How risky is high risk hip surgery?

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.

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

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.

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.

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.

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.

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.

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 :)

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!!

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 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.

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.

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!

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?

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.

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.

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?

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?

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.