To India And Back, A Second Chance At Life
To India And Back, A Second Chance At Life
By Carey London
Traveling thousands of miles to have surgery done in a foreign country may sound absurd. Still, lower costs and availability have attracted more and more Americans to go abroad for elective procedures.
Robert Vacca, 55, of Sag Harbor, recently returned from a trip to India, where he had hip resurfacing done on both of his hips. The procedure has not been approved in the States, but Vacca is living proof the surgery works.
He went from nearly wheelchair bound to reclaiming his athletic nature in a matter of weeks.
Vacca first started manifesting symptoms of bone disease when he was 14 years old. He had always been an athlete, but his brittle bones caused bone chips in various joints. Doctors at the time did not know the cause of the problem, but they treated him through surgery. He underwent six operations in the 1970s.
By the mid-1990s, his hips started to bother him and “they got progressively worse every year,” he said. “I was able to compensate until this summer, when my body stopped me from working.” Vacca was caddying at the Atlantic Golf Club in Bridgehampton.
Dr. Stephen Petruccelli, a chiropractor at the Sag Harbor Gym, had been working with Vacca before his surgery and is currently helping him rehabilitate.
Dr. Petruccelli learned of hip resurfacing from a patient who had seen a special on “60 Minutes” about how people worldwide are traveling to India for this procedure.
Additional research led the doctor to a New York Times article about Dr. Vijay Bose, of Apollo Hospital in Chennai, India, who is largely regarded as the leading resurfacing specialist in the world.
Dr. Petruccelli e-mailed the doctor, who quickly responded. “I sent him a picture of Bob’s X-rays and Dr. Bose said [Vacca] was an excellent candidate for the procedure,” the chiropractor recalled.
According to Dr. Bose, Caucasians are predisposed to bone disease. Vacca’s condition is genetic but his intense athletic background accelerated the disease. He was drafted by the Milwaukee Bucks, whose star player at the time was Kareem Abdul-Jabbar.
Doctors say hip resurfacing is more suitable for younger patients, between the ages of 17 and 70, because it is less invasive and permits a greater range of post-operative movement.
Bone is not removed, and it does not require revision surgeries. Physical activity, such as sports and exercise, is encouraged shortly after operation.
On the other hand, conventional hip replacement, the standard procedure offered in the U.S., has had a reasonably high success rate among elderly patients over 70 years old. Younger patients usually require revision surgeries because the prosthesis fails rapidly.
Dr. Bose has done around 450 hip resurfacing procedures. He trained with the procedure’s creators, Derek Mcminn and Ronan Treacy, in Birmingham, England, in the mid-1990s. He listed three advantages to hip resurfacing over hip replacement.
“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 . . . The anatomy and biomechanics after resurfacing mimic a normal hip very closely,” he said.
A metal cap is fitted over the end of the thighbone, which is fitted into a metal socket in the hip.
The second advantage is that patients are urged to be physically active after the surgery, he continued. Regular activities such as sitting on the floor or crossing one’s legs are also encouraged, whereas after hip replacement, the patient must restrict movement to prevent dislocation and “prolong the life of a prosthesis.”
Another benefit of resurfacing is that bone stock is improved because no bone is taken, unlike in hip replacement, where the head and the neck of the thighbone are removed, said Dr. Bose. “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.”
Lastly, it is believed that bone improves over time after hip resurfacing because “the polyethylene ‘wear particles’ do not damage the surrounding bone like in conventional hip replacement,” he said.
Hip resurfacing takes less than two hours and patients can resume strenuous physical activity in about three to six weeks.
Hip degeneration has several causes but the predominant one is genetics. Vacca, though “typical” in terms of his genetic predisposition, was a more unusual case because he had problems in both hips. About 30% of patients have degeneration in both hips.
While the procedure has been embraced in India, Australia, Europe, and some parts of Asia, it is still waiting approval by the Food and Drug Administration in the United States, “which can take years and years and years,” Dr. Petruccelli said. “I think a lot of it is that the doctors in this country are resistant to change.”
But while the FDA continues to study the procedure, Americans are going overseas to get it done.
Out of about 200 hip resurfacing procedures Dr. Bose will do this year, he estimated that 50 of those patients are Americans. In fact, so many people from the U.S. are coming to India for this procedure that Apollo Hospital is reportedly building an international wing to house them.
“I have no idea why American doctors are hesitant to embrace this procedure apart from the fact that this development occurred outside the U.S.,” said Dr. Bose. “I get the impression that the U.S. is much more resistant to foreign technologies when compared to home grown technologies. However, things will definitely change and it is only a matter of time before the U.S. embraces this medical innovation.”
Hip resurfacing is available in the U.S. through clinical trials, but the cost is staggering, fetching anywhere from $28,000 to $32,000. In India, the procedure is a little under $6000.
Vacca paid $12,000 for his two surgeries, 14 days in the hospital, anesthesia, and prescription drugs. “All I had to pay for was airfare, laundry, and a couple of extra blood tests,” he added.
Money aside, he had some other unfamiliar hospital experiences.
“When I arrived, no one asked me if I had insurance, no one inquired as to my method of payment, and no one asked me to fill out one form,” Vacca recalled. “When I asked who should I give the bank draft to, I was told, ‘That’s not important right now. You have surgery in the morning. Take care of it when you feel settled.’”
Dr. Bose met with his patient for an hour a day before the first surgery to discuss his condition and the procedures. On October 4, Vacca had his right hip repaired. Four days later, his left hip was repaired.
Dr. Bose checked on his patient twice a day, until Vacca was transferred to Fisherman’s Cove, a lavish resort spa overlooking the Indian Ocean for additional recovery. He was there a week before returning home to finish up rehabilitation.
“The entire service industry in India as a way of life is totally dedicated,” said Vacca. “When it comes to Americans coming in the hospital they seem to be even more dedicated to making us feel at home.”
The greatest disadvantage to traveling abroad for surgery is the generous travel time, in Vacca’s case, a 20-hour flight.
But with his quality of life dramatically improved, Vacca has no regrets.
Before the surgery, he was bending forward to relieve the pressure and pain on his hips. Three months following his operations Vacca is standing much taller and is once again mobile and pain free.
“I noticed he was about three to four inches taller when I first saw him get off the plane from India,” said Dr. Petruccelli.
“I know that I’ve been given another chance to take care of this body and to enable it to function for these remaining years,” said Vacca. “I’m going to be working out regularly, getting in shape and keeping my body in shape because I appreciate so much that I’m pain free and completely healthy in my hips.
“I want to stay active and stay in shape and appreciate all of the things I can do because I know what it’s like to be stopped.”
By Carey London
Traveling thousands of miles to have surgery done in a foreign country may sound absurd. Still, lower costs and availability have attracted more and more Americans to go abroad for elective procedures.
Robert Vacca, 55, of Sag Harbor, recently returned from a trip to India, where he had hip resurfacing done on both of his hips. The procedure has not been approved in the States, but Vacca is living proof the surgery works.
He went from nearly wheelchair bound to reclaiming his athletic nature in a matter of weeks.
Vacca first started manifesting symptoms of bone disease when he was 14 years old. He had always been an athlete, but his brittle bones caused bone chips in various joints. Doctors at the time did not know the cause of the problem, but they treated him through surgery. He underwent six operations in the 1970s.
By the mid-1990s, his hips started to bother him and “they got progressively worse every year,” he said. “I was able to compensate until this summer, when my body stopped me from working.” Vacca was caddying at the Atlantic Golf Club in Bridgehampton.
Dr. Stephen Petruccelli, a chiropractor at the Sag Harbor Gym, had been working with Vacca before his surgery and is currently helping him rehabilitate.
Dr. Petruccelli learned of hip resurfacing from a patient who had seen a special on “60 Minutes” about how people worldwide are traveling to India for this procedure.
Additional research led the doctor to a New York Times article about Dr. Vijay Bose, of Apollo Hospital in Chennai, India, who is largely regarded as the leading resurfacing specialist in the world.
Dr. Petruccelli e-mailed the doctor, who quickly responded. “I sent him a picture of Bob’s X-rays and Dr. Bose said [Vacca] was an excellent candidate for the procedure,” the chiropractor recalled.
According to Dr. Bose, Caucasians are predisposed to bone disease. Vacca’s condition is genetic but his intense athletic background accelerated the disease. He was drafted by the Milwaukee Bucks, whose star player at the time was Kareem Abdul-Jabbar.
Doctors say hip resurfacing is more suitable for younger patients, between the ages of 17 and 70, because it is less invasive and permits a greater range of post-operative movement.
Bone is not removed, and it does not require revision surgeries. Physical activity, such as sports and exercise, is encouraged shortly after operation.
On the other hand, conventional hip replacement, the standard procedure offered in the U.S., has had a reasonably high success rate among elderly patients over 70 years old. Younger patients usually require revision surgeries because the prosthesis fails rapidly.
Dr. Bose has done around 450 hip resurfacing procedures. He trained with the procedure’s creators, Derek Mcminn and Ronan Treacy, in Birmingham, England, in the mid-1990s. He listed three advantages to hip resurfacing over hip replacement.
“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 . . . The anatomy and biomechanics after resurfacing mimic a normal hip very closely,” he said.
A metal cap is fitted over the end of the thighbone, which is fitted into a metal socket in the hip.
The second advantage is that patients are urged to be physically active after the surgery, he continued. Regular activities such as sitting on the floor or crossing one’s legs are also encouraged, whereas after hip replacement, the patient must restrict movement to prevent dislocation and “prolong the life of a prosthesis.”
Another benefit of resurfacing is that bone stock is improved because no bone is taken, unlike in hip replacement, where the head and the neck of the thighbone are removed, said Dr. Bose. “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.”
Lastly, it is believed that bone improves over time after hip resurfacing because “the polyethylene ‘wear particles’ do not damage the surrounding bone like in conventional hip replacement,” he said.
Hip resurfacing takes less than two hours and patients can resume strenuous physical activity in about three to six weeks.
Hip degeneration has several causes but the predominant one is genetics. Vacca, though “typical” in terms of his genetic predisposition, was a more unusual case because he had problems in both hips. About 30% of patients have degeneration in both hips.
While the procedure has been embraced in India, Australia, Europe, and some parts of Asia, it is still waiting approval by the Food and Drug Administration in the United States, “which can take years and years and years,” Dr. Petruccelli said. “I think a lot of it is that the doctors in this country are resistant to change.”
But while the FDA continues to study the procedure, Americans are going overseas to get it done.
Out of about 200 hip resurfacing procedures Dr. Bose will do this year, he estimated that 50 of those patients are Americans. In fact, so many people from the U.S. are coming to India for this procedure that Apollo Hospital is reportedly building an international wing to house them.
“I have no idea why American doctors are hesitant to embrace this procedure apart from the fact that this development occurred outside the U.S.,” said Dr. Bose. “I get the impression that the U.S. is much more resistant to foreign technologies when compared to home grown technologies. However, things will definitely change and it is only a matter of time before the U.S. embraces this medical innovation.”
Hip resurfacing is available in the U.S. through clinical trials, but the cost is staggering, fetching anywhere from $28,000 to $32,000. In India, the procedure is a little under $6000.
Vacca paid $12,000 for his two surgeries, 14 days in the hospital, anesthesia, and prescription drugs. “All I had to pay for was airfare, laundry, and a couple of extra blood tests,” he added.
Money aside, he had some other unfamiliar hospital experiences.
“When I arrived, no one asked me if I had insurance, no one inquired as to my method of payment, and no one asked me to fill out one form,” Vacca recalled. “When I asked who should I give the bank draft to, I was told, ‘That’s not important right now. You have surgery in the morning. Take care of it when you feel settled.’”
Dr. Bose met with his patient for an hour a day before the first surgery to discuss his condition and the procedures. On October 4, Vacca had his right hip repaired. Four days later, his left hip was repaired.
Dr. Bose checked on his patient twice a day, until Vacca was transferred to Fisherman’s Cove, a lavish resort spa overlooking the Indian Ocean for additional recovery. He was there a week before returning home to finish up rehabilitation.
“The entire service industry in India as a way of life is totally dedicated,” said Vacca. “When it comes to Americans coming in the hospital they seem to be even more dedicated to making us feel at home.”
The greatest disadvantage to traveling abroad for surgery is the generous travel time, in Vacca’s case, a 20-hour flight.
But with his quality of life dramatically improved, Vacca has no regrets.
Before the surgery, he was bending forward to relieve the pressure and pain on his hips. Three months following his operations Vacca is standing much taller and is once again mobile and pain free.
“I noticed he was about three to four inches taller when I first saw him get off the plane from India,” said Dr. Petruccelli.
“I know that I’ve been given another chance to take care of this body and to enable it to function for these remaining years,” said Vacca. “I’m going to be working out regularly, getting in shape and keeping my body in shape because I appreciate so much that I’m pain free and completely healthy in my hips.
“I want to stay active and stay in shape and appreciate all of the things I can do because I know what it’s like to be stopped.”
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