How risky is high risk hip surgery?

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How risky is high risk hip surgery?

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My father is 73 years old and has many ailments diabetes, congestive heart failure, Afib, High blood pressure, and he’s on Pradaxa which thins your blood. His doctor suggested he does not have hip surgery I’ve researched it extensively and according to a few what I would call top end websites like the mayo clinic The risk does not seem extensive. He is doing really good for all the ailments he has however if something is not done about his hip he may not walk anymore and he’s already at the point where walking is very hard for him. Does anyone have a story they could share with me about how risky it would be for my father to get a hip replacement which I believe would improve his life?

Care Decisions Hip Replacement Mobility

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Problemsolve: As I said, hip surgery requires one to walk A LOT afterwards. A neighbor had to do this.

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I am 80 and also have diabetes and high blood pressure, as well as as heart problems. I have a totally collapsed hip and my doctors I have seen know that my hip is in terrible shape but the hospitals of John Hopkins, Charlotte Medical and Chapel Hill have told me point blank my
undergoing a hip replacement would be so risky, chances are I would not live through the surgery. The medical risks are hip for someone in good health but anyone with the additional issues, has an even less chance of surviving. I have some friends in my age group. Three had surgery, 2 did not survive, the 3rd one still copes with extreme pain and has more and more difficulty in getting around. This is something you need to very carefully weigh and maybe you might decide to have him see a good, very good pain management specialist and be on
chronic pain management as well as some physical therapy.

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After reading your post, I feel less worried about my decision to avoid hip surgery so I thank you for that. It is comforting to me to see other seniors living and coping without surgery although I recognize that you are forced to forgo hip replacement because of medical conditions--not because you want to avoid it. I'm scared of surgery, anesthesia, and reactions to titanium or metal elements in the hip device. I have felt pressured to undergo hip replacement. It's almost as if I'm entering a fire sale: "You should do it now before it's too late." Perhaps you are an example of what happens when my medical condition will no longer allow hip replacement. In that case I am less worried.

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Would physical therapy help him? Is he in pain? Does pain keep him from sleeping? I'm 76 and I have declined hip surgery although many doctors/friends/PTs advise me that hip surgery might relieve hip pain. I have seen hip surgery work, but I think a lot of my pain might result from muscles--not joints. I saw a pain specialist who gave me a ketamine/lidocaine cream that works great. I put it on before bedtime so that pain doesn't keep me awake. You can purchase lidocaine roll on dispensers and lidocaine patches at pharmacies. Salonpas makes some good products. If your father can strengthen his hip flexors and extensors such as the thigh muscle and hamstrings, they might be able to help him move his limbs walking without jamming the joints together. This website describes non surgical treatments for hip arthritis: https://www.impossible-takes-longer.com/

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Thanks for the information - very helpful ideas.

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Once again I thank you all for your stories, ideas, solutions, and answers. I did get my father to the doctor just yesterday and his doctor said no way for the surgery he is extreme high risk which really sucks. It was an extreme effort to get him there however I took him there and he was evaluated by amazing nurses and doctors. I guess some people are inoperable and that’s just the way life goes... thank all of you good people for your help.

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Thank you for the update. I hope your dad can get some help with his current medical issues and feel better because of that.

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It’s a shame doctors never consider delirium, only dementia, when a senior goes into hospital for surgery, with mind intact, and comes out with a dementia diagnosis. They have similar symptoms, but dementia doesn’t normally happen without a process. No doctor, but my family has instructions should I ever have anesthesia, which I will with three joint replacements on the horizon, that I’m not going in with dementia, and if I come out with it, I am to be assessed for delirium. Like patients with IBSD, dementia patients deserve so much more diagnostic effort than is often given.

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Any Surgery is Risky and the Older One gets, The more Risky and the Less Chance of Full Recovery.

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My mom just turned 94 and fell and needed partial hip replacement b/c of so much pain. She made it through the surgery and went to rehab for 21 days and was released to go home. She came to my home while she gets more in home OT and PT and I just can’t see how she’ll go back home. She doesn’t want to eat like she should, do physical therapy like she should. I do not know what will happen going forward. If she didn’t break her hip, I would figure something else out before I would do surgery. Hoping for the best for you! I would also welcome thoughts from others in a similar situation.

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My husband is 74 and having serious pain from bone on bone pain in both hips. He has arthritis, osteoporosis, and degenerative joint disease. He already uses a walker and has to walk bent forward because of the stenosis in his lumbar vertebrae. He has already had a hemorrhagic stroke 5 years ago; he has vascular dementia and COPD with heart failure (diastolic). Being active is an important part of controlling his heart failure and reducing the progression of his dementia. The hip problems are really slowing him down.

Nothing has been decided about his hip disposition, but the comments from those that have faced this issue are very helpful. Thanks for sharing your experiences.

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My first stop would be his cardiologist, they know what percentage his heart is functioning at and if this is even an option for him. It may not be the actual surgery but rather the anesthesia that he will not survive. Are there other alternatives other than totally hip replacement? Is it due to arthritis they are suggesting the surgery or something else? Try to get as much information before making a decision. Get a second opinion from a top rated surgeon (insurance companies will pay for a second and third (if needed) opinion. Information is your best friend right now so everyone can make the best decision regarding his surgical experience.

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Look into the anterior approach to hip replacement. Recovery is MUCH faster and easier than the old-style approach, no muscles are cut — just stretched. You can walk on it the first day and it can even be done as an overnight surgery in an outpatient clinic. Minimal to no chance of dislocations. Really a revolution in hip replacement techniques! I am 71 and have had both hips replaced with this method — one 9 years ago and one 5 years ago. No complications. Yes, you’re in bed with cold packs for a few days. And you still have to do your physical therapy. But if you ARE going to risk hip surgery, I highly recommend going this route.

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There are certain criteria a surgeon uses to determine if the hip replacement can be done via the anterior approach. I had mine done this way and have a persistent pain in my thigh due to manipulation of a superficial nerve. Nerve pain is really painful.
Anterior replacement can't be done on obese people. I remember that was part of the criteria.
I myself had great results but this nerve pain is terrible.

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I can only speak from my own experience so of course, make your own decision. My father at age 92 was like a 70-year-old. Very mobile, few health problems, mind sharp as ever. He was becoming shaky on his feet and one night he fell and broke his hip. There was no choice but to do a full hip replacement. He nearly died 3 times during recovery to the point they called us in to make end-of-life decisions. Fast forward, his body healed, but his mind has never been the same. I spoke with his internal medicine doctor and he said he sees this all the time. He doesn't know what causes dementia after a major surgery such as hip replacement, but he suspects it is the anesthesia or lack of the exact amount of oxygen to the brain during surgery. He admitted he is guessing, but says there is definitely a connection to the mind and surgery. If you have a choice, and his mind is good, my suggestion is do not encourage it.

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Same thing happened to my Mom when she was 80. After hip surgery she was never the same mentally. She did show some signs of dementia prior to the surgery but it wasn't bad. The doctors say the anesthesia took her over the edge. Sometimes this happens to the elderly after surgery at no ones fault. Its been 8 years and she is now in a NH due to full dementia.

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My dear MIL had a knee replacement years ago, but never fully recovered cuz the physical therapy work was too much for her. That's why the knee just froze up, & even though she could walk, it was dangerous on stairs, & she never could bend that side again. (That led to her tripping & falling more frequently). She broke her arm during a fall the following year. Honestly, the same could happen with a hip surg cuz elderly cannot tolerate the painful rehab work required afterwards. Just want you to know that Drs make it sound great, but it's BSh#t.

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My father fractured his hip in a fall last summer ie 89 yrs old and still very physical active .. had surgery and went to rehab ... it was a slow recovery and was working hard at it and pT but never felt comfortable walking wo assistance and after 6 weeks contracted mrsa which went to his heart and became septic ... rather than prolong with feeding tubes etc , he died in hospice .. 2 months of hard work down the drain and he got sick so quickly .. I still wonder if I should have been more aggressive with rehab and ultimately more aggressive with his infection with putting in feeding tube etc

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The thing that really worries me is the Afib Im pretty sure he has to be on some sort of blood thinner for that now when anyone has surgery you have to stop blood thinners before during and after the surgery for a bit of time then they put him back on thinners when risk of bleeding too much has passed also the CHF along with the AFIB I would be so afraid of heart attack this happened to two seperate people I know that had these same sicknesses I just do not know what you should do any surgery is EXTREMELY DANGEROUS FOR elderly people. 73 is not that old but surgery can make you old ....

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You are exactly correct. He has to come off of his blood thinners prior to surgery and with multiple cardiovascular issues the threat of stroke or other cardioemobolic event is very high. Living with reduced mobility from a weak hip is unpleasant but is much easier than living with brain damage from stroke. That is the risk-benefit assessment you have to make. Get a few opinions before deciding, but be very cautious.

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My mother in law has had 8 hip surgeries on the same hip in a time frame of a year and a half. Of those 8, 5 were complete replacements and three were dislocations. She had anaesthetic each time. She now has no short term memory and is in a home. Her long term memory is there to some extent but she is confused most of the time. For a retired nurse this has been devastating. She is 88 years old now and often speaks of wishing she were dead. The only excuse, provided by the surgeon, for this was that her bones were soft. There used to be an ad on the television about a class action suit against several hip manufacturers. We often wondered if they used defective parts or is it all because of her soft bones. We will probably never know the answer.

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Not sure about the chf your dad has. Do you know what stage he’s in? My mother has stage 4 chf and I can’t see her having any surgery at this point. Does the cardiologist think he can handle it?

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I'm so sorry to hear that he has a lot of health conditions at just 73. He may get through the hip surgery okay, but is he willing to to the therapy that comes after the surgery? I knew one gentleman who had both hips replaced and his doctor told him to walk and walk and walk and walk some more.

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Do research on how is hip surgery done? I've been told that the patient is hung upside down for this surgery ....ok. I'm ignorant about this, but friends have informed me that this is how hip surgery is performed.
Is your ailing father aware of this? Is he robust enough to withstand major surgery upside down?
I'd be very cautious about this, and please ask around....if possible, talk to at least 3 others who have undergone this procedure. May God be with you and your father during this difficult time.

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I'd consider getting a second opinion - some doctors are keen to over-treat, other doctors are more concerned about a death they might be blamed for. I'd also ask how they would prep and check your father - not just rely on him at home.

My mother aged 78 had major surgery for cancer when she was on Warfarin
(blood thinner) plus other meds for high cholesterol and high blood pressure. She was taken into hospital for 10 days while they dropped the Warfarin and monitored all her other med problems (3 blood tests a day). She survived the surgery, but she died three months later from the cancer and the time would have been more comfortable without the surgery. We had another problem with her Oncologist, who wanted another round of chemo and was clearly into as much expensive treatment as possible. Her specialist Physician had a noisy argument about it with the Oncologist just outside her hospital room.

At 72, your father's comfort and mobility for the rest of his life are important. Does he understand the risks, and what is his own opinion?

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Between 87-1/2 and 88-1/2 years of age, my mother had both hips replaced. Granted, she weighs 95 pounds and was very active... Everything was in her favor! She just turned 89, mostly takes care of Dementia Dad (rather than summon the caretakers.... in Assisted Living) and is doing very well! Life was garbage until she had them replaced. Put it off for years because if Dad’s failing condition.... she has more excellent days than bad ones now. I’m so glad she had the two surgeries!

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My mom's last surgery was at age 86 - a knee replacement surgery. (The replacement only lasted a couple of years, but she did well during and after surgery). She had no other underlying medical conditions. I see that your dad has several issues. But at 73 he really is a baby! :) I'm sure the orthopedic surgeon will accommodate his needs related to surgery, and so if everyone is onboard, I would say to go for it. (Possibly his primary doctor is overly conservative - again, a reputable surgeon would not move forward without the confidence to address any medical issues and also the confidence of a good outcome.)

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Some people are old at 70. Age in years is irrelevant. I just lost my best friend who had just turned 69. He had all the same ailments her father has, plus COPD. Diabetes kills.

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As an RN, let me address his surgical risks.
AFib tends to cause blood clots if not on blood thinners. So he would need to cut out all blood thinners for a couple of weeks before and after surgery. Blood clots could form and travel to the brain (stroke), heart (heart attack), or lungs (pulmonary embolism). Any of these conditions could be fatal.

Heart failure tend to have less well oxygenated blood circulating. It is also a problem with surgery since IV fluids are usually given more generously in surgery could compromise his cardiac status, his oxygenation, and delay wound healing.

Diabetes has its own unique challenges with surgery. After surgery, his blood sugar will be higher and need to be managed carefully. Diabetics also have slower healing and tend to have more wound infections.

I had a elderly patient who got a hip replacement surgery and was never able to come off the ventilator.

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Usually a cardiologist is consulted prior to surgery for clearance anyway for any heart issues. Family needs to have an in depth talk with the surgeon with regard to risk vs benefit analysis.

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Contact the ortho surgeon's office that you plan to use and speak to the nurse in the office. She can guide you. Also, ask about a Case Manager. That is their job--to answer questions and guide the case along to a successful conclusion. A SNF unit where he will recuperate can also tell you what to expect.

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I want to reiterate what Diana said in the previous answer, Find a surgeon who performs anterior hip replacement and consult with them. Learn about the differences between anterior and posterior. It can greatly reduce healing time and physical therapy time, and is much much much less invasive.
i don’t know if hip surgery is the answer for your dad, but anterior hip surgery has been a blessing in mine.

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Check into anterior hip replacement which is far less invasive--maybe you don't even need general anesthesia. Also see if you can use a device made from zirconium (instead of titanium which many people have allergies to)

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Your father has many ailments which prompted his doctor's advice. Get a second opinion from an orthopaedic doctor who performs such surgeries. Different ortho doctors specialize, i.e., hip, knee, etc. Has he had any physical therapy with P.T. specialists? Also, pool swimming or exercises are excellent and might be a better alternative with your father's negatives. Further, is his hip broken, displaced, or is it arthritis causing the problem? What do ex-rays show? Investigate, research thoroughly before making the surgical decision. A walker would help him walk by balancing his body and he could sit in it when tired. Just a few thoughts. God bless.

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Many times it's not the surgery that's the problem but the fact that the patient does not engage in rehab. Can this patient do the rehab? Does this patient have access to a pool that is excellent rehab? Does this patient have the will to do the work after surgery?

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PS: One story to share: Had a client that was 80+, maybe 90+. Goes back many years. Had a hip replacement, in the "older" days and the material they used for cement was poor quality (although the best at the time). It began to disintegrate and so she had bone on bone pain. So she wound up in a wheelchair. The story goes that no MD wanted to take on the case based on age. So she spent the rest of her life in the chair aside from transferring which she needed a bit of assistance with; there were a few falls when she attempted to transfer on her own....she had a wonderful and devoted family, 3 kids who split the care and stayed overnight with her. But she regretted not having the surgery if she could have.

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Of all the issues your dad has, cognitive/dementia is not among them...so what does dad say? No one has a crystal ball...he could in spite of it all have many years ahead. To become immobile/need a wheelchair can be very depressing/impact quality of life. So based on what your dad's thoughts are, that would tip the scales...assuming you find a surgeon willing to take on the case. And that you both understand the surgical risk and are willing to take that on. And then you want to make sure (since this is elective and you have time to do your homework) you have the absolute best people accessible including anesthesia, cardiac..consults with them, will they be present...I know probably a block anesthetic may be a possibility as opposed to general which does have some additional risk. You might want to check out a consult with Curadux...they have access to a hand-picked group of experts; the person who started the firm is the former chief of anesthesia at the Cleveland Clinic and a good guy who has been critically ill and "gets it." Good luck:-)

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Hi ,
I am not suggesting that your dad have surgery . That is between you and your dad . I can , however , tell you my mom’s story . My mom is 96 . She has many medical conditions ( diabetes, Afib, CHF, CKD, high blood pressure , among other conditions ). She fell in February and fractured her hip. All of her doctors suggested hip surgery . My sister and I were shocked . She was 96 with so many medical issues. They explained that if we didn’t allow her to have surgery that she will be in pain for the rest of her life ( and it will worsen ) and the immobility will eventually lead to bed sores , etc. To make a long story short , she had the surgery ( despite my sister and I being petrified ) , spent time in rehab , and now is better than ever .
Wishing you the best with your dad, no matter what your decision .

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hi gina how long was your mom in rehab and did she ever walk again w/ or w/out walker my mom 95 just broke her hip last sunday and had surgery it has been 2 weeks know and she has developed a pneumonia and she is in a nursing facility and before was living in asst. living she had broken her other hip 2yrs ago and recovered excellent if feel this time she is not recovering as well as before she has severe swelling both legs and is not walking at all what is the cond. of your mom know any suggestions on my mom's recovery pt for sure any idea's pool therapy what can i do it sure has affected her cognitive issues so sad

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This is a tough call, because your dad is young-ish, but he also has many ailments. So, he could have many years of life left, or he might not. There is also the risk of cognitive decline just from the anesthesia.

I've mentioned the book, Rethinking Aging: Growing Old and Living Well in an Overtreated Society by Dr. Nortin Hadler, and I feel it's a good resource for making decisions concerning tests and treatments. Perhaps you could find that at a library.
In every case, no matter what one's age, we should always try to determine what the risks are compared to the potential benefits. Often they promise far more than can be expected.
Hope things work out for you and your dad. Ultimately, it's his decision after he is presented with as much information as possible.

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How risky is high risk hip surgery?

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