Personal Views: The French connection: how I found orthopaedic surgery on the internet
Authors: Marnie Clark
Journal: BMJ (2006)

One Saturday last December I found myself unpacking my suitcase in a room in a French clinic, awaiting a hip resurfacing operation. How had I got to this stage? How was I going to communicate with the staff, whose command of English seemed to be about as good as my command of French—not wholly adequate? All the notices were in French, and I had little idea what was going to happen next.

I had been having increasing difficulty with my left leg for about three years. As a keen walker I had assumed my problem was soft tissue damage. In 2003 I was referred to an orthopaedic surgeon who thought, after reviewing the x ray pictures, that nothing needed to be done about my mild to moderate osteoarthritis.


I can't wait to see the orthopaedic surgeon's face when I tell him it has all been done


Throughout 2004 and the first six months of 2005 the pain in my leg came and went and my mobility slowly decreased. At first it was gradual, but after a walking holiday in July 2005 the deterioration accelerated. It became impossible to walk any distance without pain. Standing and sitting were very uncomfortable, and the pain would keep me awake at night. Occasionally searing pain would suddenly drive up my leg to the pelvis, causing me to fear that my leg was about to give way, as it did on several occasions unexpectedly.

I could no longer tolerate the pain and immobility. I am 54 years old and work in a job where I sometimes need to be on my feet all day. My hip problems were seriously affecting the quality of my life.

I returned to my general practitioner in August 2005 and asked to be referred to a physiotherapist and for further radiography, together with a referral to a different consultant. These x rays showed significant deterioration.

At about this time delay started to become an issue. The waiting time to see an orthopaedic surgeon is four months, followed by a wait of about six months for surgery. Because of my age I was reluctant to undertake hip replacement and preferred hip resurfacing, so to hasten the process I asked to see a consultant privately. I was concerned I might be running out of time, as excessive deterioration of the femur would preclude the option of resurfacing. The consultant said he would study the x rays and write to me in a week. Four weeks later I eventually received his confirmation that the x rays showed the need to be urgent and that he would put me back into the NHS system.

Exasperated at the continuing delays, I turned to the internet to research the possibility of having the operation abroad. There were four clear criteria in my choice: hip resurfacing experience, speed, price, and reinfection rates. My research showed that France and Belgium were the most realistic options.

I eventually selected a French doctor because of his extensive experience of total hip replacement and hip resurfacing, the possibility of surgery within 10 days, the price at just over 50% of the UK private fee, and the zero reinfection rate. All I needed was a copy of my x rays and a referral letter from my GP, who was surprised and a little sceptical until she realised I was determined.

So that is how I ended up in a French clinic. I ended up staying for two weeks—the standard time in France—having had a hip resurfacing operation, which has been entirely successful. The surgeon, a jolly man and clearly an expert, visited every day. Although I had daily doses of heparin I also had a phlebitis scan. The physiotherapist visited daily to check progress and set new challenges. The nurses regularly massaged potential bed sore locations. Dressings were changed every two days; half the stitches were removed on day 11 and the other half on my departure.

It has been a remarkable experience. I used the services of a UK company that specialises in joint replacement abroad to handle the travel, clinic bookings, and all my needs. They picked me up at my house and drove me to the clinic and back. Nothing was too much trouble, and the price was genuinely all inclusive. The only money I needed was £5 a day for access to the television in my room.

I am entirely satisfied with the quality and standard of the nursing care. Yes, you do need a basic knowledge of French to build rapport with the staff and to cope with the postoperative emotions, which can leave you feeling frustrated, anxious, and isolated. However, I met all my objectives: an urgent, high quality resurfacing procedure without reinfection at a reasonable price.

At the time of writing, 12 weeks after the initial private consultation with the UK orthopaedic surgeon, I have still not received the NHS appointment date. I can't wait to see his face when I tell him that it has all been done.