in layman's terms, that hip resurfacing is as much of an art as it is a learned skill. The angle of the cap on the femur bone is very important, the proper amount of pounding to place the stem is important, shaping the femur bone for the cap is important, how the surgeon approaches the hip itself is important.  There are many, many factors involved in a successful hip resurfacing operation.

 

There have been studies done to determine the learning curve for Hip Resurfacing with the BHR and for Hip Resurfacing with the ASR. These studies and others indicate that a surgeon needs 50, 100 or more hip resurfacing operations to become experienced. I have personally been told by a very experienced doctor that a surgeon should do at least 100 hip resurfacings before a patient decides to use them. There is a LARGE AMOUNT of debate over this number and subject.  Many people feel that a surgeon is already experienced if he has been performing THR's for many years. Hip Resurfacing, however, is a much more demanding and technical surgery than a THR.

 

 

I personally feel that experience can only be learned, it can not be taught. Many professional sportsmen have learned the technical skills to play the game - but you generally see the most experienced quarterbacks, pitchers, or goalies playing in the pros.  The difference is the experience. These people learn almost instinctively what to do, they don't take time to reason and figure out what to do.  That is the kind of surgeon I want to do my hip resurfacing - a surgeon that has seen it all and done it all.  Unfortunately a surgeon that has only done 10 or 50 hip resurfacings has not seen it all and done it all.  My personal surgeon, Dr. De Smet, even told me that he still has very difficult surgeries and he has done over 2500 hip resurfacings.

 

I feel if a person has a more difficult hip problem such as advanced AVN, cysts, misaligned hips or an unusual physical problem they were born with - they need a very experienced surgeon. If you are an older female or even male, many surgeons will suggest a THR instead of a BHR.  The more experienced doctors are more willing to tackle more difficult problems since they have the experience.

 

I have personally read thousands of emails from hip resurfacing patients on the Yahoo Surface Hippy Discussion Group. My personal observation of post-op results show that the patients of the much more experienced surgeons usually have a quicker and easier recovery. There are always exceptions often due to the prior medical condition of a patients hip or muscles, but anyone can take time and read thru the thousands of emails on the discussion group and see how patients recover after their surgeries.

 

To sum up the question of "How to Select a Surgeon", choose a doctor that you feel comfortable with. Ask the doctor:

Some of the newer doctors are not as comfortable with hip resurfacing and will revert back to a THR if they encounter problems.  A THR is an easier operation than a Hip Resurfacing.  Make sure your doctor is a true advocate of hip resurfacing. Some of the new doctors have told me that they only use hip resurfacing in special situations and still prefer doing a THR in most cases. The very experienced hip resurfacing doctors will always give a person a hip resurfacing if possible - some have even changed their mind during a THR and ended up giving a patient a hip resurfacing.

 

Ask questions and opinions from other people, then trust your own instincts and make up your own mind. It is your hip and your life.

 

Patricia Walter Webmaster/Owner of Surface Hippy - A Patient to Patient Guide to Hip Resurfacing

 

Birmingham Hip gets rival in resurfacing

 

Smith & Nephew monopoly lost; FDA approves device from Britain

 

By Daniel Connolly July 18, 2007

 

The Birmingham Hip implant by British medical device maker Smith & Nephew was the first hip resurfacing product to go on sale in the United States and has helped drive revenue at the firm's Memphis-based orthopedic units.

 

But a recent federal decision means the company will now face a rival in the fast-growing hip resurfacing market.

 

Earlier this month, the Food and Drug Administration approved the Cormet 2000 hip resurfacing device from British firm Corin Group PLC. An FDA panel had recommended approval in February. Stryker Corp. of Kalamazoo, Mich., plans to distribute the devices in the United States later this year.

 

When the hip goes on the market, it will break the American monopoly that the Birmingham Hip has enjoyed since its FDA approval in May 2006. Currently, it's the only product available in the United States for hip resurfacing, a relatively new surgical procedure used as an alternative to traditional hip replacement.

 

Both techniques are used in patients who have osteoarthritis and other joint diseases that cause pain and limit mobility.

 

Proponents of hip resurfacing say it destroys less bone than standard hip replacement surgery and is better suited for younger patients who want to maintain an active lifestyle. However, some surgeons have expressed concerns about results, including about a higher-than average early failure rate.

 

Smith & Nephew representatives have said the product is safe and effective, and the Birmingham Hip has been a sales winner for the firm.

 

In the first quarter, for instance, sales of the Birmingham Hip helped increase revenue in the firm's orthopedic reconstruction unit 15 percent to $262 million.

 

A Stryker spokesman declined to comment on competition with Smith & Nephew.

 

Brian Austin, vice president and general manager of Smith & Nephew's hip division, expressed confidence.

 

"We are realizing tremendous growth, particularly in the U.S.," he said in a statement. "We have been aware of Stryker's possible entry into hip resurfacing and are ready. ... We have a world-class training program and have already trained close to 1,000 U.S. surgeons. We are continuing to exceed our growth goals and fully intend to keep our market leading position."

 

-- Daniel Connolly

 

Smith & Nephew

 

World headquarters : London.

 

Worldwide employees : More than 8,500.

 

Local headquarters : 1450 Brooks Road.

 

Local employees : About 1,800.

 

Local presidents : Mark Augusti, president, trauma and clinical therapies division; Joseph DeVivo, president for orthopedic reconstruction.

 

Web site : Smith-Nephew.com.

 

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Health Alert: Hip resurfacing vs. replacement

 

July 5, 2007 04:48 PM EDT

 

NATIONAL - About 350,000 patients have hip replacement surgery every year. Some experts believe 45,000 thousand of them are candidates for a 'hip' new surgery.

 

Working in an emergency room keeps Ron Balliet on the run, but hip arthritis stopped him in his tracks.

 

Balliet says, "The pain - it just got so bad I couldn't deal with it anymore. I had to give up certain things. I couldn't play golf, I couldn't, I would ride my bike, I would be paying for it days later."

 

Ron's active lifestyle led to hip osteoarthritis.

 

"It just got kind of depressing you know. You feel your independence and all that go away."

 

Instead of total hip replacement surgery, Ron chose hip resurfacing. Rather than remove the end of the thigh bone and replace it with a metal stem, only a few centimeters of the bone are shaved off and it's capped with a small artificial metal joint.

 

Dr. Marc Umlas says, "The main advantage is that you preserve your own bone. You leave more of the patient's own bone in the hip." Which creates a more stable, mobile and natural joint.

 

"A number of patients have returned to running marathons, and playing tennis and skiing on these devices and that's a significant advantage, especially for a younger person who's used to being active and athletic and wants to go back and pursue those activities," added Dr. Umlas.

 

Good candidates must have strong bones. It's still major surgery, so expect to spend several days in the hospital followed by physical therapy.

 

"It was a life changing experience, because now I have full motion again. I really don't have any restrictions with movement," says Ron.

 

Many of these patients will still need full hip replacement surgery, but at least this procedure buys them time. Hip resurfacing should last about ten years.

 

Posted by Bryce Mursch

 

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South County doctor local pioneer in hip resurfacing 05:16 PM EDT on Friday, June 22, 2007 By Felice J. Freyer Journal Medical Writer

 

SOUTH KINGSTOWN

 

The guys wanted it. Guys in their 40s and 50s, who once spent hours playing tennis or doing karate, and who, now hobbled by arthritis, poured their energy into finding a solution to the pain in their hips.

 

They came to Dr. Robert C. Marchand, printouts in hand, minds made up, and said, I want this. What they wanted was hip resurfacing — a new alternative to total hip replacement that preserves more bone, and is reputed to last longer, withstand impact and allow a greater range of motion. Perhaps allowing for more years of karate kicks.

 

Marchand, who is with South County Orthopedics, had observed a hip resurfacing procedure in his wife’s native Germany. In Europe, he says, people are running marathons with hip-resurfacing implants. He thought his patients were on to something, and resolved to give them what they wanted.

 

He took a course last year in hip resurfacing in Boston and went to New York to train with a surgeon there. After persuading South County Hospital to buy the necessary equipment, he began doing the procedure last fall. So far, he has completed about 45 resurfacing procedures in people age 20 to 71. And he remains the only doctor in Rhode Island who will do it...

 

In the traditional treatment for arthritic hips, called total hip replacement, the surgeon saws off the top of the thigh bone, hollows it out and inserts a metal implant topped by a metal or ceramic ball, which rests inside a plastic cup implanted in the hip socket.

 

In hip resurfacing, instead of sawing off the top of the thigh bone, surgeons reshape it, preserving most of the natural ball. Then they cement a metal cap over the ball, which slides inside a metal cup pressed into the hip socket. Both are made of cobalt chrome.

 

Some think this metal-on-metal construction will last longer and withstand high-impact activities such as running. More bone is preserved, so that even if the implant does break down, the patient can then get a total hip replacement. Also, the ball is bigger, thought to be less likely to dislocate from the hip socket, and affording a greater range of motion.

 

All this makes the procedures especially popular with active baby-boomers. “They come in at six weeks [after surgery], cross their legs and put on their shoes,” Marchand says. “They say, ‘I haven’t done this in a year.’ ”

 

...EVEN AS patients exult, the debate continues among doctors. Dr. Scott Rubinstein, a Chicago orthopedist who favors hip resurfacing for appropriate patients, says many are discouraged from it by surgeons who don’t do the procedure.

 

“If someone’s interested in getting this done, they need to be evaluated by someone who does them,” Rubinstein said. “It’s certainly not appropriate for everyone. You need to look at this as one way to have your hip done. Like any surgery, there’s no right answer for everyone.”

 

In looking at the evidence, it may come down to a question of whether one sees the glass as half-empty or half-full. Rubinstein, like Marchand, finds the 10 years of data from Europe convincing. “I don’t think it’s going to be any worse than the other stuff. I personally think it’s going to be better,” he says. “It’s one of these time-will-tell kind of things.”

 

...Dr. John A. Froehlich, of University Orthopedics, who specializes in sports medicine and reconstructive surgery and practices at Rhode Island Hospital, also says he’s not ready for that bandwagon.

 

But he points out that patients are not facing a simple choice between old-fashioned total hip replacement and brand-new hip resurfacing. The traditional hip replacement technology has also been advancing, with procedures that preserve more bone, more durable materials, and smaller incisions.

 

He’s pleased with the results he’s getting with the latest versions of hip replacement. “I think I can give people a more predictable result the way I’m doing it,” Froehlich said.

 

With people now living into their 80s, and getting sore hips in their 50s, anyone who gets hip surgery is going to have to have it redone, perhaps multiple times, Froehlich adds. “No matter what they’re made of, they will loosen and wear. That is something that is not recognized by the public,” he says.

 

“There is no panacea.”

 

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Outsourcing to India hip surgery

 

05:21 PM EDT on Friday, June 22, 2007

 

By Felice J. Freyer Journal Medical Writer

 

When Anne Grant needed surgery on a painful arthritic hip, she didn’t go to a hospital in Rhode Island. She didn’t even go to Boston.

 

Instead, she packed her bags for India.

 

Yes, India — where Indian doctors and nurses performed the procedure that Grant wanted for a fraction of the cost in the United States. Five months later, the 61-year-old Providence woman says she’s walking and swimming without pain.

 

As surprising as her choice may seem, in heading to India, Grant joined tens of thousands of other Americans who are going overseas for medical care — to India, Thailand, Brazil, Singapore, to name a few places...

 

...“Our research showed us a very large group of aging baby-boomers were beginning to age into expensive treatment without being able to pay for it,” said Josef Woodman, author of a new book on the trend called “medical tourism.” Many are too young for Medicare but don’t have insurance — and they’re looking for help overseas.

 

Woodman estimated that last year, 150,000 Americans went abroad for medical treatments. Based on interviews with travel agents and reports from international hospitals, Woodman made the educated guess that half sought dental care in Mexico and cosmetic surgery in Brazil or the Caribbean, and the other 75,000 went for major, necessary procedures at international hospitals in Asia.

 

...Then, at a dinner party last year, her friend Lisa Grant — a neighbor, but no relation — mentioned that she, too, had a bum hip, and she was going to Belgium to have it fixed. From a 60 Minutes episode, Lisa Grant had learned about hip resurfacing, a new approach to hip replacement that preserves more of the thigh bone and is reputed to last longer. (See related story.) Although performed in Europe for more than 10 years, hip resurfacing is new in the United States, having received FDA approval only in May 2006.

 

Lisa told Anne about surfacehippy@yahoogroups.com, an Internet listserv rich with patients’ reports of their hip-resurfacing experiences. ..

 

Asked about Americans seeking cheaper care overseas, Lonks said, “You get what you pay for.”

 

He raised numerous concerns. “What happens if you have the procedure, come back to United States and you develop a complication? Who’s going to take care of it? Will your insurance cover it? … How do you know about the sterility and quality of their equipment? How about if you need a blood transfusion in India? … How about malaria? … How about typhoid or measles? Measles is a common disease in India.”

 

In an e-mail responding to The Journal’s questions about the risk of infections, Grant’s surgeon, Vijay Bose, said that “the patients are in a protected environment” and called the chances of catching something like malaria “very remote.”

 

“Over the last three years where I have been doing a large volume for American patients, we have not had a single case of malaria or other infectious diseases,” Bose wrote. He also said the hospital’s blood bank is comparable to any in Europe or North America, so patients who need a blood transfusion face the same low risks as anywhere. (Grant did not need any blood.)

 

As for the low cost, Bose had this comment: “I personally do not think that the cost is cheap in India. It is just the actual and appropriate cost for various procedures. The converse is true, it is artificially boosted and very high in the U.S...

 

...LARGE BUSINESSES and health insurers looking for lower-cost health care are watching the medical tourism trend with interest. But, says Mohit M. Ghose, spokesman for America’s Health Insurance Plans, the national trade group for health insurers: “What you have not seen is a rush by our sector to jump on board.”

 

He said insurers are worried about “legal and quality issues,” particularly who is responsible for patients’ care upon their return. Patients often cannot collect compensation if they are injured. So who will pay for the care at home if there are complications?

 

Ghose thinks the global competition will further boost a trend already under way in the United States — to develop “centers of excellence” that do many procedures, provide consumers information on how well they perform and compete on the basis of quality.

 

Ghose says he knows of only one health insurer that has gone as far as offering an overseas option to subscribers: BlueCross BlueShield of South Carolina.

 

In February, David Boucher, South Carolina BlueCross’ assistant vice president of health care, founded Companion Global Healthcare, a medical tourism agency that has a relationship with the Bumrungrad International Hospital in Bangkok. To address concerns about follow-up care, Companion contracted with a large network of South Carolina doctors to take care of patients when they return from overseas treatment.

 

“We’re not contemplating mandating care abroad,” Boucher stresses. “This is an option — we just want to help them make it a little bit easier.”

 

So far, South Carolina BlueCross’ offer to pay for medical care overseas has attracted lots of media attention and inquiries from other insurance companies — but no patients.

 

READ COMPLETE ARTICLE

Hip replacement alternative for younger boomers Updated Mon. Jan. 29 2007 5:02 PM ET

 

Associated Press

 

WASHINGTON -- Doctors are beginning to offer a new alternative to hip replacement -- one aimed at younger, athletic baby boomers who've worn out their joints too soon. Now they no longer have to wait until they hit their 60s for a fix.

 

It's called hip resurfacing, covering a damaged hip's ball and socket with smooth metal rather than cutting away worn bone and replacing it.

 

The operation hit the U.S. market last spring with Food and Drug Administration approval of the British-designed Birmingham Hip Resurfacing System. Competitors are in clinical trials here, and expected to clear FDA later this year.

 

It's not the first time orthopedic surgeons have tried resurfacing worn-out hips. But where earlier attempts failed, data from Europe suggest this latest approach uses longer-lasting materials -- with the additional promise of a joint that may hold up to the heavy recreation of today's 40- and 50-somethings better than traditional hip implants.

 

"I do have people that call me and say, 'My father had hip resurfacing in 1970 and it didn't work. Why are we doing that now?' '' says Dr. Michael J. Anderson, an orthopedic surgeon in Milwaukee who estimates that about 15 per cent of his hip implants now are resurfacings...

 

...Moreover, while patients typically recover quickly, resurfacing is harder to perform than a hip replacement, and only a small fraction of orthopedic surgeons so far are trained to do it...

 

...So resurfacing is emerging as a niche for the younger sports enthusiast. Dr. Marc Wiener, a Chicago-area internist, chose resurfacing when his own hip degenerated in his 40s, because it came with few restrictions on his activity. Wiener exercised before surgery to be in prime condition for physical therapy afterward -- and played 18 holes of golf a month after his resurfacing, hit the basketball court at seven weeks and the tennis courts in three months..

 

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