Monthly Archives: September 2014

For the past two weeks that I have been in North Carolina, I have made the rounds of orthopedic surgeons first to get a diagnosis, then to hear second and third opinions. Consensus: knee replacement. Question: What type?  Answer: Read on. Bottom line? It’s essential to get a second and third opinion!

It all started on July 5, 2014 in Teotitlan del Valle when Michelle threw a Beatles Birthday Party for Mary. There were Dr. Z on percussion and Kaszt on electric guitar, with a Beatles play list that would take any Beatles fan back to Twist and Shout.  The tasty veggie and meat lasagnas were plentiful.  The red wine flowed and three decadent cakes waited patiently on the side table for consumption. We were among mezcal and good friends.  We’ve got a loosely knit small group of ex-pats who live in the village and from time-to-time we know how to party-on, just like our Zapotec neighbors.

As we shouted out our favorites, Dr. Z and Kaszt played them, and of course, we all took spins on the dance floor, which was really the terrace overlooking sacred Mount Picacho and the Rio Grande.  And, then, the next day I could feel it in my right knee.

My sister brought me a brace when we saw each other a couple of weeks later in Mexico City. I needed it for our non-stop Looking for Diego Rivera and Frida Kahlo Art History Tour. Then, I started a regular regime of ibuprofen. Not much helped. In New Mexico I was icing and limping. In California I got a cortisone shot.

In North Carolina, the first orthopedic surgeon I saw showed me the x-rays and said, You need a total knee replacement.  I said, are there any other options. You can wait, he said, and it will get worse. I scheduled the surgery.

Friends said get a second opinion. The second surgeon I saw said I was a good candidate for a partial knee replacement. Who was I going to believe? So, I started to read surgeon bios, scheduled a third opinion and investigated the medical research literature.

Here’s what I found out:

Total Knee Replacement (TKR) involves a large incision, maybe 9-12″ inches long, removal of the knee-cap, reshaping the tibia, tibula and femur, and removal of the anterior cruciate ligament (ACL) — a crucial muscle for knee stabilization.  This surgery requires a two-day hospital stay, at least six to eight weeks of intensive physical therapy, and a post-operative recovery time of two to three months. It is major surgery.

I thought, geez, I’m going to have to cancel my winter workshops and I don’t want to do that.

Surgeon #2 recommended a Unicompartmental (Partial) Knee Replacement (UKI), told me recovery time could be halved and that their robotic technique was very successful and advanced.  Wow, great, I thought. This seems to be the answer. Plus, he graduated PhiBetaKappa and went to one of the top U.S. medical schools. What I loved about him is that he prescribed an anti-inflammatory (meloxicam) and gave me a better brace on the spot.  I was ready to cancel the first surgeon and sign on with this one.

Then, a friend said, it doesn’t matter where they go to medical school.  What matters is where they did their fellowship program.

But, oh, what the heck, I kept the appointment with Surgeon #3, even though I was tempted to cancel it since I had already made up my mind that the robotic partial knee replacement was for me.

What I found out from Surgeon #3 just blew me away.  He told me there are two types of UKIs:  fixed bearing and mobile bearing, that the fixed bearing is done by robotic surgery, and he suggested I read about the differences.  You have to be your own patient advocate to get down into the medical device details to know the complete story.

According to the literature, the advantages of the mobile bearing implant is less wear and tear on the artificial part and that it “feels more like a real knee.” But, the surgery technique is more complex and requires precision. Failure rates are related to surgeon error.

Here’s an American Academy of Orthopedic Surgeons discussion of the two surgical techniques, if you are interested.

Right now, I’m leaning toward Surgeon #3.  He did 600 knee replacements in his fellowship year, has been in private practice for six years, and uses the Biomet Oxford partial mobile bearing implant.

What do you think about this choice?

Now, my plan is to return to North Carolina for this surgery just before Thanksgiving, then return to Oaxaca before Christmas in time for all the workshops scheduled to start in January.  Meanwhile, when I go back to Mexico next week, I won’t be dancing the night away.

Questions to Ask Before Deciding

• What is the pre-and post-surgery process?
• What type of anesthetic do you use?
• Is there medication I can take for pain relief? How long can I safely take this?
• Are there non-surgical remedies to help me?
• If you recommend a TKR, what implant do you use and why?
• If you recommend a UKR, do you use fixed or mobile implants and why?
• If you do not perform UKR, why?
• What brand medical device do you use and why?
• Where did you do your fellowship?
• How many of these knee replacement surgeries do you perform  each year?  How long have you been in practice?
• If you go in and find the cartilage eroded and the knee cap damaged, what do you do? Do you do a TKR then?

Seek at least three medical opinions.  Then, go online and research the doctor’s experience and credentials. Compare where they did their fellowship and the ranking of that program for the surgical practice.

Anybody in Oaxaca know if there is a great orthopedic surgeon for knee replacement medical tourism?