July 15, 2008 SAN DIEGO ALIVE
With more people in their 40s and early 50s being sidelined by severe osteoarthritis, a new technology – hip resurfacing as an alternative to hip replacement – is giving baby boomers a chance to stay active longer.
 |
Robyn Benincasa, a runner and San Diego firefighter, had a new hip resurfacing procedure. |
The Birmingham Hip Resurfacing system takes only the cartilage off the outer part of the ball and socket joint, and installs a cobalt-chromium steel cap and cup that slides more smoothly than hip replacements, lasts longer and has less potential for leg-length discrepancy. Widely used in the U.K. since 1997, the BHR system was approved for use in the U.S. in May 2006.
This week, San Diego Alive, the Union-Tribune's video health feature, spotlights local adventure racer and San Diego firefighter Robyn Benincasa, who, under the care of La Jolla orthopedic surgeon Dr. Michael Kimball, had the procedure. Five months after Kimball resurfaced Benincasa's troublesome hip, she ran across Vietnam.
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.)
Read Complete Article by clicking here
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
br>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
AAOS SAN FRANCISCO, March 7, 2008 - Some of the purported advantages of hip
resurfacing over standard arthroplasty, though not all, seem to be real,
researchers found in a randomized trial.
But other pluses in activity and function can probably be chalked up to patient
selection bias and expectations, reported Martin Lavigne, M.D., of the
University of Montreal, and colleagues, at the American Academy of Orthopaedic
Surgeons meeting here.
In the randomized trial, patients who had hip resurfacing were significantly
more likely to return to work and sports and had better step and hop test scores
than standard arthroplasty patients did.
But functional scores and range of motion were no better than with hip
replacement, the investigators found.
Hip resurfacing gained popularity with patients and some orthopedic surgeons on
the basis of assumptions about better clinical function and ability to return to
a high level of activity.
While retrospective cohort studies reinforced this perceived benefit, Dr.
Lavigne said, "obviously there was a bias in the patient selection for hip
resurfacing." Patients who sought hip resurfacing tended to be younger, more
active, healthier, and expected a more active life after surgery, he said.
The newer procedure is still controversial among orthopedic surgeons despite
rapid increases, commented Tom Schmalzried, M.D., of the Orthopaedic Hospital in
Los Angeles, in a press conference where there was debate over the two
approaches.
"The results of good, modern total hip replacement are really, really good," he
said. "So for resurfacing to have a favorable risk-to-benefit ratio, you have to
show you are getting something you don't get with total hip replacement."
For a more objective answer to this issue, Dr. Lavigne's group randomized 210
patients who were candidates for either procedure to undergo either uncemented
28-mm metal-on-metal total hip arthroplasty or hybrid metal-on-metal hip
resurfacing.
All procedures were done by the same three surgeons with a posterior approach.
Patients were informed which surgery they underwent only afterward.
Patients had a mean age around 50. Body mass index was higher in the total hip
arthroplasty group.
Functional scores were slightly worse in the hip replacement group at six months
(17 versus 11 on the WOMAC scale) but identical by two years (5 for both).
At six months after surgery, hopping on the affected leg was significantly
easier for resurfacing group patients ("easy" or "very easy" 91.7% versus 78.9%
and "difficult" or "impossible" 8.3% versus 21.1%, P=0.023).
Likewise, climbing stairs in a step test was easier at six months in the
resurfacing group compared with the replacement group ("easy" or "very easy"
94.4% versus 76.3% and "difficult" or "impossible" 5.6% versus 23.7%, P=0.015).
Hip resurfacing group patients were also more likely to return to their prior
work (96% versus 83%, P=0.02).
The young age of the patients made this an important outcome, Dr. Lavigne said.
Among the patients, 152 had data on activity level pre- and post-procedure.
Despite similar activity levels before surgery (P=0.22), more hip resurfacing
than hip replacement patients returned to sports activities by one year after
surgery (15% versus 7% high impact and 38% versus 28% moderate impact activity,
P=0.022).
On a scale that included activities of daily living as well as sports, the
difference tended to favor hip resurfacing but was not significant at one year
(P=0.074).
"Both groups returned to a high level of activity," Dr. Lavigne said. "Hip
resurfacing patients seem to be more active, but not as much as expected."
Type of surgery had no significant impact on what factors patients reported as
limiting their return to sports activities, including implant protection,
discomfort, fear of instability, and thigh pain.
Hip range of motion -- including total arc, arc of rotation, flexion-extension
arc, and abduction-adduction arc -- was also similar for both groups among the
122 patients with data on this outcome (P>0.05).
Satisfaction with the procedure was uniformly high over time and across
treatments.
While resurfacing is a more aggressive technique, Dr. Lavigne said, the rate of
complications was similar between groups.
Long-term follow-up will be important to determine whether there are differences
in need for revision between the procedures, he concluded.
Dr. Lavigne reported receiving research or institutional support from Zimmer,
Stryker Howmedica, Biomet, DePuy, and Smith & Nephew and consulting for Zimmer.
Dr. Schmalzried reported receiving research or institutional support from
Stryker, DePuy, Johnson & Johnson, Corin, and Wright Medical Technology;
receiving miscellaneous funding from Stryker, DePuy, Johnson & Johnson, Corin,
Wright Medical Technology, Zimmer, and Smith & Nephew; receiving royalties from
Stryker, DePuy, Johnson & Johnson, Corin, and Wright Medical Technology; holding
stock options in Stryker, DePuy, Johnson & Johnson, Corin, Wright Medical
Technology, Zimmer, Biomet, Bristol-Myers Squib, and Pfizer; and being a
consultant for Stryker.
Primary source: American Academy of Orthopaedic Surgeons meeting
Source reference:
Lavigne M, et al "Range of motion after hip resurfacing and THA: A single-blind
randomized clinical study" AAOS meeting 2008; Abstract 058.
Additional source: American Academy of Orthopaedic Surgeons meeting
Source reference:
Lavigne M, et al "A randomized study comparing surface replacement arthroplasty
to total hip arthroplasty" AAOS meeting 2008; Abstract 056.
Additional source: American Academy of Orthopaedic Surgeons meeting
Source reference:
Lavigne M, et al "Return to sports after hip resurfacing and total hip
arthroplasty: A randomized clinical trial" AAOS meeting 2008; Abstract 053.