The following is my (currently ongoing) experience of FV hospital in Saigon. It was initially my main choice for a hip replacement because it was clearly the best communication I was receiving from the numerous attempts I have made. Although at the time of writing I am still dealing with them and seeing if there is a way forward, it seems to be going down hill.

The first part of the text is bulleted as it was originally part of the Vietnam landing page, but I’ve seperated it off as the story developed.

• Somebody online recommended Dr. Phat as a good surgeon and told me an MRI would be around a hundred dollars.
• Update: I sent an email query and they replied. The approximate price for one hip replacement (total I presume) is quoted as 193,700,000vnd, which is around 7500.00 usd. The reply isn’t ultra-clear but this was quoted as a package, including:
  • prophlactic antibiotics
  • pain managment
  • basic perfusion (monitoring of blood flow). seven days ina double room, one day before and six days after
  • 24 hour nurse care
  • Physiotherepy six times for one limb. And seven cold compresses.

• • Not included:
    • Expenses not related to the procedure
    • Complications
    • Follow up visits
    • Take home medicines
  • The quote also mentioned other expenses, this isn’t clear but it appears they are not included in the package:
    • Mri of both hips: 3,950,000
    • 2,500,000 contrast.
  • So the total seems to be 197,150,000vnd =  7,595.11 US Dollar
• UPDATE: I contacted them again for the consultation price, 810,000 dong (about 30 usd) to see the recommended surgeon Dr. Phat.
• Conclusion: this place is about the priciest and I only have online contact to judge them by but so far they are 100% professional and it seems to be a good choice. 
• Update: So I returned here for a consultation. The doctor spoke good English. He didn’t examine me much, just had me lie down and twisted my leg to see the movement (clothed). I’d contacted them in advance asking if I could forward the MRI and they told me to bring it. I gave it to him but he didn’t look at it, only the xray. He told me to replace both hips, left first, six weeks apart. He said for the last two years he’s only used the superpath approach, which is lateral posterior. He’s done more than 2000 before (overall, not sure how many superpath), but since he switched to superpath, he’s never had a dislocation. He said I’m a special case because the bone has collapsed so much. He felt I didn’t need any helper, and said he’d be able to get himself through recovery without a carer. I showed him my bad veins and he changed his mind and said have a carer for the first month. I told him about my myopathy and he said as long as I can stand on one leg, then I’m strong enough (I could). I also asked about the sleeping arrangement, i.e. I can only sleep on the floor nowadays, and so if I only have one done, I’ll still need to be on the floor, how will we manage this? Well he asked me to demonstrate how I get up and down off the floor. I showed him. He said we will arrange a very hard bed for the hospital and then make sure I can get up and down off the floor before being discharged. I asked about the implant. He had no idea what the manufacturer is called, I think he looked it up and said microport. I asked what size and he said that it would be decided during surgery. — So, it wasn’t amazing. He didn’t look at me much. However, he answered all the questions. It was over when I decided I had all the information. The hospital was nice and the staff were friendly. The superpath approach is really interesting. I asked about aftercare, homenurse and stuff and he said contact them two weeks before I’m ready and they will arrange something. I asked if I need any equipment to prepare and he said no, then suggested just a raised toilet seat. Overall, I’m not sure how it will go, obviously, but so far this is the best I’ve found.

 

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Second Visit

After that first consultation I returned home but there were a lot of unanswered questions. Initially, when he mentioned Superpath, I hadn’t known it was available so I was on a bit of a high. But when I left and looked into it, and also looked back on our meeting, I started to have doubts.

One thing was that he refused to look at me, examine me or take any medical history whatsoever. The only assesment was standing on one leg for a few seconds, which he took as enough evidence that my muscle was OK for the operation (but I brought an MRI specifically to check). I was angry that I’d contacted them before to check that they would be able to view the MRI but then he only used his phone as said connection was too slow.

Also, when I asked about dual mobility, his answer was that is isn’t possible because ‘your cup is not a cup’, and that could have meant displasia or the acetabulum is too shallow or something, although none of this made sense in refusing dual mobility, if anything it adds to the reason to use it.

But at the time, as I said the communication via email was good, it was the only definte quote I had received and seemed the best bet. I decided to return and make sure he looked at the MRI. I’ll bring up the reasons again for needing DM and see if he’ll examine me (bulimia and previous investigation for myopathy (possible genetic cause)).

It didn’t go well. I’ll include the update below, which I wrote about an hour after seeing him. I wrote it for AI to ask my best next move. It includes a list of questions in Q and A format as this is what I took into the consultation in my notebook, and wrote the answers as he was speaking to me realtime.

I’ll mention before I start, he seemed irritated off the bat, perhaps irritated I had more questions as he had told me to email with the date I wanted the surgery. He also wouldn’t put the xray on the lightbox but just held it before him, and again point blank refused to look at the MRI. There was no physical exam. Again, he asked no questions about my medical history.

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I’ve just had a consultation with my surgeon (a surgeon) about getting a hip replacement. I’m not happy with things really as he seems to have lied. I’ve been through so many doctors now, he was my last hope (I’m poor, expatriate in Vietnam). I’m going to post my notes here, what was said.

 

[Note: for the second time I brought the MRI and asked him to look at it to assess my muscle at the back as it seems wasted to me, and he flat out refused, saying MRI’s don’t show anything. If I can stand, then the muscle is strong enough for the surgery.]

1 – Is this a technically demanding hip replacement?

A – All hip replacements are technically demanding.

2 – Does the socket need reshaping, grafting, cages or screws?

A – This was like getting blood out of a stone, although this was the case for most questions, but no grafting. The actabular has no cup shape and so he would create one by removing bone and placing the cup deeper within. This can work because there is no bone loss. He showed me where screws can go but wouldn’t commit as to whether they would be used, and this worries me because it would push the cost up and they might not use when they are needed (as they have quoted me a fixed package price).

3 – Will visibility be OK using superpath?

A – Yes.

4 – Do I have dyspasia? 

A – Yes.

5 –  How bad is it on a scale of one to four?

A – He didn’t understand/wouldn’t answer.

6 – Does it need a custom implant?

A – This is not available in Vietnam.

[Note: I found a copy of my xray from 25 years ago taken when my hip first hurt, and he said straight away that there is no congenital deformity, it has currently collapsed because of the disease]

7 – Do I have AVN?

A – No. Only OA.

8 – Are standing xrays or other tests needed before surgery, dexar for bone quality? More Xrays?

A – No. He works from a single xray alone. There might be an extra test, but only if the anestheologist orders it.

I said my knee hurts also, shall I get it xrayed in case  it is also a problem, and he didn’t seem bothered, basically said it’s up to me.

9 – Are the abductors weak from misuse (increased leg length risk). Do I have myopathy? How is the capsule support, stretched or thin?

A – REFUSED TO LOOK AT THE MRI, because it won’t make any difference to surgery. When I said that it would make a difference to implant choice, he was visibly irritated (and I was soon to find out that there was only one choice). He said that THERE ARE NO TOOLS TO HAVE DUAL MOBILITY USING SUPERPATH, and I already know this is incorrect, so pressed him, and he finally admitted that they only have one type. Initially he was saying that there is only one type manufactured, but then admitted that they only import one type. He didn’t know it but looked it up and said it’s the profemur gladiator. (Note: dual mobility can be used with superpath using the dynasty implant (same manufacturer), so either he didn’t know that or lied).

While he said this I was taking notes and, as I knew it was a lie, I wrote down his exact words, word for word, and I include a picture of this below.

10 – Do you use x-ray or fluoroscopy in the operating room to verify cup placement and stem and compare interoperative imaging, as I cannot wear shoes and so uppers are not a possiblity.

A – Yes. Leg length discrepency is a risk and shoes would be required. (Note, this was not mentioned before and he would have performed the surgery without ever informing me presumably).

11 – If the femur cracks during surgery, can you abandon surgery, or convert to anterior approach only?

A – It took a long time for him to understand, and then a long time to get the answer. First he said he’s never had a bone crack, it’s not possible. But there is some published talk online available where he talks about this happening and how he converts. So then he said it can happen, but in less that 0.01% of cases. He would stay with the same incision but increase the size and cut muscle. I asked if this was basically converting to posterior approach, but he again became irritated and so I’m not sure what the answer is.

12 – Which implant options will you be taking into theatre? Which sizes? What are the materials. Is it possible for me to choose 36mm or bigger?

A – Again he was confused and had to look up the answers. He didn’t understand the head size being in milimeters. He looked on the computer and the stem size is standard 132mm. The heads are size 4,5,6, up to 7. So this is some non-standard Microport measurement. I won’t know what size I have. He said the ‘rim lock actabulim liner poly biolocs date ceramic head’. This is what I wrote in my notes. It sounds like polyethelene liner with ceramic head.

13 – If it goes wrong and keeps dislocating, is it modular, can it be converted to DM.

A – No. No.

So, this was the ‘consultation’. I hinted that I might have a neuromuscular disease/myopathy, and he said that is something completely different. Basically I need to go somewhere else, assess any risks and make the decision myself. He is only concerned with doing the operation and just come again if I want it. He then threw a business card for Microport across the table and told me to call them if I have any more questions (rudely).

A big issue is what to do if it goes wrong becuase it seems the whole thing would need to be replaced.

The other issue is that there is only one implant available. Last time I asked about dual mobility and he said it’s not possible to consider because ‘your cup is not a cup’, but now I know that is irrelavant. It’s not a possibilty because they choose not to import a suitable model, possibly because it would push up the price of the package, I don’t know.

I’m writing this today, a couple of hours after going there, and I feel pretty broken. This doctor was my last chance, no one else came through, the vast majority didn’t even answer my emails. The thing is, I could accept some limitations, but he seems to have been deliberately misleading (at best) on a couple of points, and the other is his lack of basic knowledge, like head sizes and terms (complex procedure).

Nothing else to say right now, just unhappy.

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