[Laner]

My father is 60 and he has a cyst on his hip that is causing him a lot of pain. His ball is also fairly shot, and the doctors here in Canada want to do surgery.

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.

He was just prescribed Oxy last week. He has been in pain since summer 2016, but has been fighting through it. Now its too much.

I am going to see about medical marijuana while he is here too. He does not want to smoke, but I would imagine that edibles would be the way to go anyways.

The doctors say it looks like Feb 2017 at the earliest for surgery. Its Canada, so its free, but that is a long time away and he hates laying around on Oxy.

My questions to the RVF world:

Is anyone familiar with clinics in Mexico that do this type of surgery?

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

Anyone know much about medical tourism at all?

I want him to do this fast, fuck money. He has too many grandkids that need their big Indian jungle gym back.

[DaKi]

There are actually at least four types of THR approaches that I am aware of, but the two most popular are posterior and direct anterior. I had a THR of my right hip done via the direct anterior approach on March 25, 2015 (at the age of 43). My new hip "ball" is ceramic, and the socket it sits in is crosslinked polyethylene.

The advantage of the direct anterior approach over the posterior approach is huge. To access the hip via the posterior approach, the glute muscle behind the hip to be replaced is cut, and then later closed after the hip is replaced. As you might imagine, having a 4-6 inch incision made through your gluteus maximus is..._not a good thing_. Additionally, the posterior approach results in some movement restrictions--due to possible dislocation of the prosthetic--that do not exist for the direct anterior approach.

The direct anterior approach, on the other hand, involves accessing the hip via the upper thigh, by spreading--rather than cutting--the muscles of the upper quadriceps. Recovery is typically much faster, more complete, and less painful than via the posterior approach.

An excellent overview: https://youtu.be/5NqJa_J2dfw

If I can answer any questions, please ask away.

[Laner]

Thanks!

My biggest concern is the downtime (now- since June) due to the injury, and the time he gets into surgery (Feb at the earliest).

At 60yo, this possible one year wait + recovery time is quite long.

He just retired last in January, so I want him to be able to start this new part of life out with High Energy and be able to do the physical things he loves- mechanics, skiing, motorcycles. The weight gain from becoming more immobile will be harder to shed the longer he waits.

I found this link for some clinics in Mexico. https://www.health-tourism.com/hip-repla...ry/mexico/

I want to encourage him to look more into this option. Get is done.

In the meantime, what are your thoughts on marijuana edibles for pain?

[DaKi]

(11-13-2016 04:17 PM)Laner Wrote:  

Thanks!

My biggest concern is the downtime (now- since June) due to the injury, and the time he gets into surgery (Feb at the earliest).

At 60yo, this possible one year wait + recovery time is quite long.

He just retired last in January, so I want him to be able to start this new part of life out with High Energy and be able to do the physical things he loves- mechanics, skiing, motorcycles. The weight gain from becoming more immobile will be harder to shed the longer he waits.

I found this link for some clinics in Mexico. https://www.health-tourism.com/hip-repla...ry/mexico/

I want to encourage him to look more into this option. Get is done.

In the meantime, what are your thoughts on marijuana edibles for pain?

If marijuana--in whatever form he prefers--helps with pain, by all means go for it. If he can get a cortisone injection into the hip joint, that may provide some pain relief for weeks-months. If he is going to be taking NSAIDs regularly, Celebrex (celecoxib) is probably the best bet. Acetaminophen/Paracetamol can of course also help a bit. Not gaining weight will also help him now, because he will put less stress on the hip joint.

[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.

[DaKi]

(11-18-2016 02:11 AM)Thomas the Rhymer Wrote:  

(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?

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.

Generally, the important parts of a hip replacement (from the perspective of having a meaningful difference WRT outcome due to surfaces) are the "ball" (femoral head component) and "socket" (acetabular component). Very broadly speaking, the two current options that are most highly thought of are--

ceramic ball in ceramic socket

and

ceramic ball in highly cross-linked polyethylene (really, really durable and low-friction plastic) socket

I have the latter. Steve Carell (actor, comedian, writer) has the former. While cermaic-on-ceramic is more durable than ceramic on highly cross-linked polyethylene, this advantage is kinda academic as both are so durable that one is unlikely to need a new THR due to surface friction. Cermaic-on-ceramic has one big disadvantage that I am aware of: it tends to squeak, audibly, in a significant minority of patients. Steve Carell is one of them

A minor disadvantage of ceramic is that if it breaks--very unlikely (hence, _minor_ disadvantage)--getting all the little pieces out of the hip area during revision surgery can be a major...challenge.

Some patients--older men, mostly--are still offered metal balls (heh), which tend to be less durable and can create metal dust particles which increase friction and to which some people (mostly women) seem to be "allergic" to--I would personally avoid this option.

BTW--here's my THR. My surgeon was young, incidentally, so here's the prosthetic that was given to me by my young hip doctor