2nd Vietnam TMain Issues:
Chronic, lifelong lower limb weakness with progressive hip degeneration. MRI shows both hips affected, left worse, with a cyst present. Significant mobility limitations, pain on soft surfaces (both lying and sitting, during and after), and long history of possible muscle wasting. Preparing to discuss surgical options for hip replacement or resurfacing.

1. Lifelong Symptom History

Childhood to Adolescence (age 5–16):
– First episode of severe leg pain at age 5, unable to bear weight. No diagnosis given.
– Chronic knee pain, aggravated by prolonged sitting on the floor in cramped space, hemmed in with other pupils.
– General weakness, poor athletic performance compared to peers.

Young Adult (age 21–25):
– Difficulty squatting, knees creaking and cracking.
– At age 25, sudden onset of severe hip pain (both sides, left worse at the time) with joint clicking, crunching, and weakness. Unable to walk for days; never fully recovered.
– One past shoulder dislocation. Shoulder muscles appear wasted to patient.

Current (30s–40s–Present):
– Ongoing muscle volume loss in thighs, buttocks, shoulders, and face.
– Previous electrical stimulation testing suggested myopathy; diagnosis remains uncertain.
– Both hips severely affected (MRI confirms left worse than right, with cyst).
– Hip locking and occasional dislocations, worse when lying down.
– Pain on soft surfaces (both lying and sitting), during and after use.
– Shin pain (mostly left, sometimes both) and foot pain after walking.
– Discoloured ankles and shin hair loss; history of left leg venous insufficiency with long periods of swelling.
– Max walking distance ~1 km before pain starts.
– Cannot stand from a chair without using hands (present for 25+ years). Cannot get up from the floor without support.
– Back pain triggered by unsupported sitting.
– Skin changes in buttocks area due to muscle loss and prolonged sitting.

2. Current Functional Status

– Sleeps on hard surface (yoga mat) due to hip pain on mattresses.
– Cannot use overly soft or cushioned chairs. Uses buoyancy aid to create a firmer sitting surface when chairs are too soft.
– Needs lower back support when sitting; pain develops otherwise.
– Last recorded weight: 79 kg, but can fluctuate up to 10 kg in a month (usually within 70–79 kg range). Waist size stays the same — possible fluid retention.
– Pain types:
• Sharp joint pain (likely arthritis)
• Radiating shin/toe pain (possible PAD)
• Deep aching in hips
– Responded well to physiotherapy in the past, despite appearance of gradual muscle wasting.

3. MRI & Key Questions for Surgical Planning

– Both hips damaged; left worse with cyst.
– Questions for surgeon:
1. Is the muscle around the hip weak? Would this require a special implant (large head or dual mobility) to reduce dislocation risk?
2. Is a dual mobility implant even available in Vietnam?
3. If a dual mobility implant was used and had an internal dislocation, would replacement parts be available quickly, or would I risk lying in hospital at high cost waiting for import?
4. If only one hip is operated on, how will the other side’s pain be managed during recovery, given I cannot tolerate mattresses and will be in a cheap hotel without a recliner?
5. How will sleeping be managed post-op in my case?
6. Will venous insufficiency in the left leg be a complication?
7. Can spinal anaesthesia be considered instead of general? I have woken early from general in the past.
8. How will my longstanding inability to squat or stand from the floor without hands affect recovery and dislocation risk?
9. Does my history of extreme slimming and possible lifelong weakness point to a muscle disorder that should influence implant choice or rehab?

4. Other Medical Considerations

– Possible Peripheral Artery Disease (PAD) under evaluation.
– Past swelling and damaged veins in left leg.
– Plan to update vaccinations during this trip; request advice on whether any special vaccines are recommended for surgery and recovery.

5. Post-Op Environment & Limitations

– Lives alone; no home assistance.
– Recovery will be in a basic hotel with hard bed and no recliner.
– Needs simple, stable, safe sleeping and movement strategy after surgery.

Surgeon Briefing

Main Context:
– Lifelong weakness, possible myopathy.
– MRI: Both hips damaged, left worse with cyst.
– Severe pain on soft surfaces (lying & sitting), during and after use.
– Cannot squat, stand from floor, or rise from chair without hands (25+ years).

Surgical Planning Questions:
1. Muscle condition around hip – need for large head/dual mobility implant?
2. Dual mobility availability in Vietnam?
3. If internal dislocation – are replacement parts locally available?
4. How to manage pain in non-operated hip during recovery?
5. Sleeping arrangements post-op without recliner or mattress tolerance?
6. Venous insufficiency in left leg – surgical implications?
7. Spinal vs general anaesthesia (past early awakening from general)?
8. Impact of lifelong weakness & possible muscle disorder on recovery & dislocation risk?

Other Considerations:
– PAD under evaluation.
– Weight 79 kg, fluctuates 70–79 kg (possible fluid issue).
– Recovery alone in basic hotel.
– Needs safe sleeping & movement plan post-surgery.