Carer for the previous 9 years, had a fall at work in 2016. She injured her right knee, she was given crutches and painkillers. This put an increased strain on her left hip, which is now so painful she cannot go outside on her own.
She takes Tramadol 50 mg three times a day (an opiate medication not unlike Oxycontin) with occasional Co-codamol.
Her X-ray shows moderate to severe degeneration in the left hip, mild changes only elsewhere.
She needs two crutches to support herself, which means she cannot even carry something from one room to another. She goes out every three weeks when her friend gives her a lift and helps her go round a local supermarket. Another friend might also take her shopping but they have to get a cab.
Her GP said to her “You are too young to have a hip replacement”, and despite her lack of mobility and changes on her X-ray, has not even referred her to an Orthopaedic Surgeon
This despite Hip Replacements being one of the great success stories of 20th Century Medicine, along with imaging, antibiotics and trauma care. Ms X has no children or close relatives, but has worked all her life, and would do anything to get back to work, but she doesn’t have £20,000 to have her operation privately.
HOW COULD IT HAVE BEEN DONE DIFFERENTLY?
! – Proper management of her original knee injury, with X-ray and MRI investigations of the state of her joints
2 – Physio Assessment of her musculoskeletal function, and a personal exercise programme to help restore normal function in her knees and other joints
3 – Lifestyle and dietary advice, arthritis is a degenerative condition exacerbated by too much sugar, poor eating habits, previous injuries, unbalanced activity.
4 – In the face of further decline, early surgery – don’t wait until she is sixty, has developed complications from her inactive lifestyle and will never get back to work.
Active intervention early and our friend could have worked for another ten years. Caring may not be the most glamorous of work, but it is essential and human. And we need carers until we have fully implemented Aldous Huxley’s Brave New World, where everyone goes into a Soma Coma at the age of thirty, assuming nothing happens to hasten the deadline.
Painkillers and Crutches are not a health service, and we are fooling ourselves if we think the NHS should be clapped for such service. It was set up to help the working man and woman get back to work – it is time we either return to original concept, or update the model, such that referrals are not left in the hands of General Practitioners, but are made automatically, without the need for human intervention. And think of the money saved by removing the Middle Man aka General Practitioners. And you would have a lot more doctors available to practice real medicine.
Age is irrelevant when referring to hip replacement. As the single most successful orthopaedic surgery, it should be done when the patient needs it, not when an out of date, money minded, “General Practitioner” gives permission.
There are reasons for hip surgery and reasons to avoid it. Age is irrelevant.