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Medical Tourism And Well-Being: Trends and Strategies
Published in Frederick J. DeMicco, Ali A. Poorani, Medical Travel Brand Management, 2023
Frederick J. DeMicco, M. Cetron, O. Davies
Some Indian medical centers even provide services that are uncommon elsewhere. For example, instead of having the entire hip joint replaced, patients can undergo “hip resurfacing,” in which damaged bone is scraped away and replaced with chrome alloy. The result is a smoothly functioning joint with less trauma and recovery time than total replacement, and at lower cost. The operation is now widely available in the U.S., but Indian tourist clinics offered the procedure long before it received FDA approval; this long practice has given Indian orthopedic clinics success rates better than those of most other institutions in the world. Other advanced services available in Indian clinics include radiotherapy and radiosurgery to destroy cancerous tumors from outside the body, robot-assisted surgery, and bone marrow transplants for genetic disorders yet to receive FDA approval in the U.S.
Surgery of the Hip
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Daud TS Chou, Jonathan Miles, John Skinner
The indications and contraindications of hip resurfacing are almost the same as those for THA. In addition, there are further contraindications that reflect the need to maintain the femoral neck: Femoral head cysts greater than 1 cm diameterOsteoporosis – recommended to investigate with dual-energy X-ray absorptiometry (DEXA or DXA) in perimenopausal women/high-risk groupsNeck length of less than 2 cmSignificant lateral head-neck remodellingHead:neck ratio less than 1.2
Wear Model of Liner in Hip Replacement
Published in Z. Yang, Finite Element Analysis for Biomedical Engineering Applications, 2019
As Americans age, more and more individuals need joint replacements, such as a total hip replacement (Figure 17.1). The Agency for Healthcare Research and Quality estimated that about 250,000 total hip replacements are performed in the United States each year [2]. This significant demand for hip replacements inspired the development and production of hip-resurfacing devices, as well as more research into the hip replacement procedure. In the past, research primarily focused on wear tests to predict the mechanical wear of the implant devices. In addition, some finite element models were developed to simulate the wear of the hip replacement [3–6]. In this study, the wear of the hip replacement in ANSYS190 was simulated.
Lessons learnt from early failure of a patient trial with a polymer-on-polymer resurfacing hip arthroplasty
Published in Acta Orthopaedica, 2018
Job L C Van Susante, Nico Verdonschot, L Paul A Bom, Pawel Tomaszewski, Pat Campbell, Edward Ebramzadeh, B Wim Schreurs
All surgeries were performed in collaboration by 2 out of 3 experienced hip (resurfacing) surgeons (JvS, BWS, PB) using a posterolateral approach. The surgical technique was matched with a hip resurfacing procedure as has been described before (Amstutz et al. 2006, Smolders et al. 2011). The Gradion HIP TCR was implanted and both the acetabular and the femoral component were cemented with low-viscosity cement after standard reaming. Both the acetabular and the femoral side were slightly over-reamed (1 mm) to allow adequate cementing and avoid any potential for deformation during insertion. Prior to cementing, the acetabular component was fitted on a vacuum suction device facilitating cemented implantation of the flexible device in a perfect concave shape. Accordingly, preparation of the femoral head was performed by reaming, after which the flexible femoral component was cemented onto the femoral head again using a vacuum suction device to facilitate curing of the cement with the desired convex shape. The use of these custom-made vacuum suction devices while cementing ensured maintenance of a perfectly matched concave and convex spherical shape for the acetabular and femoral components, as had been confirmed earlier during in-vitro testing of the cementing technique on saw bones. Patients received antibiotic prophylaxis with cephalosporin preoperatively and 24 h postoperatively, periarticular ossification prophylaxis using diclofenac 50 mg for 3 days, and thrombosis prophylaxis with nadroparine (2,850 IE subcutaneous) during hospital admission and continued for 6 weeks after surgery.
Patient-reported outcomes in hip resurfacing versus conventional total hip arthroplasty: a register-based matched cohort study of 726 patients
Published in Acta Orthopaedica, 2019
Alexander Oxblom, Håkan Hedlund, Szilard Nemes, Harald Brismar, Li Felländer-Tsai, Ola Rolfson
There are only a few previous studies comparing functional outcome scores between hip resurfacing and THA patients (Pollard et al. 2006, Mont et al. 2009, Costa et al. 2012). A retrospectively matched (sex, age, BMI, and activity level) study with a 7-year follow-up showed no difference in Oxford Hip Score but a higher level of activity as measured by UCLA score, and higher percentage (7% MoM-HR vs. 33% conventional THA) of patients participating in sports in the MoM-HR group (Pollard et al. 2006). Despite matching and medium–long follow-up, that study consisted of a rather small group of patients (53 MoM-HRs, 51 conventional THAs) making it difficult to draw certain conclusions. In another matched case-control study comprising 100 patients (50 MoM-HRs, 50 conventional THAs), the authors found no differences in mean Harris Hip Score (90 HR vs. 91 THA) or in patient satisfaction scores (9.2 HR vs. 8.8 THA) in short-term follow-up (Mont et al. 2009). As Harris Hip Score is limited to functional criteria, such a measure does not give an appropriate description of the patients’ functional outcome. In an assessor-blinded randomized controlled study (Costa et al. 2012) with 1:1 treatment allocation, hip function was similar between MoM-HR and THA at 12 months’ follow-up as measured with Harris Hip Score (88 MoM-HR vs. 82 THA) and Oxford Hip Score (40 MoM-HR vs. 38 THA). Furthermore, disability rating and activity level were similar in the first year after surgery. In that study, the long-term effects of HR were not studied. In the meantime, a 5-year F-U report is available that also shows similar hip function or health-related quality of life following a total hip arthroplasty vs. hip resurfacing (Costa et al. 2018).
Resurfacing hip arthroplasty better preserves a normal gait pattern at increasing walking speeds compared to total hip arthroplasty
Published in Acta Orthopaedica, 2019
Davey M J M Gerhardt, Thijs G Ter Mors, Gerjon Hannink, Job L C Van Susante
Increasing numbers of young patients choose hip arthroplasty instead of accepting hip impairment. In an attempt to increase implant durability and future revision options the metal on metal (MoM) resurfacing hip arthroplasty (RHA) was introduced, improving implant stability with the use of larger femoral head diameters and preservation of femoral bone stock (Amstutz et al. 2004, Grigoris et al. 2006, Gerhardt et al. 2015). Patients benefit from regaining hip function near to normal as gait analysis studies and questionnaires have shown (Mont et al. 2007, Bisseling et al. 2015). However, the use of RHA has decreased over the past decade due to concerns about adverse reactions to metal debris (Langton et al. 2010). Still, the hip resurfacing concept, restoring patients’ mobility particularly in young active patients, remains relevant since previous studies have reported somewhat better functional outcome after RHA versus THA (Pollard et al. 2006, Heilpern et al. 2008, Haddad et al. 2015). So far, only 2 randomized controlled trials have been performed comparing postoperative gait between RHA and THA (Lavigne et al. 2010, Petersen et al. 2011). In these studies, the clinically perceived benefit of RHA compared with conventional THA on patient mobility and gait could not be confirmed. However, these studies may not be entirely conclusive since a limited number of patients were enrolled and measurements were done at normal walking speed. More modern gait analysis does allow assessment of patients’ gait pattern at increasing walking speeds and inclines. The advantage of using an instrumented treadmill is the ability to continuously increase speed and walking incline to detect gait differences that may not be detected at a normal or slow walking speed.