Tam Anh Hospital

I arrived on my latest trip to Saigon, all in with Dr. Phat from FV as I had exhausted all other possibilities. But when I realised he was giving me false information, trust was broken and I was devastated. I spoke to AI about it and it said that I had exhausted the main possibilities, but to try Tam Anh as they had a clinic near me in district seven and they handle a lot of complex cases.

I decided to at least go there to just ask what kind of implants they have, as FV had lied about their stock. I took a taxi and it turns out that it, the hospital, is right next to VNVC – so I’ve actually been around it many times. I walked into the pleasant reception and a helpful, non-English-speaking woman approached me. I told her what I need and was directed up to the first floor.

There I got to reception and explained I just want to know what implant stock is carried. As usual, it was ‘see the doctor’, and I explained that and they often don’t know the answers to these basic questions. So I’m not going to pay for basic information. They told me to wait, and then led me over to the doctor, ‘no need to pay’.

I was introduced to a man. His business card says Ths.BS cki Ho Van Duy An. He was a young, well-presented doctor speaking perfect English. So this free chat to obtain basic information turned into one of the most thorough, intelligent consultations I have ever had. He looked at my xray, asked me to undress and pressed my muscles. He said it’s primarily AVN, not osteoarthritis. Stage four both sides. He answered all my questions. He recommended his colleague Dr Dinh Khoa, who used the ABMS approach, an anterior, muscle-sparing approach that, like superpath, doesn’t involve cutting muscle. The whole thing will cost 6-7000 usd. Extra days staying will be 100usd inclusive (three million, which is less than 100). I think he might have got some numbers mixed up because he said the expected lifespan is around 5 years. He said there are three companies they use for the implants, a Swiss one called XNov, and an Italian one called Permedia Group Lepine.

So I looked it up afterwards, the last one is actually two different ones and all are actually French, and so he was getting confused. There was very little information available online, but AI looked into it for me and said they are legitimate companies.

So this was great. Dinh Khoa would be there Monday. I went back to reception and they said it’s not possible to make appointments, but drop in. A receptionist gave me his (the receptionist’s) Zalo contact and said I can let him know I’m coming.

It was a couple of days to wait and when I contacted this guy he answered immediately, and confirmed I could pay by credit card. The full consultation cost was 190,000 – a QUARTER the price of the idiot of FV.

I entered and it was another young, well-presented man with perfect English. I noticed there was a nurse in the background and she had also been there on the first visit. So I asked him my questions.

1 – Is my operation beyond a routine replacement?

A – No. It’s routine. About one hour surgery. Bilateral not recommended because of my age.

2 – Does the socket need reshaping, autographing or screws?

A – He will use a reamer and screws are required as it’s shallow (135 or 13.5 degree angle, I can’t read my notes, and this is a reason he isn’t too keen on dual mobility) and not a good shape. Dual-mobility cups generally don’t have any screw facility, and so it might not be recommended, but he will look into which companies make DM with screw possibility. He never uses cement.

3 – If you use ABMS wil visibility be good enough?

A – Yes, plus they’ll be an xray to check intraoperatively.

4 – Do I have hip dysplasia?

A – No.

5 – Do I have AVN?

A – Don’t know.

6 – Will my poor circulation be an issue during the operation?

A – Yes. Anti-coagulants will be prescribed for one month. I will be able to change my own compression stocking right away.

7 – Do you use xray or fluoroscopy in the operating room to verify cup placement and stem and compare leg lengths?

A – Yes. But there will be a leg length difference which will be corrected on the second surgery.

8 – What materials will you choose for the implant.

A – There is titanium, ceramic costs a little more and can break. Polyurethane costs less. At the end of the notes I’ve written: ceramic on ceramic is a higher price (I recall he told me it can crack), and ceramic on polyurethane is cheaper.

9 – I can only sleep on the floor, not anything soft. Can this be accommodated?

A – Yes.

10 – Do I need to buy anything, like grabber, toilet seat, ice etc.

A – No. He showed me a video on his phone of someone after a few days operation, squatting. I told him I’ve not done that for 25 years and there is no muscle whatsoever, but he was confident that I would be able to again. He said I wouldn’t be released from hospital without a helper and I said I don’t have one, and he said I can pay daily for extra stay for about four million extra, which he said is two or three hundred, but it’s actually one hundred, as the other guy said.

11 – What medicines would I be on post op?

A – antibiotics (after, not before), anti-inflammatory, painkillers and anti-coagulants.

—

He then listed the manufacturers of implants they stock, very different from what the other guy said:
Link (from Germany)
Implantcast (Germany)
Evolutis (France)
XNov – Swiss
Mathys (Swiss)
Zimmer
Smith and Nephew.
They also have Microport, like FV, which can be put in with ABMS, not just superpath.

So there is quite a bit of difference in what the other guy told me, but basically the full range, and I haven’t heard of this before.

So I asked what the plan was and it was basically go home, prepare and come back with a 90 day visa, but the actual implant will be decided once he’s done some tests. I asked which tests and it was more xrays and dexa for bone quality. He also said we’d check my knee as that’s often where the pain is.

So I had the tests today. I have osteoporosis. It’s not severe but will need two spaced injections, medication and about a year to treat, but after the second replacement.

Both my knees are perfect (from the two new xrays), and so it’s referred pain.

He has the scan he needs now for what he calls templating, where he kind of draws the implant in place to see how it looks or something. So he’s going to do this today and email me with the implant choices. He will send a list of dual mobility which have a screw option, and then the non-dual mobility one which he would recommend, due to this degree angle issue he mentioned or whatever.

Note: I just noticed I’ve written ‘never cements’. Extra days staying would be 4 million per day, which he says is two or three hundred usd. After surgery I would be on painkillers, anti-inflammatories, antibiotic (taken after, not before) and anti-coagulants.

Update

After this I had to visit the hospital a few times asking for when the templating would be done. He didn’t get back to me so I paid to see another doctor. I had decided to start osteoporosis treatment in case this drags on (the other doctor wasn’t interested and I think assumed he would be operating soon). This new doctor said he can template now, and tried, but the connection was slow and so he didn’t do it. He said straight up that he would never give me a dual mobility because of the increased wear. He did this without me asking about it (I was there for advice about osteoporosis). This is a bit concerning as he said this outright, with no medical history or examination and when I suggested then it was simply his policy he took offence.

But clearly this is the case. I’ve seen four doctors there. The only one who examined me was the free one who doesn’t operate. None of them took a medical history. When I bring up the risk factors, bulimia, drinking, myopathy, they ask no questions or take no notes.

I think most Vietnamese doctors give the same few implants and get to know those implants well. They don’t take a history because it would make no difference, everyone gets the same. Possibly they don’t want the risk factors on your file because then they would be able to say that you didn’t inform them.

Anyway, he printed out a prescription to start the medication and I was done there.

A few days later I did get the email about templating. Dr. Khoa had measured my acetabulum, but he’d done the WRONG SIDE, the non-surgical side. It’s quite obvious which side is worse plus we discussed this. Also, the acetabulum measures 60-64mm and they don’t have this in stock. This was all the email said.

I replied and asked if he could template the correct side, as there can be big differences and it’s possible my left side (the surgical side) is the size that matches their stock. I also asked about the possibility of a special import. He didn’t reply.

So I found the contact details for all the manufacturers he had mentioned and sent out emails asking about their stock and the possibility of special import, but I received no reply except from Zimmer, who gave me the correct details for the manufacturer.

Then I got an email from Dr. Khoa asking if I’d contacted the manufacturers as one of them had contacted him about stock, but they don’t have it. This was ambiguous. It wasn’t certain if they don’t have it in the hospital or in Vietnam. I replied and asked which company had contacted him so I could follow up, plus AGAIN asked if he could template the correct side and would a special import be possible.

As of yet there is no reply. Currently I’m finding other ways to contact the suppliers.

Another thing is that, their app is quite good (Tam Ahn) but because I don’t have a local number I cannot access and download my test results. I contacted customer services, and they said they can send me it manually, including scans, although again I never received anything.

So currently, this seems my best bet. The doctors are not great, but this might just be the way that Vietnam is. But the environment is very nice, the support staff were fantastic.

I think it might be the case that, in Vietnam (and everywhere?) most such doctors just do the same simple replacement for everyone and if you are complex, you need a revision specialist who has more experience. So the next step is to find the import, whether it is there in the country at all, and see a suitable doctor if it’s possible.

Update: Two months later, no contact. I’ve reached out and am still trying to get the templating xray digitally so I can get second opinions. This is ongoing.

I’ve also identified another possible surgeon at Tam Ahn. My vague plan is to return as I want to get the oesteoperosis treatment, and also my second shingles shot, so this is my reason to get a definitive answer on if the implant is available, then either choose here or move on.