Excerpt from Anne’s Blog
Wednesday, January 10, 2007

4. Top Docs
On Sunday afternoon, March 19, 2000, a new yahoo group appeared with a question mark: Surface Hippies?

The first posting reads: "Hello out there! My name is David. I am 46 years old, with a wife and three small children (6, 4, and 9 months). I am three weeks and two days post-op...."

This is not a very large group, so it should be easy to remember names. Let's hear from everyone." —David

Today 5,547 members post well over 2,000 messages each month at Surfacehippy Yahoo! Health Groups.

One of those members, Vicky, instantly takes me under her wing. She has returned from India enthusiastic about Dr. Vijay Bose and offers her research to other prospective surface hippies. She responds to my email in less than an hour and sends spread sheets comparing eight doctors: their prices, the number of procedures each had completed, the length of their incisions, and their rate of "revisions"--operations needing correction. Vicky offers to share this with other prospective surface hippies. Click here to contact Vicky Marlow.

Following Vicky's advice, Phil puts x-rays of my hips and knees on a glass table with a fluorescent light beneath. He stands on a ladder and shoots digital photos. (You could also photograph x-rays against a computer monitor. Some radiologists will save you the trouble and deliver your x-rays on CD.)

I email these to four doctors using the addresses Vicky provides. Within an hour my first response comes from Dr. Koen De Smet in Belgium. Credited with 2,107 resurfacings, including Lisa's, he is author of the informative report on the metal-on-metal Birmingham hip resurfacing prosthesis (BHR) that is now state-of-the-art in Europe and Asia. Click to download PDF.

Dr. De Smet writes:

Dear Anne,

Looking at your x-rays you certainly are still a candidate for resurfacing!!! You have osteoarthritis of both hips. Right one is bone to bone, left still is not so quite bad yet. Your right knee has also started arthritis, but mainly at the patellofemoral side (after kneecap). I think that mainly the knee problem will be from the right hip! Good bone quality, so best thing to do is resurfacing!! If you require any further information? Just ask.

Greetz,
KOEN

With the intimacy of the internet, we are already on a first name basis. I welcome his lack of pomposity. But his price, while far less than in the U.S., is still twice that in India. Besides, Phil and I have been to Europe already, but never Asia. Every few hours I check my email to see if Dr. Bose has responded. I hear from two American doctors, agreeing that I may be a little old for the process, but both consider me a likely candidate. Where, oh where, is India? Vicky sends off an email on my behalf to the Apollo Hospital in Chennai, guessing that Dr. Bose is off teaching other docs the procedure.

Finally, he writes back:

Dear Ms. Grant,

Thanks very much for your mails with the x-rays of your hips and knees. Apologies for the late reply. I was out of chennai to do some surgeries in another city. As you are only 60 yrs of age, hip resurfacing would be a much better option than conventional hip replacement. Hip resurfacing would enable you to be very active after the surgery. I have assessed your x-rays in detail. Your right hip shows bone on bone arthritis but excellent bone stock. I am happy to report that you would be an excellent candidate for hip resurfacing surgery. Your left hip shows the changes but to much lesser extent.

Regarding your knee, both of them show degenerative changes but nowhere near needing major intervention like a knee replacment. The best option for the knees to have a conservative knee rehab programme concentrating on the patello femoral joint. The patella (knee cap) shows the max. Changes especially the right side. The physio combined with a course of visco-supplementation injection would be my suggestion for your knees. Further once the hip surgery has been done, then there is a good chance that your knee may feel better as referred pain in the knee from hip arthritis is very common.

I will also need details of your medical history and the extent of severity of your hip problem. Please give information regarding the following: co-existing illness like diabetes etc/ previous surgeries/allergies/ current medications/ previous hospitalisation details (if any). Kindly add a description of your hip symptoms and how it affects you.

I have attached some information on hip resurfacing.

Currently, I do hip resurfacing for about 15 Americans / Canadians every month.

Hip resurfacing is a technique invented specifically for younger patients with hip problems. Conventional Total hip replacement, while being a good option for an elderly person (above 70 yrs) is a poor choice for young patients as it will fail rapidly. The hip resurfacing operation is an alternative to hip replacement and has 3 crucial advantages.The first is that no plastic (polyethylene) is used like in conventional hip replacement. Since an anatomical sized 'metal on metal' bearing is used it lasts for a very long time, manifold that of conventional hip replacement and is extremely popular in Europe, Australia and some parts of Asia. The anatomy and bio-mechanics after resurfacing mimic a normal hip very closely.

The second advantage is post operatively: patients are encouraged to be very active and must play some sport, do swimming etc. No activity is restricted including sitting on the floor, crossing legs etc. In short, it behaves like a normal hip enabling patients to return to their normal lifestyle. In contrast after a hip replacement one has to behave like an elderly person (for whom this has been designed) to be safe from dislocation and to prolong the life of a prosthesis. There are also other advantages in Resurfacing like preservation of bone stock (as no bone is removed in this operation unlike hip replacement where the head and neck of the thigh bone is completely removed.) Further it has been proven that bone stock actually increases after hip resurfacing due to the restoration of normal biomechanics in the hip and proximal femur.

The 3rd advantage is that the polyethylene 'wear particles' does not damage the surrounding bone like in conventional hip replacement and the quality of bone actually improves with time after hip resurfacing. This makes a revision solution (if at all needed) very straight forward surgery, unlike the very complicated revision scenario in a conventional THR.

The patient is usually made to walk full weight bearing the day after the operation and is usually discharged from the hospital at about 5- 6 days from the operation. They can resume any work at 3 weeks from operation and sport is started 6 weeks from operation.

I have also attached some details of our centre in Chennai, India. The hospital where I work is known as Apollo speciality hospital in Chennai, India, and this hospital is as good as any other facility one sees in Europe or North America. The hospital has an excellent international patients division which would help you with your requirements. Complimentary pick-up at the Chennai airport is always arranged by the hospital for all International patients.

www.hipresurfacingindia.com

www.apollohospitals.com

I have now done more than 700 hip resurfacings and have the largest series of hip resurfacings for AVN & for fused hip resurfacings in the world. There have been many overseas patients including some from Canada, USA and the U.K.

The cost of the Hip Resurfacing surgery package in Chennai, India, at Apollo hospital would be a 'package rate' of U.S $7,000 for one side. This is an all inclusive rate and includes the following:

• Pre-op consult with surgeon
• Pre-op consult with aneasthetist
• Hip resurfacing  implant. (The BHR manufactured by smith & nephew and the ASR manufactured by Depuy are the ones used.)
• Single private suite with toilet, TV, Internet connection etc. This has an attendant's couch as well.
• Professional fees for surgeon, assistant & anaesthetist
• All pre-op investigations (Surgipak) which includes ECG, Echocardiogram
• Liver, Renal & Clotting profiles.
• Consult with cardiologist (if required.)
• Diet
• Pre & Post op Radiology
• Nursing
• All medicines
• Operation Theatre charges
• Private nurse for the first two post-op days. (This is very useful for patients travelling alone.)
• There are no additional costs for routine hospital stay apart from personal usages like telephone, laundry etc.
• Payment can be made at admission by banker's cheque, traveller's cheque or by credit card. Personal cheques are not accepted. U.S dollars or Euros are the accepted currencies.

The hospital arranges for the patient to stay in a seaside resort close to chennai by the name of Fishermans' Cove before flying back. The cost for this would be extra. The resort has facilities for Ayurveda--traditional Indian therapies which are known to rejuvenate the mind and body.

A total of 11 full days gap (Hospital+Resort) from surgery is advised (mandatory) before taking a long-haul international flight.

The person to contact regarding travel arrangements like airport pickup and resort bookings is Mrs Shoba Bhasker at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it She is the International patient co-ordinator. Kindly post a copy of any e-mail to me so that I keep a track of things as well. Kindly take note that a tourist visa is mandatory to travel to India. Please do apply for a tourist visa and not a medical visa as other formalities are involved in a medical visa. A tourist visa can easily be obtained from any Indian consulate.

List of Indian embassies world wide where one can apply for a visa to travel to India can be found here.

Link for the U.S embassy

If you need any further clarifications please let me know.

I have attached the link to a recent article that appeared in the News & Observer published in Raleigh, U.S.A and a link to the CBS 60 mts programme which featured our facility and my patients

http://www.newsobserver.com/672/story/427249.html

http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998_page4.shtml

With best regards,
Dr. Vijay C. Bose
MS (Orth); DNB (Orth); M.Med.Sci (Trauma) Birmingham; MCh (Orth)
Liverpool; FRCS(Orth) U.K
Consultant orthopaedic surgeon
Department of hip surgery
Apollo speciality Hospital
320 Mount Road
Chennai-600 035
India
Mobile: +91-98400-32251
www.hipresurfacingindia.com

His email relieves Phil's anxiety.

Nine days after I had emailed my x-rays, Dr. Bose puts me on his surgical calendar for January 19th, 2007. I am in!

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