[Thomas the Rhymer]

(11-13-2016 01:06 AM)Laner Wrote:  

There seem to be two types of surgery; Anterior and Total Hip Replacement. I am not sure too much on the differences, or what he needs exactly.

What are some of the things to ask when looking into clinics in Mexico?

I'm not an orthopaedic surgeon, and I'm not involved in medical tourism, so take my advice for what is - a generalist doctor's opinion. I have been involved in receiving and sending ill patients on airplanes, so at least that helps a bit.

As I understand it-
- This operation involves replacing the hip joint
- The 'anterior' and 'posterior' and 'lateral' methods are only about where the cutting is done. All hip replacements are total hip replacements.



This is a somewhat technical article but you should be able to follow it:
http://emedicine.medscape.com/article/20...verview#a2

Of importance is to find out what make of implant they want to put in. You don't want to put in some cheap implant that will break or crack. Ideally you also want an implant that has a track record. A friend of mine's father had a knee replacement with a state-of-the-art implant, which broke 2 months after the operation - it turns out that the 'state-of-the-art' implant had serious flaws in its design that were not properly fixed before it came onto the market. It might also be possible to buy the implant yourself - that would save you on the hospital markup for the implant. Different implants also have different shelf lives. Cheap implants may only last 5 - 10 years, which for 95 year olds in old age homes is fine; but for a 60 year old you want something that will last a long time and withstand wear and tear. You want to research the implant they are going to put in before it is in your father.

Also, find out what the implant is made from (to assess if your father may be allergic to it - most implants are made of titanium, and titanium allergy is a thing). Also, does the implant come with a guarantee? Some manufacturers are not very good with quality control so you want a free guaranteed replacement should the implant break before the end of its expected shelf life.

With regards to the clinic, you want to know what is the experience of the surgeon, and what is his complication rate. If he says he's never had any complications, you know that he is lying and that it's better not to use him as your dad's surgeon. All surgeons have complication rates, and the ones lying about it tend to lie about it because they have higher complicatin rates than average. You would also want to know what approach he intends to take, and why. Ask him about what are the most common problems he has experienced doing this operation. Ask him how many of these operations he has done.

You also want to have proper travel planning. Getting your dad to Mexico and back with a buggered hip, even after the op, will be a challenge. He will need anti-clot injections or medications before and after the trip, and also very clear discharge instructions, and a clear plan of who will pre-assess him before the flight, and who will re-asses as soon as he gets back. His usual family practitioner can probably take over this role. I personally refer to the American Aerospace guidelines, and I recommend you give your Canadian family doctor a copy if you and the doc are not quite on the same page:
https://www.asma.org/asma/media/asma/Tra...edguid.pdf

This above is important!: the trip back may be more dangerous than the operation itself. There is a very high risk of a massive blood clot when you take a patient on an airplane after a major operation. You don't want to give your dad a stroke or a heart attack, so planning the trip carefully and medically is important.

All major operations have a risk of sudden death. It might be tiny, provided you are in a good facility, but it will always be there and even in the best hospitals patients die for the darndest reasons. If your dad dies on the operating table in Mexico, you will need to have some sort of contingency plan in place for dealing with the body. Know what the procedures are, and maybe have some sort of travel insurance that includes expatriation of a body if you intend to bury him in Canada.

You will need to ask the Mexicans if they have cover for medicolegal liability, and who is it with, and then you should check with the insurer if the account is current; and you should familiarise yourself with what is the procedure should be you wish to institute a case of medico-legal negligence against the Mexican doctor. One of the biggest issues around medical tourism is that if there is a proper medical mess-up, the patient is often too ill to travel to the country involved to prosecute the case, and some countries require an actual physical presence. So sometimes people are so ill they just drop the case because they are too ill to travel from their home country back to the country where the procedure took place.

You are going to pay good money to have this operation, and you need to be prepared to walk away if you are not happy with the service. It is private healthcare, and you should demand standards. Beware of the sunk costs fallacy; even if you've taken your dad all the way to Mexico, if you are unhappy about the procedure, or the surgeon, or anything at all, then cancel it and walk away, even if its 5 minutes before the operation. The power is in the Mexican doctor's hands, because he knows it is going to be extremely hard for a Canadian to sue him, so you need to be 100% convinced that you the doctor's hands are good enough to trust.

I hope this helps. Consulting your usually family doctor in Canada for an opinion will also probably be useful.