Entries by Patricia Walter

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May 1, 2008 By Avery Comarow

If he could have, Brad Barnum would have kissed the ground when he climbed out of the car in Ruidoso, N.M., at the end of March. But the 53-year-old building contractor had undergone major remodeling himself—and his new knee and two new hips ruled out kneeling for a few more weeks. Still, he was ecstatic. More than two months after leaving for the hospital, he was home, and he had afforded the otherwise unaffordable. By having the work done in India, at Wockhardt Hospital in Bangalore, he'd gotten his new joints for just $23,000. Even after adding about $5,000 for airfare, passport, visa, and incidentals, the total was nearly 80 percent less than the $125,000 or more he easily could have been charged by a U.S. hospital. And that bill wouldn't have included physician fees and "ancillary charges."

Barnum is one of thousands of Americans—estimates range from an ultraconservative 5,000 to 500,000 annually if minor procedures are counted—who are leaving the States for surgery when they have to come up with funds themselves. They may be self-employed or work for a small business and lack health insurance, for example, or their procedure may not be covered. More than 1 in 4 workers earning at least $60,000 a year went without insurance in 2006, according to a Census Bureau survey; too well-off to be eligible for medical assistance, they can often wring tens of thousands of dollars out of hospital "rack rates" by going abroad. Some employers and big insurers like UnitedHealth and Blue Cross and Blue Shield are so intrigued by "medical tourism" that they're beginning to sniff for signs that it might be smart to cover it. "I was totally amazed not just at the quality of the medical care but at the quality of the service," says David Boucher, an assistant vice president of healthcare services at BlueCross BlueShield of South Carolina who has visited many facilities abroad. "The initial driver may be price, but patients' positive experiences will do a lot to advance the movement."

So far, there's been mostly talk, with little action from employers and health carriers. In fact, the first verified case of major surgery abroad as an employee benefit took place only earlier this year. (The patient reportedly paid nothing out of pocket for a knee replacement—in fact, the company, a North Carolina manufacturer, paid him a tidy sum for saving so much money.) Wockhardt, where the procedure was done, won't name the company.

Meanwhile, patients are finding their way abroad on their own. Wockhardt's hospitals in Bangalore and Bombay operated on about 850 U.S. patients in 2007, more than double the 2006 total. In Thailand, Bangkok's Bumrungrad Hospital says it treats more than 38,000 Americans a year—a somewhat inflated figure that represents "patient encounters," not individual patients, and includes expatriates. Other hospitals in India and Thailand, as well as centers in Singapore, are actively courting Americans, and the governments of South Korea and Taiwan are about to launch campaigns.

Low-budget dentistry, Botox-ing, lipo, and other cosmetic work have for years drawn Americans into Mexico and to other Latin American countries. But the growth in serious elective surgery halfway around the world is new. Josef Woodman, who publishes the Patients Beyond Borders series of guidebooks to finding good care, thinks about 50,000 patients a year leave the country for major noncosmetic elective procedures such as joint replacement, coronary artery bypass, new or repaired heart valves, or back repair.

Many, like Barnum, do the legwork on their own. But concierge services like MedRetreat.com and IndUShealth.com are multiplying, to help with lists of potential hospitals, appointment scheduling, arranging airport pickup and drop-off, and general hand-holding. (Information from Woodman's annual hospital survey has been incorporated into the World Hospital Finder, a U.S. News search tool for people who are seeking care abroad.)

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Pseudotumours Risk For Hip Resurfacing Highlights Need For Regular Clinical Follow-up For New Devices

Link  http://www.medicalnewstoday.com/articles/114601.php

July 11, 2008

As the incidence of metal-on-metal hip resurfacing has increased in recent years, especially in younger patients, research published in the Journal of Bone and Joint Surgery - British Volume (JBJS-Br) discusses occurrences of "pseudotumours" as a result.

The researchers estimate that approximately 1% of patients who have metal-on-metal hip resurfacings develop pseudotumours within five years of treatment. A pseudotumour is 'a soft-tissue mass associated with the implant…neither malignant nor infective in nature', but that causes pain and discomfort to the patient.

Most worryingly for patients and doctors is that the causes of the tumours are unknown. The research discusses possible causes including 'toxic reaction to an excess of particulate metal wear debris.' The article stresses the need for further research to be done into the incidence of pseudotumours in patients who have had this treatment.

The paper concludes that the incidence of pseudotumours must be related to metal-on-metal hip resurfacing highlighting 'the need for regular clinical follow-up for new devices'. Such follow-up would follow NICE recommendations, but the current NHS climate makes this difficult, if not impossible, to achieve.

Read the research abstract

Notes

- The Journal of Bone and Joint Surgery - British Volume is a world leading orthopaedics journal with an Impact Factor of 1.868

- JBJS-Br publishes twelve issues a year of high-quality, peer-reviewed research, overseen by an international editorial board led by Editor James Scott

- The Journal was first published in 1948 by The British Editorial Society of Bone and Joint Surgery, a registered charity (No. 209299), with the object of the advancement and improvement of education in orthopaedic surgery and allied branches of surgery and the diffusion of knowledge of new and improved methods of teaching and practicing orthopaedic surgery in all its branches

- You can find out more about the Journal at http://www.jbjs.org.uk

Journal of Bone and Joint Surgery, British Volume

Link  http://www.medicalnewstoday.com/articles/114601.php

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11, 2008

As the incidence of metal-on-metal hip resurfacing has increased in recent years, especially in younger patients, research published in the Journal of Bone and Joint Surgery - British Volume (JBJS-Br) discusses occurrences of "pseudotumours" as a result.

The researchers estimate that approximately 1% of patients who have metal-on-metal hip resurfacings develop pseudotumours within five years of treatment. A pseudotumour is 'a soft-tissue mass associated with the implant…neither malignant nor infective in nature', but that causes pain and discomfort to the patient.

Most worryingly for patients and doctors is that the causes of the tumours are unknown. The research discusses possible causes including 'toxic reaction to an excess of particulate metal wear debris.' The article stresses the need for further research to be done into the incidence of pseudotumours in patients who have had this treatment.

The paper concludes that the incidence of pseudotumours must be related to metal-on-metal hip resurfacing highlighting 'the need for regular clinical follow-up for new devices'. Such follow-up would follow NICE recommendations, but the current NHS climate makes this difficult, if not impossible, to achieve.

Read the research abstract

Notes

- The Journal of Bone and Joint Surgery - British Volume is a world leading orthopaedics journal with an Impact Factor of 1.868

- JBJS-Br publishes twelve issues a year of high-quality, peer-reviewed research, overseen by an international editorial board led by Editor James Scott

- The Journal was first published in 1948 by The British Editorial Society of Bone and Joint Surgery, a registered charity (No. 209299), with the object of the advancement and improvement of education in orthopaedic surgery and allied branches of surgery and the diffusion of knowledge of new and improved methods of teaching and practicing orthopaedic surgery in all its branches

- You can find out more about the Journal at http://www.jbjs.org.uk

Journal of Bone and Joint Surgery, British Volume

Link  http://www.orthosupersite.com/view.asp?rid=29416

By Gina Brockenbrough
July 2008

DENVER — Patients with foot and/or ankle surgical wounds who are taking COX-2 inhibitors may have a significantly higher incidence of delayed wound healing than those not taking the medication, according to new research presented here.

To evaluate the potential impact of COX-2 inhibitors on surgical wound healing, Chad Lamoreaux, MD, and colleagues performed a retrospective study of all foot and ankle patients operated on by a single surgeon using the same wound care plan during a 3-year period. The investigators excluded patients with pre-existing foot and ankle wounds and those with a history of chronic ulcers.

The results were presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting.

Of the 175 patients included in the study, 12.6% had delayed wound healing, which the investigators defined as a postoperative delay, infection, wound sloth or lesion that was followed for a period in the wound care clinic. Of the total study group, 18 patients were on preoperative standing doses of COX-2 medications, which included either celecoxib or rofecoxib.

The investigators discovered that nine of the 18 patients taking a COX-2 inhibitor had delayed wound complications compared to only 13 of the 157 non-COX-2 patients. While the groups were similar regarding demographics such as age and gender, a closer examination revealed a non-equal distribution of patients with diabetes and tobacco use.

After excluding patients with these risk factors, the investigators found that only six of the remaining 150 non-COX-2 patients had wound-healing complications (4%) compared to four out of the 13 remaining COX-2 patients (31%).

"[We] did make several assumptions to do this paper," Lamoreaux said during his presentation. "The distribution of Celebrex (celecoxib, Pfizer) vs. Bextra (valdecoxib, Pfizer) was not looked at. Also, the usage of the nonspecific anti-inflammatories was not looked at. But with the normal patients, our findings still showed a very significant impact of COX-2s on their ability to heal their surgical wounds."

For more information:

Lamoreaux C, Santrock RD and Deemer J. COX-2 inhibitors and wound healing complications. Presented at the American Orthopaedic Foot and Ankle Society 24th Annual Summer Meeting. June 26-28, 2008. Denver.
 

Link  http://www.newsweek.com/id/46170

July 2006

At 42, Sally Seeley was barely able to walk. Diagnosed with osteoarthritis in her late 20s, she tried a range of treatments from water aerobics to Vioxx. But her condition only got worse. Finally, an orthopedic surgeon recommended total hip replacement. She worried that she was too young for such surgery, but she just couldn't stand the discomfort any longer. "The pain was gone immediately," says Seeley, now 49. Three months ago, she had her right hip done; she's already back at work.

Joint replacement was once considered a last resort for elderly patients who were immobilized. Now, thanks to improved artificial joints made from longer-lasting materials like titanium, patients in their 50s and younger are signing up in growing numbers. More than 600,000 hip and knee replacements were performed in the United States last year. While the average patient was well over 60 years old, the number of people younger than 65 getting the surgery has grown by 20 percent over the past five years. "Maybe 10 or 15 years ago, the threshold was the ability to walk or do errands," says Dr. Edwin Su, an orthopedic surgeon at the Hospital for Special Surgery in New York. "Now it's continuing to ski, golf or windsurf."

Doctors compare joint replacement to replacing tires on a car that's out of alignment. Over the decades, your weight can wear down your bones. This is especially true for patients with arthritis, where inflammation destroys the cartilage surrounding the joint, causing the bones to grind together painfully. In knee replacements, the most common joint-replacement procedure, doctors cut into the joint and remove the damaged portions of the tibia (the lower leg bone), patella (kneecap) and femur (thigh bone). They are replaced with metal and plastic components. The surgery lasts at least two hours and requires general anesthesia. Artificial knees generally last from 10 to 15 years. Hips are the second most commonly replaced joints, followed by shoulders...

 

June 2008

Link http://www.nbc11.com/msnbchealth/16748813/detail.html

Timmi Ryerson, a San Diego stock market analyst, says her left hip actually works again, thanks to an orthopedic specialist in India.

...What's new about these procedures is not the exotic locales the three chose, but the way they paid for their far-flung surgeries.

While at least 150,000 Americans travel abroad for medical care every year, according to the American Medical Association, Ryerson, Mason and Davies represent a small but growing category of medical tourist: patients whose insurance companies have agreed to foot at least part of the bill.

"I think that's the solution to our health care crisis," said Davies, 53, whose company plan, Delta Dental, maxed out his dental benefit, about $2,500, toward the $30,000 he spent to repair damage caused by years of grinding his teeth, a procedure that would have cost an estimated $80,000 in the United States.

Increasingly, some of the nation's larger employers and leading health insurers agree.

Once the province of the poor and uninsured, medical tourism is gaining attention of industry giants such as CIGNA, Aetna and Blue Cross/Blue Shield, who say they either have begun or are considering pilot programs that provide limited coverage for foreign care. One Montana firm, Employee Benefit Management Services Inc., recently began offering medial tourism plans to its 120 self-insured clients in the Northwest...
 

"I just think that others need to be aware that they are able to have a safe procedure done out of the country for a price at a third the cost," she said.

Ryerson, 61, said her private Blue Cross plan paid 80 percent of a $7,000 hip resurfacing surgery in Chennai, India, that would have been about $55,000 in the U.S. - if she could get it at all.

In 2006, the hip resurfacing device necessary for her surgery had just been approved for U.S. use by the federal Food and Drug Administration and not many domestic doctors had experience with it. Dr. Vijay Bose, her U.K.-certified surgeon in India, had performed the surgery more than 1,100 times.

"Doctors here didn't know what they didn't know and I didn't want to be a guinea pig," she said.

While she was there, Ryerson also had cosmetic surgery and dental work done at her own expense...
 

 

I am honored that some of my overseas patients have got together and made a plaque in appreciation of our hip surgery team and a donation for the Jay Coulter fund.

Gary Klein has come back to Chennai to get his second hip done. He brought the plaque and the donation.

I have attached a picture of the plaque.

With best regards

Vijay bose
chennai
Asian Regional Center for Hip Resurfacing (ARCH) Website