Knee Replacement in Panama v. the U.S.A.

My mom’s knee had been degrading for years. By the time she saw a doctor there wasn’t really much of any cartilage left, just bone scraping against bone. 

Back in 2021, my parents lived in the Pacific Northwest of the United States. My mom’s doctor, who was chosen for her by proximity and her insurance company, determined that knee replacement surgery was the best choice. To qualify for the procedure, she had to pass a number of exams spread out over a number of months with a number of specialists who eventually all gave her the green light to have the surgery scheduled. The surgery was assisted by a robot in an out-patient clinic tucked into the corner of a stripmall. Thankfully, everything went well and my mom, still foggy from the anesthesia, was driven home by my father. My mom spent most of the next few weeks teetering between consciousness while my sleep-deprived dad fed her prescribed opioids to stave off the pain while leggings compressed her legs to reduce the chance of blood clots.

Following the surgery, my mom would visit a physical therapist for the next few weeks and would eventually be able to bend her knee 110 degrees, which was hailed by her doctor and the physical therapist as an unprecedented success.

My mom and dad moved to Panama last October. By that point, the pain in her other knee had become unbearable and it soon became obvious that she’d need a second replacement surgery. After a little searching and meeting with doctors, my mom met a surgeon that she clicked with who worked with the same robot that had performed her first surgery. Before the surgery could be scheduled, she needed to be examined by specialists. Astonishingly, unlike in the United States where it had taken months to schedule appointments and meet with everyone she needed to meet with, she was able to have all of her appointments scheduled that same day, including with a dentist, which her American doctor hadn’t required. This was fortunate, as the dentist discovered a number of small fractures in her teeth and a low-level infection that she most likely had off and on for years. The fractures and infection were treated and after a week of antibiotics she was reevaluated by the doctor and her surgery was scheduled.

On the day of the surgery, we arrived at the hospital to check in. The process took less than an hour and all of the paperwork was available in English. Each patient was assigned a number that was displayed on screens in the waiting room, similar to what you’d find at an airport, allowing us to follow my mom’s progress through the procedure.

After a few hours, the doctor entered the waiting room. He informed us that my mother’s surgery had been a success and we were instructed to meet her in the hospital room where she’d stay under observation for the next two days. The room was nice and clean with a partial view of the bay. Instead of the compression leggings, my mom had been given a shot to reduce the likelihood of blood clots. Instead of opioids, my mom was hooked up to an IV system that dripped painkillers and antibiotics. When the pain was severe, she was given oxygen which helped alleviate her discomfort.

My mom’s physical therapist has been coming to our house twice a week since my mom was discharged from the hospital. The physical therapist told us that the average woman can bend their knee 120 degrees after this type of surgery and she was concerned that the knee that my mom had replaced in the United States could only bend 110. We’re at a point where my mom can walk around the house unaided, around the street and mall with a walker, and can bend her knee more than 120 degrees.

As you can see, we’re in a unique position where the exact same medical procedure was performed on the same patient with the same technology in two different countries: the United States and Panama. This allows us to compare and contrast both experiences. So what are some of the main takeaways?

The American doctor and physical therapist were extremely confident in their abilities, but, in retrospect, didn’t have a lot of knee replacement surgeries under their belts. In Panama, for comparison, my mom was one of six knee replacement surgeries that day. Six more were scheduled for the next day. Not only does Panama City have a larger population than my parent’s part of the Pacific Northwest, but it has a lot of medical tourism. The Panamanian doctor and physical therapist were way more experienced than their American counterparts and did more to ensure that my mom was up, active, and pain free as quickly as possible. This might be due to medical tourists needing to leave the country relatively soon after their procedure.

It also seems that the American doctor cared more about what was best for my mom’s insurance company and not so much what was best for her. The procedure, which is the removal of the knee and replacement with a metal equivalent, was somehow done as an out-patient procedure. Instead of being held in a hospital for observation, she was sent home and fed pain pills. The Panamanian doctor, on the other hand, seemed to care more about my mom’s wellbeing than anything else. He performed the surgery in a hospital and let us choose which hospital based on our budget. Following the procedure, my mom was held, treated, and observed by nurses, doctors, and physical therapists over the next few days. Her concerns were addressed and her medications modified to suit her needs. This was impossible in the United States, and a lot of stress and pressure fell on my dad’s shoulders.

It’s important for expats, especially expats living in Panama, to recognize that while the United States has some good medical care, so do other countries, especially Panama. My mom’s surgeon earned his medical degree here, but learned how to perform this particular surgery in Canada and at Oxford University. The hospital where the procedure was conducted is an affiliate of Johns Hopkins. And all of this for a fraction of what it cost in the United States. So if you’re worried about healthcare in Panama - don’t be. Don’t let that be the reason to hold you back from making the move. From my personal experience I can assure you that you’ll be taken care of and treated by absolute professionals.