How risky is high risk hip surgery?

Depends.....if he qualifies for non- invasive hip replacement, then the risks are low. I think the major concern is for the effects of anesthesia and potential risk of infection. Which Dr. suggested not to move forward? Cardiologist? Orthopedic Surgeon? PCP? Endroconologist? This should be a team effort and everyone’s opinion should be weighed. Hip replacement surgery carries no greater risks than any other routine surgery, and if there is only one naysayer than it would be up to your dad if he wants to err on the side of caution or improve his quality of life.

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?

My mom also had many health problems including diabetes and depression, but had hip replacement at age 84. One of my main concerns, would she participate and go through with 30 days of rehab. We discussed this quite a bit before her surgery.

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.

The fact that the doctor is not for it, that is important.  Has he elaborated about why he doesn't see your dad as a good candidate?

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.

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?

I was 60 when I had a full hip replacement; the pain of bone on bone was terrible. I was given an epidural, not general anesthesia, big difference, and some propofol to knock me out (my choice; I could have chosen to remain awake). The procedure took 75 minutes. Recuperation was pretty easy, released from the hospital the next day with no Rx for rehab. Rehab for hip replacement, with most doctors, is daily walking. First with a walker, then a cane, then with no assistance. I had a full recovery and was back to work in 4 weeks. I needed lots of help for the first 10 days at home; moving around in bed is hard; it feels like your butt weighs 1000 lbs, is the best way to describe it. I had a toilet riser and a picker-upper-grabber-thingy, but could not put shoes or socks on for a solid 3 weeks. I was also sent home with oxygen b/c my numbers were dropping when I slept (due to pain meds). I have no pre existing health conditions, which should be noted. As 'easy' as the surgery was, it was NO cake walk at 60 with no health concerns to worry about. The scar is about 5" long and took quite some time to fully heal.

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!

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 best friend is a diabetic and slow or non healing wounds are a frequent complication for surgery. She had an incision that took a year to heal and still gives problems. If you trust the doctor who knows your parent, please listen. She insisted on surgery and then refused to comply with rehab at home.

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.

Thank you all I appreciate all the answers I think I will listen to his doctor I guess if things get worse I’ll have to move in with him as I do not believe in nursing homes.. And I’ll stay off of Dr. google lol thanks again!!

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 :)

I know how difficult it is to want to help. My husband and I tried for years to help my FIL. Nothing helps. Given your dad's illnesses, another big help you can offer him, if you haven't already, is to talk with him about what he wants and what he doesn't want in terms of treatment, pain management, and prolonging his life. Helping him get this important paperwork in order - living will, will, durable power of attorney medical/financial - is a process that will bring you both peace of mind knowing that you (or whomever he designates) understand and will respect *his* wishes. Consulting an elder law attorney is a good idea.

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.

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.

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.

The human body is not a car, in which a part can be removed and replaced, without complications. My MIL had both hips replaced in her 80's. The surgeries were successes. She died of complications months after the second one. It's the old story: The surgery was a success, but the patient died.

I would imagine being bed ridden with a broken hip is not only full of complications but painful as well.

Sounds like His health is not good to begin with. I would get several opinions from surgeons about his chances and let him decide.
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.

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.

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 .

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:-)

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.

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.

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)

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.

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.

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.

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.)

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!