Thursday 13th August 1992   Morning surgery 09:20

“We’ve just seen Robert Parry for you, Dr Lewis.” Dilys started her presentation with her customary enthusiasm. “He is a 72 year old man with a 2 year history of left sided hip pain. It has been getting gradually worse, especially in the last few months.”
“He is limping badly and using a stick,” Dylan said. “He says he can walk about 200 metres, now. He used to be able take his dog for miles.”
“He feels the pain here.” Dilys put her hand on her hip. “It radiates into his groin, like you said Dr Lewis, and down the front of his leg. He’s got a bad back but he says that’s a different pain. His hip is very stiff when he gets up in the morning or after he has been sitting down. It can take about 15 minutes to loosen up.”
“What were your examination findings?”
“I think he has got a Trendelenberg gait.” Dylan look pleased with himself.
“No, he’s not Dylan. He’s just got a bad limp.” Dilys frowned at Dylan. “He has got wasting of his thigh muscles, all his hip movements were very restricted especially internal rotation . . .”
“He’s got a fixed flexion deformity.”
“I was going to tell Dr Lewis that, Dylan. We did Thomas’ test.”
“I suggested doing it, Dilys. You . . . “
“Very good,” Dr Lewis interrupted. “Do you think he needs a hip replacement?”
“Well,” Dilys explained, “he can’t cut his toenails. He’s having trouble getting out of the bath. He even says he has to pull his leg up to get into the car.”
“He can’t do much gardening now. He’s got quite a big garden,” Dylan added.
“His biggest worry is his wife. She’s got dementia and he’s the carer. He’s really worried he won’t be able to look after her for much longer.”
“It does sound like he needs a new hip,” said Dr Lewis.
“He’s worried about going into hospital. Who would look after Mrs Parry whilst he’s there?” Dilys looked as worried as Mr Parry must have been.
“We could probably arrange for her to go into a residential home whilst he is in hospital and when he is recovering from the surgery,” Dr Lewis said reassuringly. “We can ask social services to look into that.”
Dilys looked relieved.
“Does he need painkillers?”
“He says he prefers not to have any. He does take paracetamol now and again.”
“Would you like me to come and explain things to him?”
“No, we can do that, Dr Lewis,” Dilys said. “Do you want Dylan to write the referral letter and I’ll phone social services.”
“That sounds perfect,” said Dr Lewis, “after all, Dylan is very good with all the technical terms. I am sure he will impress the orthopaedic surgeons.”

Do you think he needs a hip replacement?
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