Week 6

On Monday I joined Dr. Schneider with Mandy and Jacob with the expectation of observing an amputation surgery. However, a few angioplasty cases with higher priority took it place in the operating room. Both cases involved the thrombosis of the periphery artery in legs and causing anoxia and local tissue damage. The surgery started by inserting catheter from the artery of the other leg, reaching the clot region with guidance of X-ray image and contrasting agent, and inflating a balloon to improve blood flow. It is beautiful to see how minimal damage/pain this type of surgery has been done to patients. They fall asleep on the operating table for most time of surgery even without major anesthesia, and there was one female patient even snoring all the time.

Tuesday was another clinic day that seeing over 50 patients. There was an interesting case that the patient looking forward to a revision of hip replacement prosthesis. From X-ray analysis, it was clear that the pelvis socket of the prosthesis was anchored higher and also tilted by a larger angle compared with that in normal case. The abnormality resulted in significant restriction on the lateral movement of the leg and severe pain symptom. The patient explained that according to her previous surgeon such weird replacement location was arranged to save space for the lumbar spine surgery that performed right after her hip procedure. Such explanation seemed making no sense to Dr. Cross as he provided a solution that can perform normal procedure in both cases without any interference. Yet it was too late, despite no infection or dislocation caused by the prosthesis, the height difference on both sides influenced the loading distribution on pelvis and skewed her back, causing significant pain on her even only walking for two blocks distance. When Dr. Cross said unfortunately there was nothing he could do to improve such situation, there was a big sorrowful emotion flashed on the patient face.

Over the week I also attended a couple meetings. In the arthroplasty meeting on Thursday morning, doctors discussed on a complicate case that the patient was diagnosed with osteolysis before the total hip replacement surgery. Soon after the procedure, 2 dislocation spots on the pelvis socket were identified and the socket was stabilized by a lot of screws in a revision. Two years later, the patient felt increasing pain on the lateral side. To solve the issue, a secondary revision procedure was performed during which the lax poly part and the prosthesis head were replaced. At that time, the femur part of prosthesis was still very stable, but it was replaced with a piece of long stem prosthesis as well to prevent future dislocation due to the presence of osteolysis symptom. This time, the pain relieve didn’t last for more than 15 months. The surgeon is really confused about the symptoms this time because the X-ray data analysis shows the prosthesis remains intact. Some doctor suggested the pain might be due to the hyper reaction towards the poly if the patient had been suffered from poly debris during the last revision surgery.