Orthopedics

“Oh my aching (circle one or more) back, knee, hip, neck, wrist, ankle, shoulder...” If you find yourself uttering that sentiment several times a day, you’re not alone. One in every seven of us has an orthopedic impairment, and four out of every five experience significant back pain at some time. Orthopedic complaints are the most common reason why patients make appointments to see their doctors. In the US alone, more than 7 million people each year require hospitalization for an orthopedic condition. Millions more do not seek treatment, electing instead to live in chronic pain, most often for financial reasons.

In recent years, orthopedic specialists have increased their ability to provide care and restorative treatment, especially in the arena of joint replacements. Since the first knee replacement was performed in 1968, the demand for artificial joints to replace natural ones lost to age and osteoarthritis has grown dramatically.

Part of the reason is an aging population, but don’t be misled. Senior citizens aren’t the only patients seeking orthopedic treatments and surgeries. More than 20 percent of Americans are affected by arthritis, and two-thirds of them are under the age of 65.

A Canadian survey released in 2003 showed that the number of knee replacements performed on patients under 55 rose by 90 percent between 1994 and 2001. The reasons? More active lifestyles, better prostheses, and improved surgical techniques.

Why It Works for Medical Travel

Orthopedic patients travel for the same reasons other medical travelers do: they want quality treatment at an affordable price. They find both at some of the top orthopedic hospitals and specialty centers abroad, where prices can run as much as 80 percent lower than at home. Like other medical travelers, orthopedic patients may find that their surgery is labeled “elective,” in which case a health insurance policy may not pay even part of the cost. Patients in countries served by national health plans may find the waiting list uncomfortably long for the most sought-after procedures, such as knee and hip replacements.

There is another factor that weighs heavily in the decision making of many orthopedic patients, and that’s the availability of the newest and most technologically advanced treatment methods. Some countries err on the side of caution when innovations come along. They require long spans of time and lengthy periods of clinical trials before new techniques are approved for general use.

The upside of that approach is safety. Patients in “cautious countries” aren’t likely to be harmed by experimental techniques that fail. The down side is that doctors in those countries may find themselves lagging behind in their mastery of a new technique when approval is eventually granted. Doctors overseas may have developed greater expertise because they have been using a technology longer.

Orthopedics patients are spoiled for choice when seeking treatment overseas. Dozens of fine JCI-accredited hospitals offer outstanding orthopedics services and surgeries at the hands of experienced, often Western-trained surgeons.

Special Considerations

All orthopedic surgeries carry a risk of complications. While rare, patients should not ignore this when deciding about surgery. Some risks are specific to a particular procedure. A repaired or rebuilt ligament may stretch or tear. A fracture may not heal properly. An operation done to slow the progression of age-related arthritis may accelerate it. A procedure performed to reduce pain may increase it.

Happily, orthopedic surgeons can, on average, boast high success rates for their patients. After knee arthroscopy, for example, more than 80 percent of patients return to walking, yard work, and other light activity within one week. Success rates for knee replacements run around 90 percent, but 10 percent of knee-replacement patients may encounter difficulties. Stiffness, pain, or swelling may occur. The prosthesis may become infected, in which case antibiotic treatment or “revision surgery” may be necessary. Other risks include:

• failure of the surgery (the most common postoperative problem)
• infection (some sources say the risk is 1-2 percent)
• stiffness or loss of motion of the joint or nearby joints
• blood clots
• injury to nerves or blood vessels

For the medical traveler, these risks can be diminished in three ways:
• Don’t return home too soon
• Make sure you have a good understanding of your physical rehabilitation program before returning home
• Ensure that your hometown specialists (including your physical therapist) are ready and willing to supervise your rehabilitation in the weeks and months following your return

Planning Tips

Before you plan an orthopedic treatment at home or abroad, discuss your alternatives fully with a specialist. A major surgery to correct a minor annoyance may not be a wise choice. Make sure, also, you understand what you can reasonably expect as an outcome of a successful surgery.

Be realistic. If you’re 70, you not going to return to the athletic prowess you enjoyed when you were 20. But, assuming a knee replacement looks right for you, you may look forward to walking, bicycling, golfing, and swimming—although skiing, basketball, and racquetball are out.

Home-Again Tips

Orthopedic specialists emphasize the need for formal physical therapy and informal self-motivational therapy after nearly every orthopedic procedure. The longer a joint stays immobile (after healing), the less likely becomes its return to normal movement and functioning.

Orthopedic patients have to be just a little bit tough in both body and mind. For example, getting a repaired rotator cuff moving again is going to hurt, but performing the daily exercises recommended by the orthopedic surgeon and the physical therapist is a must. Doctors tell us that their patients who work with consistency and persistence—working their way through moderate pain—fare best in the end.