You should have exhausted all non-operative, conservative approaches such as physical therapy to strengthen the joint, oral non-steroidal anti-inflammatory medications, weight loss, using a cane or walker injected anti-inflammatory or cartilage building medications. Despite recent advances in technology, the typical prosthetic knee lasts only 10-20 years, so it is favorable to delay the surgery with non-operative interventions for as long as possible. Reoperation is difficult and carries a higher complication rate.

If you are considering knee replacement surgery make sure you first consult with an experienced orthopedic surgeon in your area. There are many diseases of the knee, which may cause pain or functional problems that DO NOT require knee replacement. You may benefit from a lesser procedure such as arthroscopy (using a scope to examine the knee) to remove or repair damaged cartilage. There are also other procedures that may be better alternatives in younger patients such as osteotomy, microfracture or osteochondral allograft transfer (OATS). Discuss your options with an orthopedic surgeon.

If it does end up that an orthopedic surgeon in your area agrees that your best option is to have the knee replaced, you may consider having your surgery done in Mexico by a qualified, well-trained, board certified orthopedic surgeon. Many people do not have adequate insurance and you can usually save $20,000- $30,000 with MedToGo. To ensure your safety and to optimize outcome, you will have to follow certain guidelines. MedToGo will be there to ensure that you are informed at every step of the way.

GUIDELINES FOR KNEE REPLACEMENT SURGERY

By choosing to have your surgery done in Mexico, you will have to organize your own preoperative evaluation and post-operative rehabilitation. Our goal at MedToGo is to inform you of the medical reasons for knee replacement, the steps you should take to insure that you are fit for surgery and the potential complications you must consider. We will then provide you with guidelines for your rehabilitation and what to expect. We recommend that you work in conjunction with your primary care provider to facilitate the process. First consider the INDICATIONS FOR SURGERY:

1. Severe Pain
2. Significant loss of function
3. Severe arthritis (rheumatoid or osteo)
4. Osteonecrosis (dead bone) of the knee
5. Tumors of the knee

If you have documentation of any one of these conditions, you may be a good candidate for knee replacement surgery. Next, you must provide documentation from your local physicians that you are a good surgical candidate and that you do not have any contraindications to surgery.

CONTRAINDICATIONS (reasons why you cannot have the surgery) include:

1. Active infection in the knee or anywhere else in the body
2. Poor extremity circulation
3. Neurologic disease affecting the extremity
4. Faulty extensor mechanism (i.e you have ligament and/or muscle disease or conditions that do not allow you to straighten your leg)

A thorough PREOPERATIVE EVALUATION must be performed on every patient prior to surgery, which includes:

1. Complete history and physical
2. Chest X-ray
3. Laboratory workup (PT/INR, CBC, CMP, UA)
4. 12-lead EKG (electrocardiogram)

If the preoperative evaluation finds that there is an increased risk from any health condition, referral to and clearance from the appropriate specialist is mandatory.

Also, you should review treatment alternatives (conservative non-operative interventions vs operative non-knee replacement surgery), and discuss the risks and benefits with an appropriate medical professional.

COMPLICATIONS of knee replacement surgery include:

1) Anesthetic allergies or reactions to anesthesia
2) Thromboembolism or deep venous thrombosis (blood clots that develop in the leg or arm): Potential, and sometimes lethal complications
3) Infections: Uncommon, but potentially serious. Prosthetic joint infection may result in prolonged hospitalization and even a need for removal of the infected prosthesis, followed by reimplantation of a second prosthesis.
4) Nerve injuries or arterial injuries (rare)
5) Periprosthetic fracture: A fracture to the bone that holds the metal implants.
6) Wound dehiscence: stitched wound falls apart and opens up
7) Polyethylene and metal wear: May lead to loosening of the prosthesis, and a revision might be necessary.

The ultimate success of the procedure will depend tremendously on your participation in a qualified postoperative physical therapy program. Increased range of motion, decreased pain, and improved quality of life can be determined by the amount of physical therapy and rehabilitation performed by the patient.

FINAL PREPARATIONS

Non-steroidal anti-inflammatory medications should be stopped 7 days prior to surgery. Warfarin (Coumadin) should be stopped 3-5 days prior to surgery (consult with your local doctor to determine if stopping Warfarin is safe).

POSTOPERATIVE CARE AND EXPECTATIONS

Immediately after surgery you will receive low dose blood thinners to prevent dangerous blood clots that can form in the legs. You will stay in the hospital for 3-5 days. You will begin your rehabilitative exercises, which will focus on range of motion, normal walking mechanics and thigh muscle strengthening.

After surgery you can expect to return to near normal activities of daily living in approximately three to six weeks. Still you should avoid running, jogging or high impact sports. The more active you are with the prosthetic knee, the faster it will wear out. Cycling, swimming and walking are encouraged. Some people prefer to have their entire post operative rehabilitation completed in Mexico where it is very inexpensive when compared to the equivalent in the US. Please ask your health care coordinator if this is an option you would like to explore.

Our physicians and health care coordinators have extensive, hands on experience working with doctors and hospitals throughout Mexico. We began developing our network of Mexico’s finest doctors and hospitals in 2000 by conducting personal interviews and educational background checks on more than 700 Mexican doctors and inspecting over 80 private hospitals. We spent 6 years researching the Mexican healthcare system before we referred our first patient for surgery in February of 2006. As a result, if you decide to let MedToGo coordinate your surgery or medical service in Mexico, you can be assured that you will be working with the country’s finest doctors and institutions.

You will have also hired a team of U.S. physicians and health care and coordinators that will oversee your care and serve as your advocate while you are in Mexico. You will not be alone. Unlike other cheap Knee Surgery solutions, your safety and peace of mind are our primary concern. Furthermore, we can offer you complete healthcare packages with up to 75% off the price of a comparable experience in the U.S.-without a compromise in quality.

• Our physicians meet and hold personal interviews with all Mexican physicians.
• We verify the doctor’s educational experience and credentials, including board certification and licensing.
• We request and check professional references and assess a doctor’s local reputation through various professional and personal resources. Doctors must be in good standing with their community and hospitals. There must be no history of current or repeated legal malpractice.
• We review physician resumés and give preference to physicians who have been consistent with continuing medical education, who are active in their medical societies and who have been entrusted with leadership roles within their institutions.
• We examine evidence of their surgical success rates.
• Prior to including a surgeon or physician into our program, we attend his/her operations to evaluate competence and skill.

But if you hire MedToGo we will not only provide you with a selection of Mexico’s finest health care providers and coordinate your procedure, we will also be your advocates while you are abroad and not rest until have returned home.

Your Mexican hospital and doctor compensates MedToGo for marketing services, and MedToGo does not add additional fees to the cost of your package. MedToGo does not accept cash incentives or alterations in compensation from physicians or hospitals. This ensures that our recommendations are unbiased and based solely on our experience and quality assessment.

As you may know some hospitals in Mexico expect a family member to bath and change bedding for the patients. These services were provided at CIMA Hospital on a daily basis. The hospital is clean, well managed and well equipped. I also appreciated the presence of female personnel in the operating room during my surgery. Translators were provided whenever I was unable to communicate in my limited Spanish.

The medical team that you assembled for my surgery was impressive. Meeting the team before the surgery gave me added assurance that my needs would be met. After my discharge from the hospital on 8 January 2009 the follow-up care at City Express Hotel by Drs. Valenzuela and Rabeil, your nurse Ismael, and yourself was very much appreciated. Delivery of medications by messenger to my hotel room was a pleasant surprise.

The physical Therapy provided by Dra. Linda Guerrero Walker, in the hospital, in the hotel room and at her office, has been amazing. I have achieved more flexion and regained more muscle strength two weeks after the left knee surgery than I did four weeks after the right knee had been done in La Paz. She is an excellent therapist.

One notation about improvement of services, putting a wheel chair lift on the van that was originally provided, but could not accommodate my limited mobility, would have made my trip easier for me and would not have required an ambulance. The van was too high off the ground for me to climb into and there was not adequate leg room for a knee that would not bend without severe pain. But it all worked out OK with the ambulance.

I would also like to that Robert Page at Med-To-Go for making the arrangements for my surgery. It is nice to have a third party advocate in my corner. I look forward to dancing again in the near future, and returning to a more active cruising life style as we continue to enjoy Mexico and its wonderful people.

Sincerely

Susie Wilson

MARK SAWKO, PROCEDURE DATE: 2/20/07
I had total knee replacement surgery performed by an orthopedic surgeon in Puerto Vallarta, Mexico. I had health insurance in the United States, but due to a pre-existing condition (3 previous knee surgeries), my insurance carrier would not cover me. With the assistance of MedToGo, I chose to have my surgery in Puerto Vallarta with a surgeon they knew well and trusted.

Before deciding on this physician, I did some checking on the cost of having the surgery done in the states and learned that I would have to pay in the neighborhood of $45,000 for my surgery, hospital stay, rehab and follow ups some 400% more than what I wound up paying in Puerto Vallarta. This did not include my flight and hotels or any incidentals that I had to pick up while staying in Mexico. It did include the surgery, 3 nights stay in the hospital, follow-ups by the surgeon in the hospital and in my hotel room, 4 sessions of rehab performed by a qualified doctor and physical therapist, all medications, and a walker, which I only used 2 days.

My experience in Mexico was amazing. I feel that the operating-physician was a well qualified, detail oriented, and experienced orthopedic surgeon, and I was very lucky to have him doing this surgery. He took the time to call me every day and to visit my room on numerous occasions to see how I was doing. I would recommend him highly. While I would have liked to do the surgery in the United States, the monetary angle was monumental in my decision to go to Mexico. Now after going through the whole procedure, I would say it was the best decision I ever made.

If you would like to contact me, please e-mail me at marksawko@aol.com