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?
And how can hip replacement be "non-invasive"? There are ways of resurfacing and relining the ball and socket joint rather than literally sawing the end off and hammering in a new one, but even that involves dislocating the hip joint and, necessarily, deep and long incisions. "Non-invasive" can only be a comparative term, surely.
So, alternatives...
How bad's his hip?
Is your father overweight, as well?
If your father is in pain, it is hard for him to stay mobile and exercise. If he is immobile and doesn't exercise, his health (including his hip) will continue to deteriorate. I appreciate the Catch-22.
Who's working with him to improve his mobility? Does he have PT or anything like it?
A friend of mine, age 75, fell, had a hip replacement, fell again in PT, same hip replaced again, came home, fell again fractured the same hip, now in a nursing home. Her overall health was bad, now it is much, much worse. If it had not been an absolute emergency, the doctors would not have performed any surgery on her. She had a lot of the same issues as your father, now after these surgeries her mental health really has declined too.
What does your father want to do?
As it turned out she did pretty well and the new hip gave her pain relief and she got some mobility back.
Among the many concerns about such a surgery take a good look at the feasibility of rehab for the patient. If they can’t or won’t do rehab the surgery is a waste of time and unneeded trauma.
MIL fell and broke her hip, she was 82 1/2 at the time, with AFib and high blood pressure but no other complications. She has never been very compliant (about ANYTHING! lol) and wasn't exactly a star patient in rehab when she had shoulder replacement. I think she just doesn't believe or understand (and not because of dementia, she just thinks she knows better ;) ) how important it is to do everything the therapists ask, and follow all the restrictions the doctor gives her.
Surgery went well, and she even came out of anesthesia more "with it" than usual (she knew my middle dd, and realized that she'd been thinking she was my youngest dd for ages - and apologized -- WOW!) She did only so-so in rehab for 6 weeks, and came home.
And, the result is, she has a lot of pain in that hip radiating down into her leg, especially when she walks a long time (like the grocery store) If you think your dad will give his all to therapy and come out of this stronger and with a better quality of life, then it might be worth the risks.
Best of luck in whatever you decide - it could be a hard road both ways.
My father was 90 when he fell and broke his hip. Fortunately, he did not need hip replacement but rather a few pins to shore up his bone. He did recover nicely, but wasn't able to walk afterward and wound up wheelchair bound.
If your dad's doctor is against the surgery, perhaps get a second opinion? I mean, it's not going to be an EASY thing for him, one way or another, but neither is the pain that's associated with a bad hip! Not being able to walk at 73 isn't a good thing either. But the top priority is your dad's health and not having a surgery like this kill him prematurely, you know? All sorts of things CAN go wrong with such surgeries. But if he DOES go through with it, look into the epidural and propofol anesthesia vs. general which is WAY easier to wake up from
Best of luck!
"Management of patients on DOACs in the perioperative period involves an assessment of thromboembolic event risk while off anticoagulation compared to the relative risk of bleeding if such drug is continued."
Or, in English, if the Pradaxa is stopped the patient is at higher risk of the strokes and heart attacks it helps to prevent; and if it isn't stopped he's at higher risk of dangerous bleeding during surgery.
I don't know if it's true of Pradaxa specifically as well, but I do know that Clopidogrel (another type of anticoagulant) meant that my mother could not have her wrist fracture treated under local anaesthetic - it had to be done using a Bier's block which was a whole 'nother bundle of fun on its own. This is to do with the risk of irreversible nerve damage because of the anticoagulant's interaction with the anaesthetic used, as far as I remember, and it all goes way over my unpaid grade - talk it through with your surgeon.
If there are alternatives to surgery those should be explored first. It depends what condition the actual hip joint is in.
In the early 2000s, my dad had a minor surgical procedure, on an outpatient basis. He had to stop taking a blood thinner for the surgery, which went very well. Two days after the surgery, he had a massive stroke, from which he never fully recovered. He died one month later.
I am relieved that I didn't have to make the decision for either of my parents about having surgery. I strongly advise against trying to sway your father or his physician.
The other important thing, going on what you've said, is to think about the alternatives. Supposing your father isn't a good risk for surgery - that doesn't mean that *nothing* can be done to improve his quality of life and his mobility. Find a physical therapist with some imagination and the skill to motivate and encourage your father; ask around about what kind of activities he might be helped to join in with - how about swimming, just as one example?
Two last things:
1. - you say his hip "crackles" when he walks, but what does the imaging show? Ask his surgeon to talk you through any scans or x-rays that have been done, and tell you what he does suggest if he can't recommend surgery.
2. You don't "believe" in nursing homes? Oo. That's a big subject! Look around on the forum :)
Hip replacement surgery is a common procedure but not an instant fix for all persons with trouble walking. A lot depends on your father's motivation. Maybe some non-surgical treatment or physical therapy could improve his condition.
Full health assessment and of hip, proper imaging.
What does Dad want?
Is he compliant with his medications? The difference between being compliant with medications and having things like diabetes, high blood pressure, AFIB out of control is great. If he has good control of his diseases, it lowers the surgery risk tremendously.
I’m 67, having hip replacement next month, plus both knees soon after. I’ve got well controlled high blood pressure, high cholesterol, early diabetes (A1c is 5.7), hypothyroidism, and other health concerns. By taking my medications religiously, and closely limiting carbs for the early diabetes, my risk is much reduced. I am on oxygen for interstitial lung disease. Also compliant with using my oxygen. The reasons I’m going ahead with three more joint replacements as quickly as possible, besides pain of bone on bone joints, include my spouse’s precarious health. We have no family here, so every time he needs an artery blockage opened back up, bypass surgery, cancer follow up, I’m the caretaker. I need to do these surgeries while I have good blood sugar control, as diabetes slows healing. I already have diabetic peripheral neuropathy, so it’s increased surgery risk for me.
I point these things out to you, to explore if Dad can get better control of his diseases, to reduce his risk. He may be taking his medications regularly already. Does he maintain tight control of his diabetes? Can his cardiologist tweak his medications to improve risk there?
If he will allow, maybe go with him to his specialist appointments (assume there is a cardiologist involved in his care),
Like what was stated previously, offer to help with resources to get his affairs in order.
best wishes, keep us apprised here.
A hip replacement is a bit different. I like the idea of the epidural anesthetic another poster suggested. If your dad is of sound mind and can listen to the pros and cons and then makes an informed decision, then I would say it’s up to him to decide if it’s worth the risk. All surgeries carry risks...it’s quality of life that is often a major deciding factor when it’s elective.
Hip surgery can really go wrong and even have to be repeated. I know someone who has had both hips done twice and nearly died from one of The second ones. I also knew someone who died a few days after her hip surgery from a blood clot. It's a dangerous surgery and should only be done as a last resort, especially for health compromised individuals.
I have had both knees replaced from 40 years of rheumatoid arthritis damage and hard use, and recovery was a lot of work. The pt is extremely important in regaining range of motion and strength. I have no other health issues whatsoever so I was a good candidate for the surgeries.
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.
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 .
i don’t know if hip surgery is the answer for your dad, but anterior hip surgery has been a blessing in mine.
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.