How risky is high risk hip surgery?

As far as your father is concerned, the "risky" part is not the hip replacement, it's the general anesthesia that is required. Another risk may be discontinuing the blood thinners before the surgery. He may be at risk for blood clots during the immediate post-op phase of recovery.

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.

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 .

It's a good thing to inform yourself! And the internet is a wonderful resource - there are images and descriptions from all sorts of highly respectable organisations which explain things much more clearly than one poor overworked doctor can do in a hurry. You just need to take everything with a grain of salt and don't *rely* on it until you've checked that what you've understood is correct, with somebody whose authority you trust, and who knows about your particular situation.

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 :)

A few things to consider:
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.

It sounds like no one at the Mayo Clinic has actually examined your father and "diabetes, congestive heart failure, Afib, High blood pressure" are all excellent reasons to listen to *his* doctor and *not* put him through hip surgery. What facts or professional expertise do you have that support your belief that surgery would improve his life?

This is the big fly in the ointment:

"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.

My mom had knee-replacement surgery last year, at age 90. She has high blood pressure, is overweight, and has arthritis but otherwise is considered "healthy" by her physician. She did well after the surgery and is as mobile as an overweight almost 91-year-old person with arthritis can be. I was most concerned about the effects of the anesthesia on her brain functioning but there were no such ill effects.

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.

My father was on Coumadin (warfarin) when he fell and the bone round his hip replacement broke away. It was a big deal type of surgery to get it repaired but we had no choice. He was 96. Right after the surgery they immediately start back on the anticoagulant to prevent the DVT. The biggest risk with your dad is the anesthesia and the diabetes and the role it plays in poor healing. My dad would not comply well enough with PT after his surgery to be able to walk again.

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.

I am only an amateur, I am not medically qualified, but all the same I am surprised that you have come to the conclusion that the risk of hip replacement surgery in a patient with the brief summary you've given does not seem extensive. I would've thought it would look like a nightmare.

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?

My mother had it done at 72, she was fine, however, she is in excellent health...still at the age of 94, your father is not.

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?