Wednesday, July 15, 2009

Bummer Dudette!

So my PA came up to me on a particularly busy day the other day and asked if I would help "pull this back in". I love putting dislocated hips back in (closed reduction), and I was ready for the whole conscious sedation thing and the satisfying 'clunk' of the prosthesis dropping back into the socket but WHOA NELLIE! This is not a hip dislocation, this is a prosthetic failure. This patient had a total hip arthroplasty done some months prior and had noticed that her right leg was shorter than her left and that it seemed to be 'going the wrong way' when she walked. The screws used to set the prosthetic portion of the joint into the acetabulum have pulled out of the very thin bone and the hip is not dislocated at all, in fact, the ball and socket seem to have a very cozy relationship! Needless to say we did not yank on this thing, but gave that call that every Orthopedist dreads... hardware failure. Ortho docs, what is the prognosis for the second swing at this thing?


  1. Ohhh. My father-in-law just got had his third hip replacement done in May. The cement used in the original repair had started to deteriorate. It was a lengthy surgery and he lost a lot more blood than they anticipated. Normally he is a really tough guy, but this was hard on him.

    However ... my husband talked to him last weekend and he was up on his roof messing with his satellite dish. Happy ending.

  2. Don't worry, with National Health Care Total Hips will only be done in Back Alley's like abortion's used to...

  3. Scary thought - read an article about a dood in a socialized health care country who performed hardware removal on himself. Essentially the dood was on "the list" for elective surgery but the wait was so long and he was in so much pain that he took a pocket knife, an allen wrench and a needle and thread into the shower, cut down the incision line and proceeded to remove the screws. When he got to the last screw, dood couldnt get it out and the stabalizing plate had grown into the bone. After being shipped off to the local ER/ED, he got his surgery.

    Shudder... as I am a candidate for hardware removal and were I put on a list there would be a butter knife taken to my leg.

  4. How about inserting sockets? Then 3 months to attach or grow into the bone. Then use machine screws to attach the prosthetic.

    This avoids using wood-putty to fill in the old screw holes.

    OK, I'm not a doctor.

  5. Ugh.. I feel ill. I just had to have a syndesmosis re-do. I hope this one works. Anyone ever use a tightrope device on a hip?

  6. Sorry to go off topic here, but I felt this was important. There is a provision that will eliminate individual purchase of private insurance in the senate's draft of the health bill. As I understand this, it will make it illegal for insurance companies to issue policies to individuals (?!). How do we fight this? What does going postal feel like?

  7. This is a bit off topic too, but after reading PeggyU comment and going to that link, I'm pissed. At the behast of many of this site, I began reading Atlas Shrugged last night, as it final arrived from Amazon. About three pages into my reading I could not have more disturbed and irritated. While it may not be happening to the extreme that Rand has written about, I see government interference in our lives beginning to explode. I got about half way through it last night and simply couldn't believe what I was reading. It seems that much of the populace today is no different from the mindless drones who spout of jibberish every time they open their mouths in that book. For the greater good of the public my ass. I work hard for what I have and don't care for any more freeloaders. No one is entitled to what I have worked for.

    So my question for you good doctors is this: Why not refuse to deal with any government programs? I'm sure it's easy said that done, but I'm curious to see what would come of it.

    Keep it up! Love what I read here. But what I see going on in our government makes me want to re-think my current process of applying to med school...

  8. PeggyU: Surely this isn't a surprise to you! We've been telling you guys that this was the agenda all along. Even for those in the Congress with whom it may not be the agenda, it's going to be the ultimate result of the program if passed. The argument that insurance companies can compete with the government is ludicrous. Be very afraid!

    Anon: Here's the problem. Some docs WILL refuse to deal with the gov't. Some do now, but only those who can. Plastic surgeons, psychiatrists, "doc in the boxes", etc. Some specialties CAN limit their business to "cash only", or private insurance only. But most can not.

    A significant number of docs who can afford it will just retire (they have told me so). Then who is going to take care of the patients? There is already a shortage.

    Med schools are already having trouble filling their slots and have lowered their standards just to try and fill the classes. After the election, my daughter and 5 of her pre-med friends changed their majors saying: "I'm not spending 7 more years of school and 3 to 5 (plus) years of residency to deal with the government. I just wanted to take care of patients".

    Also,if the gov't limits incomes via taxation on "the rich" a good number of docs who make 250 to 300K/yr. will realize that it makes no economic sense to work the same for less money. They can either work a lot more (when they already work 12 hours a day or more)....or they can work less and earn under the cap) which will only add to the shortage.

    The majority of docs wouldn't refuse or can't refuse to deal with the gov't. our practices won't allow it. An emergency doc can't refuse to see certain patients. Our concern is for the limitations that will come when the government begins to limit what services are available to patients as well as the inevitable doctor shortages. We have enough trouble finding PCP's and specialists to take care of patients NOW!

    Have you heard anyone on the left address this problem? "Universal Care for everyone" sounds so wonderful and touchy-feely that those unfamiliar with medicine (in the real world) just eat it up. The left is more interested in paying lip service to the problem and taking advice from physicians isolated in academic practice.

  9. Anonymous: After watching what my parents, both health care professionals, had to deal with I was determined not to follow in their footsteps. I have 5 brothers, and none of them went into that field either, but instead went into engineering, law enforcement, auto repair, and ranching.

    However, I am somewhat regretting that decision now as it would be good to have those skills in case things really do come completely to pieces. At least I could have looked out for my own family. There is that to consider.

  10. I don't really mean to post as an anon, but my blog is more of a personal, family blog, and I try to keep it that way when possible. So forgive me for not divulging that information.

    Continuing from my previous comment, I just want to say how feed up I am with my generation. The generation of "I" everything. It's sad to see people who feel that they're entitled to everything while wanting to work for nothing. They complain that health care is affordable while they live New York working as freelance photographers (if any of you every read that NY Times article from a while back about the middle class white kids complaining about how hard life is). My wife and I are in our mid-20's, she just finished her undergrad and I'm almost done (studying Biomedical Engineering, but don't really want to be an engineer). We've had insurance since the beginning of our marriage. Is it expensive? Yes, somewhat. But we realize how important it is and make it a priority. We make sacrifices for other things that we might want for things that we need. She's worked full time and I've worked nights, so we can survive. If people would only accept a little personal responsibility for themselves, this world would be a much better place. If something goes wrong, blame yourself, not someone else.

    My fear is that if we continue to tax the rich at such a high rate, the rich will no longer want to play. It would seem to me that they would reach a point were they no longer need to work and could just live off of their accumulated wealth. What happens to the projections for paying for this health care reform mess when the rich no longer want to play?

    erdoc85: I do realize that many doctors hands are tied far beyond their control. It will be interesting to see when the government does take over, and all of these doctors retire, what they'll try to do then.

    I still think I'll go into medicine when all is said and done. My hope is that it's one field where I'd almost always have the gurantee of a job, even it's not in the ideal situation.

    Thanks for your thoughts!

  11. One of the scariest things I see, in popular media ie cable news,hosts and guests have no idea what they're talking about. One only needs to watch Tom Arnold waxing sagacious about delivery of care in America for about 30 seconds before you want to grab one of the screws from that poor lady's failed hardware and jam it into your carotid.

  12. Surely this isn't a surprise to you!

    As I had commented on another thread, it is not a surprise to me that liberals and this administration in particular want to shove universal care through whichever way they can. I guess I was just so fixated on how they would go about undercutting private insurance companies, in a way that would lure businesses into buying into the government-created plan, that I didn't stop to think about individuals purchasing their own plans as being targets. I presume this also means an end to supplemental plans and long-term-care coverage purchased by individuals? Great, huh. That means the government essentially "owns" us and can Schiavo us if it feels like it.

    I need antacids.

  13. Sounds like a job for either Heli-Coil® Screw Thread Inserts or JB Weld

  14. PeggyU - the universal insurance proposal only will be thrown out quickly. Even most Dems don't favor it and expect its demise. Too unpopular. The big difference I think will be that insurance will be relegated to a niche role for the rich that don't want to wait for needed surgeries, etc.

    As for retiring Docs I doubt the government can do much. Whatever may be happening I think calls for slavery and forced Doctor labor are a little far off. But then again I guess after EMTALA it wouldn't be too surprising