I saw a 17 year boy last week. He came in on crutches, unable to weight bear on either leg and in constant pain. He has bilateral total hip replacements, different length legs, and has been referred to the Pain Clinic – the “Fountain of Medical Desparation”.
He came to the attention of the Orthopaedic surgeons as a 13 year with pain in his hip. This was diagnosed as slipped femoral epiphysis, first on the left and then the right. This is a condition where the top of the femur slips off the femur. It is caused by being overweight and some much rarer hormone problems. Further information here
The top of the femur was pinned back in place on both sides. However this did not help and a year later he had major surgery on both hips, where the femur or (thigh bone) was cut and rotated to provide a better fit for the hip joint to make up for slipping of his epiphysis (top of the femur that fits into the hip socket). Osteochondroplasties, or for reasons best known to this orthopaedic surgeon as “Open reduction, left / right femoral epiphyses with surgical dislocation”. That is not a good description of a failed surgical procedure.
His orthopaedics notes were interesting for their lack of information. Like most medical conditions, this condition has a cause, has conditions that make it more likely, and has non-orthopaedic interventions that are essential steps in order to get the best outcome.
Neither operation, right nor left, was a success, and given the anatomy and age of the patient, this is not surprising. At 15 years of age, the femurs are still growing, and an adult male may not reach his full height until he is 25 years old. Moreover, although it was not mentioned in his orthopaedic notes, the young man was morbidly obese and had been since he was ten or eleven. Obesity makes everything worse, and causes slipped femoral epiphyses.
Unfortunately for this young man, what looked like good news was actually not good news. He was under the care of the Paediatric Orthopaedic Surgeons of a major London Teaching Hospital. And no one from such an elite establishment can admit to being fallible, or even consider a second opinion, let alone refer to a specialist orthopaedic hospital, such as Stanmore. The Royal National Orthopaedic Hospital, Stanmore is a world class centre. A 17yr old young man who cannot walk 20 metres without severe pain deserves the best orthopaedic care a so called National Health Service can provide, under whose auspices all patients are supposed to be treated equally.
Bilateral slipped femoral epiphyses should be a relatively straightforward condition that is treatable and should not leave a teenager crippled for the rest of his life.
HOW IT COULD HAVE BEEN DIFFERENT
This young man has a difficult background, his parents, especially his father with whom he now lives and who provides the nearest to “care” he has, was physically abusive to him throughout his childhood. He put on weight during his teenage years, mostly following a particularly brutal assault from his father where he nearly drowned. No one took any interest in his teenage weight gain. He was under the “care” of Child & Adolescent Mental Health services from the age of 15 years for aggressive and self harming behaviour.
However it is his obesity that has done him the most immediate damage, and not even a mention of a dietician. His orthopaedic management seems to have been a bit brutal, no bedrest, no period of non-weight bearing, or any other intervention that might have slowed the progress of his condition. Now, over five years before his legs have finished growing, he has ended with two total hip replacements, and unable to walk to the corner shop and back without a rest half way.
If this young man had been from a nice white middle class background, would the NHS have served him so ill? Personally, I doubt it, His nice white parents would have asked questions, and might even have asked for a second opinion and he might have been referred to the UK’s centre of excellence with such a thorny problem. This to my mind, is discrimination in healthcare. As it is, he is condemned to lead his life in his bedroom, with a mutt who pees on newspaper in the corner of his room, because he rescued the dog from an even worse place.
After Covid we need to Build Back Differently, not do more of the same, leaving the same elite group of ageing white men in charge. Old men need to retire and make room for younger people, with new ideas and new perspectives. And even you think BLM go too far when they pulled down a statue, a part of me thinks, that maybe with the right background and skin colour, the outcome in this case might have been very different and this young man’s future might not be so gloomy.