December 27, 2006
To India And Back, A Second Chance At Life
One of the biggest scams in American medicine is hip replacement surgery. In many cases, an alternate, less intrusive procedure yields even better results. Our own Bob Vacca should know — he traveled to India for the surgery. Carey London got the scoop.
Traveling thousands of miles to have surgery performed 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 suitable for 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 awaiting 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