General orthopedic doctor in Bangkok?

[Lorry]

Any recommendations?

 

Symptoms: pain in thigh, sometimes (not often) radiating to lower leg, feeling of weakness in the thigh > painful walking with a limp

 

Doctors:

Physical therapy doctor: this is musculofascial pain,  you need physical therapy

(helped just a bit over 3 months)

Hip specialist: your hip x-ray is bone on bone, range of movement of hip joint is reduced,  you need a hip replacement

(steroid injection into the hip joint to confirm that the pain is actually coming from the hip was refused by the specialist)

Spine specialist: your lumbar spine MRI shows multiple narrowed foramina, you need spinal fusion, never mind the missing neuro symptoms like Lasegue etc

(epidural steroid injection to confirm the pain is actually coming from the spine has not yet been requested)

 

I really love doctors :p)

 

[Sheryl]

I don't think a general ortho will be any help.

 

Proceed with lumbar epidural is my suggestion if good spine specialist thinks spinal cause is likely.

 

I don't know whom you have seen but Prof. Wicharn at BNH spine center is the best.  

 

There are often  better options than fusion for narrowed foramin BTW. 

 

Negative lasegue does not rule ot lumbar cause. 

 

Regarding the hip (which is certainlt aldo a possible cause) do you have normal range of motion? And which hip specialist did you see?

[Tropposurfer]

Sounds like you have chronic arthritis to me.

 

If a doctor said to you (after looking at your pics), that you have bone to bone degeneration of the hip joint the pics are super clear and don't lie.

Even a layman can see the state of the joint once it gets to this stage compared to a healthy joint with cartilage intact.

 

From the symptoms you describe it sound to me like you are in need of a replacement.

All the symptoms you list are atypical of chronic degenerative arthritic hips.

 

Take it from someone who suffered for quite a few years from this, if you do have arthritis it will only get worse and worse and eventually may affect your knees too. These knee problems comes as a result of your gate (walk and stance) being affected over some years.

 

Steroid injection won't help (cure) if indeed you are bone to bone in the joint. Even strong opioid drugs like 30 mg Codeine 4 times a day don't work when the deterioration gets to certain point.

 

If you have bursitis yes steroids can help and in some joints e.g. shoulders (I've had that too).

I had Cortisone - one injection, and it completely cured the bursitis in my right shoulder.

 

Bursitis is not chronic degenerative arthritis! 

 

I had bi-lateral (means two) hips replaced rotors and cuffs but not in LOS ... done at Sydney's St Vincents Orthopaedic Private Hospital @ $50K AUD.

 

In BKK you can get bi-laterals done by really good surgeon for maybe $35K up to $50K AUD. Yes you might find it cheaper but the quality and aftercare might be less than optimal.

Do a bit of research and you'll see there's lots to consider before the knife e.g what type of prosthesis e.g. steel or porcelain etc.

 

I'd advise to look for a hospital that offers a few days intensive rehab post-op. I did this, at St Vincents in a special ward, and we did 4 or 5 hours of rehab a day, every day.

I walked out steady and haven't had any issues at all.

This is great and really sets you up for a speedy and safe recovery once you go home.

 

I'd also strongly advise you seek a surgeon that does an anterior entry.

This is towards the front/side of the thigh.

 

The old posterior opening takes a ton longer rehab and is not as effective in preventing dislocation post-op, also this entry point requires a much larger incision and cutting through a lot more of the gluteus maximus and hamstring muscles thus much more pain and muscle knitting time. 

 

Many of the big hospitals in BKK have excellent Orthopaedic surgeons and rehab facilities. Samitivej, Bumungrad, Chula, BKH, BNH, are a few that provide superb care.

[Pdavies99]

I know many have bad health issues such as yours, but quite often it is just a short-term inflammation.

 

Consider one or two weeks of taking 50mg daily of Diclofenac Sodium, (or 25mg twice daily)  it is a Non Steroid Anti Inflammatory drug.   A few weeks of this can often settle everything down to normal....Up to you.

 

Good luck.

[Lorry]

On 3/30/2023 at 10:19 PM, Sheryl said:

Proceed with lumbar epidural is my suggestion if good spine specialist thinks spinal cause is likely.

Sounds like a good idea.

The way this started was more like a radiculopathy (result of soft mattress, lifting and carrying heavy loads). It sometimes gets worse when I cough,  something I wouldn't expect from hip arthrosis.

Pain even in rest.

I tried traction,  it made it worse. 

 

 

On 3/30/2023 at 10:19 PM, Sheryl said:

Regarding the hip (which is certainlt aldo a possible cause) do you have normal range of motion?

No, abduction is quite limited. Extension not normal,  either. 

So, yes, I certainly do have an arthitic hip, but I doubt whether my current symptoms really stem from the hip.

 

On 3/30/2023 at 10:19 PM, Sheryl said:

And which hip specialist did you see?

Dr Somyot, and he referred me to  Dr Nadhaporn, both Bumrungrad.

[PPMMUU]

Based on your symptoms, it's likely that you should see a spine orthopedist. If you're not satisfied with the one you see, you can always find another. Alternatively, if you prefer, you can also see a general orthopedist. 

[Lorry]

Update: I went to see Dr Sarij, Spine Center Bangkok Hospital.

He turned out to be just the kind of doctor I was looking for: he has also done hip replacements, sees more than only my spine or only my hip, had a look at spinal MRI AND at hip x-ray, examined both hip and spine and discussed his findings with me.

Recommended.

[Sheryl]

13 hours ago, Lorry said:

Update: I went to see Dr Sarij, Spine Center Bangkok Hospital.

He turned out to be just the kind of doctor I was looking for: he has also done hip replacements, sees more than only my spine or only my hip, had a look at spinal MRI AND at hip x-ray, examined both hip and spine and discussed his findings with me.

Recommended.

What was the outcome/conclusion?

[Lorry]

7 hours ago, Sheryl said:

What was the outcome/conclusion?

Hip has arthrosis. Range of movement limited.

There also is a small disk herniation L1/2.

Both conditions may explain my symptoms. 

When he moved my leg, he could provoke the typical symptoms of hip arthrosis (like pain, limited ROM) but not those of disk herniation (like numbness or Lasegue). So he thinks the symptoms probably stem mostly from the hip. He suggested a steroid injection into the hip to see, how much of an improvement this will bring.