5:43 AM
waniemy
Hemiarthroplasty.
That day, for the very first time, I heard that word.
I cup my head and face in my hands, digesting hard every single word from the doctor in front of me.
My mom is trembling beside me. Shocked.
Only after 1 month we found out this truth, a painful truth.
In the first week of Hari Raya, while my sisters and I were chit chatting in the kitchen, enjoying a delicious chocolate cake moist, we suddenly heard a bang. It was 12 midnight sharp. We quickly checked and found my mom lying on the floor painfully in front the of the kitchen door. She was throwing a small plastic bag of rubbish when she accidentally stepped on a pair slippery slipper next to the rubbish bin. She couldn't get up. My brother scooped and held her to the car. We went to the clinic but the X-ray was closed at 10pm. The doctor wrote a letter and asked us to bring her to hospital. At Hospital Sg Buloh (government hospital), the doctor checked her up and casually said "Mak cik tak yah risau. Tak ada patah. Tak perlu X-ray." (Don't worry aunty. No fracture. No need X-ray.)
Believing the stupid doctor, we assumed it was just a torn muscles, no fracture. For 1 month, we tried various traditional massages but still she felt the pain on her left thigh joint. Seeing her condition wasn't getting any better, I decided to bring her to a specialist. She resisted. By nature, she's a person who easily feel scared and afraid. I ignored her resistance and drove her to the specialist hospital.
As soon as Dr Muiz saw my mom entering his room with her crutches, seeing my mom's left leg, he already had something in his head. Without telling us his speculation, he first sent her for an X-ray.
In front of our very own eyes, he explained the X-ray result. Comparing the left hip condition with the right one, we were very shocked and speechless. It was a fractured hip. Fracture neck of femur, to be exact.
There was no other option but a surgery! Hemiarthroplasty surgery!
Incompetent government hospital
Dr Muiz said, when elderly fall down, rule #1 is she/he must take X-ray!
How could the government hospital be so casual about it? So irresponsible!
We drove all the way to the hospital that midnight just to get an X-ray when the doctor confidently said nothing to worry, no X-ray needed!
I believe that we are not the first one who was tricked by the incompetent government hospital. There are so many similar cases out there. Can we sue the hospital?
Hemiarthroplastry
Hemiarthroplastry is an operation that is commonly used to treat a fractured hip. Hemi means half, and arthroplasty means joint replacement. The two make up hemiarthroplasty, half joint replacement. It only replaces the ball portion of the hip joint, not the socket portion. In total hip replacement, the socket is also replaced.
How does the hip joint work?
The hip joint is one of the true ball-and-socket joints of the body. The hip socket forms a deep cup that surrounds the femoral head, the ball of the upper thigh bone. The surface of the femoral head are covered with articular cartilage, a slick material that allows the surface to slide against one another. Blood supply to the femoral head only comes through the neck of the femur.
Hemiarthroplasty prosthesis
Amazingly, not only vehicles have spare parts but human body has too. The fractured femoral head can be replaced with a metal head called hemiarthroplasty prosthesis.
The prosthesis is composed of a metal stem that fits into the hollow marrow space of the thighbone (the femur) and a metal ball that fits into the socket of the hip joint.
There are 2 types of prosthesis:
1) unipolar prosthesis
- it has a solid metal ball that replaces the femoral head
2) bipolar prosthesis
- it has a femoral head that swivels where it attached to the stem
- designed to reduce the wear and tear on the articular cartilage inside the socket
It is unclear whether the swivel offers any significant advantage. Both types seem to work well.
Nevertheless, the original bones, Allah's creation can never be challenged. SubhanAllah.
There are few limitations with the prosthesis. The rule of thumb is to ensure that the knee cannot be higher than the hip joint when bending. Some limitations to avoid dislocation are:
- can no longer squat (cannot bend the hip more than 90 degree)
- cannot cross the legs
- must sit on a chair. Cannot sit down on the floor. For performing prayer, she can no longer do the normal way. She must sit on a chair to do so.
Before operation
The biggest challenge was to convince my mom to go for the surgery. She refused. She was scared that she would die. To be honest, this is the first time ever for someone in my small family going for a surgery. My dad, sisters, brother and I tried to convince her by giving her advice and moral support. She was still reluctant.
One day, I showered her and saw the skin on her thigh went wrinkled and shrunk. I cried and asked her to go for the surgery before it is too late.
Other family members and her friends visited her and gave motivation and moral support for her to be strong to go through the surgery. Finally, she agreed.
During the operation
Anesthesia
Anesthesiologist provides 2 options to my mom: 1) Whole body anesthesia
and 2) Half body anesthesia (from waist down). He said option 2 is less risky and allow her to recover faster after the surgery. Despite being scared, she took option 2 because she was afraid that she couldn't wake up again if she takes option 1 but with a condition. She requested to close her eyes and ears so she couldn't see and hear anything. They only stuffed cotton on her ears but she can still hear everything. The funny thing is that somehow she found great courage and able to chit chat with the doctor during the operation.
Implant insertion
The surgeon makes an incision on the side of the thigh to allow access to the hip joint. Only then, he saw that the femoral head is no longer inside the socket, but it was dislocated to the back of the hip. From the front view of the pelvis X-ray, we won't be able to tell this. The dislocated fractured head knocked on nearby parts of the body causing a small crater formed on top of the head. The surgeon removed the head. He inserted the metal stem of the prosthesis into the femoral canal. Since my mom is over 50 years old, her bone was not that strong. Hence, the surgeon used the epoxy-type cement to bond the metal stem to the bone. He then attached the metal ball and relocated back into the hip socket. Before he close the incision, he makes sure that the hip works properly and the joint moves easily.
Alhamdulilah everything went well. Thanks to Allah, my mom does not suffer any other critical illnesses such as high blood pressure, diabetes, heart problem etc which make the surgery less risky.
After the operation
The operation took 2-3 hours. Having risk-free condition, she was immediately transferred to her ward room for rest. Doctor advised her to only take in food after 5 hours to give some time for the anesthetic to fade away. The next day, only after the blood at the incision part went dry, the doctor applied water proof plaster.
Physiotherapy
Only on the third day, she started to go through the physiotherapy
. The therapist guide her on how to get up from bed, how to walk and how to climb the stairs. For a start, she should only apply around 20% of her body weight on the operated leg.
Now, she's back at home. Recovering. Her next visit to doctor would be end of this month.
I pray to Allah so that she can recover fast and well. InsyaAllah. Ameen.
My mom's X-Ray result (Before and After operation)
In the first X-ray picture, you can see the head of the left thigh bone is fractured. Front view of the x-ray couldn't tell the exact condition in which the fractured head was actually dislocated and was behind the hip instead of inside the socket.
The later picture shows the shining metal ball bonded to the thigh bone, replacing the fractured head of femur.
Please pray that my mom recover fast and well and she can walk without limping and live her life happily.
InsyaAllah. Ameen.
P/S: For those out there, please remind your old folks to be extra careful and avoid falling down because elderly suffer more risk due to the fall as their bones are aging.
That day, for the very first time, I heard that word.
I cup my head and face in my hands, digesting hard every single word from the doctor in front of me.
My mom is trembling beside me. Shocked.
Only after 1 month we found out this truth, a painful truth.
In the first week of Hari Raya, while my sisters and I were chit chatting in the kitchen, enjoying a delicious chocolate cake moist, we suddenly heard a bang. It was 12 midnight sharp. We quickly checked and found my mom lying on the floor painfully in front the of the kitchen door. She was throwing a small plastic bag of rubbish when she accidentally stepped on a pair slippery slipper next to the rubbish bin. She couldn't get up. My brother scooped and held her to the car. We went to the clinic but the X-ray was closed at 10pm. The doctor wrote a letter and asked us to bring her to hospital. At Hospital Sg Buloh (government hospital), the doctor checked her up and casually said "Mak cik tak yah risau. Tak ada patah. Tak perlu X-ray." (Don't worry aunty. No fracture. No need X-ray.)
Believing the stupid doctor, we assumed it was just a torn muscles, no fracture. For 1 month, we tried various traditional massages but still she felt the pain on her left thigh joint. Seeing her condition wasn't getting any better, I decided to bring her to a specialist. She resisted. By nature, she's a person who easily feel scared and afraid. I ignored her resistance and drove her to the specialist hospital.
As soon as Dr Muiz saw my mom entering his room with her crutches, seeing my mom's left leg, he already had something in his head. Without telling us his speculation, he first sent her for an X-ray.
In front of our very own eyes, he explained the X-ray result. Comparing the left hip condition with the right one, we were very shocked and speechless. It was a fractured hip. Fracture neck of femur, to be exact.
There was no other option but a surgery! Hemiarthroplasty surgery!
Incompetent government hospital
Dr Muiz said, when elderly fall down, rule #1 is she/he must take X-ray!
How could the government hospital be so casual about it? So irresponsible!
We drove all the way to the hospital that midnight just to get an X-ray when the doctor confidently said nothing to worry, no X-ray needed!
I believe that we are not the first one who was tricked by the incompetent government hospital. There are so many similar cases out there. Can we sue the hospital?
Hemiarthroplastry
Hemiarthroplastry is an operation that is commonly used to treat a fractured hip. Hemi means half, and arthroplasty means joint replacement. The two make up hemiarthroplasty, half joint replacement. It only replaces the ball portion of the hip joint, not the socket portion. In total hip replacement, the socket is also replaced.
How does the hip joint work?
The hip joint is one of the true ball-and-socket joints of the body. The hip socket forms a deep cup that surrounds the femoral head, the ball of the upper thigh bone. The surface of the femoral head are covered with articular cartilage, a slick material that allows the surface to slide against one another. Blood supply to the femoral head only comes through the neck of the femur.
Hemiarthroplasty prosthesis
Amazingly, not only vehicles have spare parts but human body has too. The fractured femoral head can be replaced with a metal head called hemiarthroplasty prosthesis.
The prosthesis is composed of a metal stem that fits into the hollow marrow space of the thighbone (the femur) and a metal ball that fits into the socket of the hip joint.
1) unipolar prosthesis
- it has a solid metal ball that replaces the femoral head
2) bipolar prosthesis
- it has a femoral head that swivels where it attached to the stem
- designed to reduce the wear and tear on the articular cartilage inside the socket
It is unclear whether the swivel offers any significant advantage. Both types seem to work well.
Nevertheless, the original bones, Allah's creation can never be challenged. SubhanAllah.
There are few limitations with the prosthesis. The rule of thumb is to ensure that the knee cannot be higher than the hip joint when bending. Some limitations to avoid dislocation are:
- can no longer squat (cannot bend the hip more than 90 degree)
- cannot cross the legs
- must sit on a chair. Cannot sit down on the floor. For performing prayer, she can no longer do the normal way. She must sit on a chair to do so.
Before operation
The biggest challenge was to convince my mom to go for the surgery. She refused. She was scared that she would die. To be honest, this is the first time ever for someone in my small family going for a surgery. My dad, sisters, brother and I tried to convince her by giving her advice and moral support. She was still reluctant.
One day, I showered her and saw the skin on her thigh went wrinkled and shrunk. I cried and asked her to go for the surgery before it is too late.
Other family members and her friends visited her and gave motivation and moral support for her to be strong to go through the surgery. Finally, she agreed.
During the operation
Anesthesia
Anesthesiologist provides 2 options to my mom: 1) Whole body anesthesia
and 2) Half body anesthesia (from waist down). He said option 2 is less risky and allow her to recover faster after the surgery. Despite being scared, she took option 2 because she was afraid that she couldn't wake up again if she takes option 1 but with a condition. She requested to close her eyes and ears so she couldn't see and hear anything. They only stuffed cotton on her ears but she can still hear everything. The funny thing is that somehow she found great courage and able to chit chat with the doctor during the operation.Implant insertion
The surgeon makes an incision on the side of the thigh to allow access to the hip joint. Only then, he saw that the femoral head is no longer inside the socket, but it was dislocated to the back of the hip. From the front view of the pelvis X-ray, we won't be able to tell this. The dislocated fractured head knocked on nearby parts of the body causing a small crater formed on top of the head. The surgeon removed the head. He inserted the metal stem of the prosthesis into the femoral canal. Since my mom is over 50 years old, her bone was not that strong. Hence, the surgeon used the epoxy-type cement to bond the metal stem to the bone. He then attached the metal ball and relocated back into the hip socket. Before he close the incision, he makes sure that the hip works properly and the joint moves easily.
Alhamdulilah everything went well. Thanks to Allah, my mom does not suffer any other critical illnesses such as high blood pressure, diabetes, heart problem etc which make the surgery less risky.
After the operation
The operation took 2-3 hours. Having risk-free condition, she was immediately transferred to her ward room for rest. Doctor advised her to only take in food after 5 hours to give some time for the anesthetic to fade away. The next day, only after the blood at the incision part went dry, the doctor applied water proof plaster.
Physiotherapy
Only on the third day, she started to go through the physiotherapy
. The therapist guide her on how to get up from bed, how to walk and how to climb the stairs. For a start, she should only apply around 20% of her body weight on the operated leg. Now, she's back at home. Recovering. Her next visit to doctor would be end of this month.
I pray to Allah so that she can recover fast and well. InsyaAllah. Ameen.
My mom's X-Ray result (Before and After operation)
Fracture neck of femur (Before operation)
After hemiarthroplasty operation
In the first X-ray picture, you can see the head of the left thigh bone is fractured. Front view of the x-ray couldn't tell the exact condition in which the fractured head was actually dislocated and was behind the hip instead of inside the socket.
The later picture shows the shining metal ball bonded to the thigh bone, replacing the fractured head of femur.
Please pray that my mom recover fast and well and she can walk without limping and live her life happily.
InsyaAllah. Ameen.
P/S: For those out there, please remind your old folks to be extra careful and avoid falling down because elderly suffer more risk due to the fall as their bones are aging.
