The published studies of the Geriatrics Society, found those who had the surgery were twice as likely as those who didn’t to gain mobility and the ability to take care of one’s self. At the Neurologic & Orthopedic Hospital of Chicago, we find that total hip arthroplasty improves everyday life for patients and is as beneficial to people in their 80s or 90s as it is for someone in their 60s. While the number of surgeries conducted in the U.S. has increased dramatically over the last decade, statistics indicate fewer than 25 percent of patients who could benefit from the procedure elect to receive it. Also, the surgery saves money for the health-care system, because the average self-pay is far less than the long-term expenses of health care for the mobility impaired. Health economists estimate a $50,000 a year savings associated with a disability-free life.
Osteoarthritis of the hip is a progressive type of arthritis that affects
about 10 million Americans. Associated with aging and obesity, it causes
pain, decreased mobility and increased risk of falls and fractures. Hip
replacements are performed when medications and physical therapy fail.

As total hip replacement is an invasive treatment with a long rehabilitation period, some physicians don’t like to offer the option to patients older than 85, and that is also why some older patients are reluctant to choose it when it is presented. At the Neurologic & Orthopedic Hospital of Chicago, we have created a preoperative methodology of health care screening prior to a hip replacement for all age groups that maximizes preparedness and minimizes the risks inherent in any surgical procedure. We at the Neurologic & Orthopedic Hospital of Chicago treat the individual patient without age related bias.

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Bench spoke to about 100 people at the Pineville Convention Center Tuesday night about receiving a hip replacement four years ago after his hip joint had worn down to bone-on-bone — especially because he squatted an estimated 400,000 times behind the plate during his career.

“I know pain,” said Bench, who has had numerous broken bones — and seven broken cups. “I could hardly sleep.” A doctor friend of his recommended he receive a Stryker ceramic-on-ceramic hip. Since then — after a recommendation from his doctor — Bench has gone around the country holding seminars and meetings promoting Stryker’s products and talking with people about the benefits of receiving his total hip replacement.

“I thought about making a comeback,” Bench said of how he felt after his post-operative physical therapy. “Then I pulled a muscle vacuuming, so that was the end of my comeback.”

According to statistics they presented, 43 million Americans suffer from arthritis — including 21 million from osteoarthritis alone — and 300,000 people receive hip replacements per year.

Yet, ceramic-on-ceramic replacements have drawn some fire recently as some recipients have noticed squeaking in their new hips — which has led to some lawsuits.

According to a May 11 article in the New York Times, Stryker received a warning last fall from the Food and Drug Administration regarding the squeaking and other problems associated with all ceramic hips. Stryker also recalled ceramic hip parts from their Cork, Ireland factory for sterility reasons, but the medical products company said neither the warning nor the recall had anything to do with squeaking.

Though there is some concern in the medical community research has shown no conclusive evidence between squeaking and a failure of the implants’ systems. In our experience, any hard on hard, such as metal-on-metal or ceramic-on-ceramic, replacement can squeak. Depending on the patients’ needs we at the Neurologic & Orthopedic Hospital of Chicago use a combination of ceramic-on-polyethylene, metal on metal, or metal on plastic.

Though Bench has experienced some squeaking, he said, it doesn’t bother him. “I don’t care if it plays ‘Dixie,’” Bench said.

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I mentioned that the rest of the world was in the process of learning what those folks already know; the fear, the pain and the hope when the diagnosis has been made.

It was a wonderful day with children’s games and face painting, Salsa music, burgers and hot dogs, and, of course the walk. I think we all left feeling a bit more hope and strength through our relationships with one another. I think that is one of the major determinants between who wins and who loses. But you can do neither unless you at least run. And we raised almost $100,000 for brain tumor research, another important determinant.

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The meeting started at 7am and ended with few breaks after 7pm. We ate at the Crab House after which our group of five went to the Foot message spa. One and a half hours of foot message.. Shortly we leave Beijing to Wenzhou where we visit a regional hospital for the day lecturing and operating. Initially our stop was to be Tianjin but Tianjin is close to the region ofd the earthquake and all priorities are to the trauma victims. We have been told the back log of surgery to fix broken bones may take months.

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The Chinese people are as friendly as can be imagined with warmth and smiles. The girls are very fashion-conscious and the eye make up is amazing. I am told plastic surgery is exploding here and much of the eye makeup is permanently tattoed rather than applied daily.

This morning I walked over to the adjacent convention center owned and managed by the government to give a series of lectures. My physical therapy colleague presented the first formal PT talks ever given in China, as China has no formal physical therapy. After a surgical procedure the patient is totally dependent of family for assistance with no monitoring of outcomes.

So here is how it works. Patients have a choice as to where to go for surgery. Competition between hospitals is fierce but based on word of mouth as health care marketing is illegal. While the government pays for part of the hospital stay which is three weeks and relatively inexpensive, the patient pays for the surgeon and the implant. We are led to believe by US media that the Chinese population is well off, a joint replacement may require a five year wait as the family accumulates enough money to economically support the senior family member. Bear in mind that while there are 20 Chinese cities with populations over 10 million, that still leaves a billion people living in rural China. A patient is admitted 10 days before surgery so as to be made healthy. All hospitals in China with one or two exceptions are governmental financed. .001% of surgeons have travelled outside of China for training; anesthesia is almost universally general. Bad results are not recorded or monitored. An orthopedic surgeon earns about $1,000 per month and relies on “creativity” to afford living here. The goal of orthopedic surgery in China is different from that in the US in that while all patients desire pain relief, in China the desired functional end result is walking, squatting and biking. The first lecture series in the morning was to the JST Hospital staff, the best equipped hospital in Beijing with 800 orthopedic beds. 20 operating rooms in the JST are equipped with state of the art artificial intelligence while there are no such ORs in Chicago. In the afternoon I gave a series of lectures for three hours at the Peking University Third Hospital modernized two years ago. I did rounds with three patients per room but quite comfortable, and immaculate.

Four lectures, 20 minutes each tomorrow.

Mitch

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I will keep you updated during my trip.

Mitch

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It is my job to provide the patient undergoing a hip or knee replacement a safe and satisfactory perioperative experience with the best possible outcome. At the same time, I must focus on the long term success and survivorship of your implant. Recently, I had three orthopedic surgeons visit me from Norway. In our exchange of information, the question arose as to how a chose a hip or knee prosthesis. While I informed my visitors that I chose that which I believe best for my patient based on patient demand, my long term clinical outcome studies, and the most recent scientific and industry updates; my guests indicated that their single criterion is the minimum of ten year results to be found in the Norwegian governmental mandated data base concerning a particular hip or knee prosthesis.

In Norway, Sweden, and Australia for instance, every time an artificial joint is implanted in a patient, there is a mandatory reporting process and those reports on patient complication, satisfaction, prosthetic survivorship and outcome must be continually updated with a governmental regulated central data base. In the U.S., there is no such requirement and there is no mandated central authority overseeing the joint replacement profession other than the FDA. The patient in the United States is dependent on the integrity of the Orthopedic Surgeon to do the right thing. Only when there is a large scale failure of an implant does the patient or occasional joint replacement surgeon become aware via a FDA “recall” mechanism. While there has been on going discussion as to the benefits of a national data base in America, it seems there will some time before on is established.

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Some hospitals are very good but many are not “brimming with infectious bugs, systemic error and negative hospitality.” One in 200 patients who spend a night in the hospital will die of medical error. One in 16 will pick up an infection. Death from preventable hospital infections each year exceeds more than 100,000.

Patients have a choice; it’s called the specialty hospital. A recent University of Iowa study of tens of thousands of Medicare patients found that complication rates are 40% lower for hip and knee surgeries at specialty hospitals than at big community hospitals. A 2006 study funded by Medicare found that patients of all types are four times as likely to die in a full-service hospital after orthopedic surgery as they would after the same procedure in a specialty hospital.

In mid 2006, I began admitting patients to the Neurologic & Orthopedic Hospital of Chicago because the large teaching hospital with which I have been affiliated for 35 years could no longer provide the efficiency and the services I requested that met the standards I required to assure patient satisfaction. At the time I wasn’t aware of the innovations in care that would be afforded by my patients undergoing hip or knee replacement surgery at a specialty hospital. Soon, I will have completed over 600 hundred joint replacements at NOHC with a complication rate of less than 0.03%. The Forbes article suggests the “heart of the health care industry has failed the consumer.” Remember though, you as a patient have a choice, it’s called the specialty hospital where services are delivered with a concern for the hip and knee. Less costly, less infection, and greater satisfaction—its available to you in Chicago’s only specialty hospital, the Neurologic & Orthopedic Hospital of Chicago.

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