83 year old mom is getting a hip replacement. Any words of wisdom?

[Earl49]

Originally Posted by MikeBmusic

It's important to know the hospital's and doctor's competence in doing the procedure - how many replacements do they do a year? Better to travel further to get a place with more experience.

Ditto!! We have a world-class joint replacement program here in Boise. They do things like make the patient and their caregiver take a three-hour class beforehand on what to expect, learn to do "pre-hab" exercises to prepare you, what exercises to do and to avoid and what side effects to expect after the surgery. The class covers devices like grab bars, walkers, and canes, and how to deal with things like stairs or stepping into the shower. Then they send you home from the final pre-op blood work and assessment with the necessary prescriptions in-hand, to be filled before the surgery. They also help get you set up with the PT of your choice in advance of the surgery.

Contrast that to a friend who last week had a knee replacement done in Anchorage. She is staying with other friends, and got virtually no preparation. They sent her home from the hospital with paper prescription orders (now her caregiver has to run around town getting the pills and supplies, leaving her alone when she is most vulnerable and needs the most help). Turns out some of the meds are not routinely stocked in Anchorage at all and must be shipped up from Seattle -- another pharmacy trip while abandoning the patient. When complaining to the surgeon's office, the nurse admitted that the doctor knows all of this, but simply doesn't make the effort to prepare patients. He may be a good surgeon, but this is not good "care" - it's more like assembly line work.

Joint replacement is not trivial, but it does give you back mobility and quality of life that the pain was robbing. If not for my knee replacements, I would likely be in a wheelchair by now at age 58. Instead, I now walk a mile or two regularly, take four tai chi classes per week, and ride my bike around town. This has cut about ten years off my apparent medical age, which far exceeded my calendar age for a while.

It was a painful and intense experience, but 1000% worth doing. FWIW everyone (including my PT and surgeon) says that hips are much easier on the patient than knees. Go for it and good luck!

[Edgar Poe]

Originally Posted by 815C

Anyone had a parent in their 80's get a hip replacement If so, any words of wisdom? She's pretty healthy otherwise, but I've obviously got some concerns about this.

Thanks!

My Mom fell 4 years ago at age 87. The ER said they saw no break and we were grateful for that. However her Doctor came in and said he spotted a small hairline fracture and recommend3d replacement.
We felt he knew best as he told us if it breaks it may be worse.
My Mom was an avid bowler, runner, and worked outside a lot.

After the surgery and rehab, she can no longer bowl, can only run short distance like 8 to 10 feet, and she hardly goes outside anymore. In addition to the above, she had discomfort over a year.
UNLESS YOU ARE CERTAIN OF A SERIOUS BREAK OR DAMAGE DON'T DO IT.

Ed

[Chicago Sandy]

I had two knee replacements a year apart. Each time the rehab was brutal, but after 6 months I wondered why I waited as long as I did. Everyone I know who had hip replacements bounced back much faster than with knees—the post-op pain is much less intense, the physical therapy less arduous. The only tricky part is that for a few weeks after a hip replacement one must sleep on their back with a special wedge pillow between the legs; also no bending at the waist. And simultaneous bilateral hip replacements are easier than bilateral knees.

With my knees, I was discharged after three nights in the hospital. Because therapy was twice a day and there are stairs up to my house, my insurance company did the math and realized in-patient rehab for 10-14 days would be cheaper than sending a medi-car for me twice a day and paying Athletico for all those sessions. First time, I had no idea, so by the time I realized I’d need inpatient rehab, the only slot I could get that my insurance would cover was pretty primitive with lousy food (served in my room) and no activities. Second time, I was able to reserve a bed in a joint-replacement-only rehab center, with top notch physical and occupational therapy, great food (waiter-service dining room) and plenty of activities. For hip replacements, it’s not unusual to be discharged as soon as one can walk with a walker and practice stairs. Joint replacement patients are weight bearing and up & walking as soon as the nerve blocks wear off. It’s essential to prevent blood clots.

Second the advice to make sure it’s a first-rate joint replacement center which does hundreds of procedures, and a surgeon who does at least several a week. Also, the pre-op orientation classes and pre-hab physical therapy to strengthen the muscles that will be taking over for awhile during recovery. If not going directly into rehab, get the painkiller prescription filled before surgery. If it turns out they’re not needed, pharmacies have special disposal facilities (and they tend to be cheap, so it’s not like you’re throwing away a lot of money).

[doctorc]

I’m a physician (geriatrician) and have had multiple patients who have had hip replacement surgery. Advanced age is not a contradiction for a hip replacement as long as one is generally healthy and cleared for surgery. I’d recommend getting at least 2 opinions from orthopedic surgeons who specialize in joint replacement surgery. The determining factor for a good physiologic recovery is the REHABILITATION program. At our facilities post-op hip patients are referred to a specific inpatient rehab facility for the initial program then (usually 10 -14 days later) discharged to an outpatient and home program. In our area we use a large rehab hospital . She should do well with the right program.
Blessings,
Doctorc

[Chicago Sandy]

And Medicare covers inpatient rehab--so go for it!

[XYRN]

I'm an ICU nurse.
I dont know enough about her level of discomfort and overall health to guess at risk vs benefit.

However, I do know that unplanned things happen, especially in the post-op elderly so i would make sure you've had frank discussions on scenarios such as post-op pneumonia or respiratory failure resulting in extended intubation/ventilation, strokes, heart attack and/or heart failure, kidney failure, and what level or amount of continued treatment she would want if things went that way.

I've seen the very old get trached, feeding tubes placed through the abdomen and people shipped to long term rehab where they often expire in days or weeks.

Not trying to shock you or be a doomsayer, but the worst thing isn't when complications occur, but when they occur and family (the legal decision makers if the patient is unable to contribute) DON'T HAVE A CLEAR IDEA WHAT their mom or dad would want. Families go thru hell, and sometimes put their loved one thru torture, when nobody can agree to say "stop, they wouldn't want this". Or, on the flipside if mom or dad has said they WOULD want every last measure and treatment we can try, then they can find some solace in knowing that whatever unpleasantness the patient is going thru at least it was their choice.

I'm not just talking about a legal advanced directive, although it's a great idea, but at the least have those conversations, get some idea of what it is that means quality of life to them, and what they would want if that quality is no longer realistic.

We all go at some point, but it can be peaceful even in the setting of a post-op disaster, it doesn't have to result in extended suffering and kicking and screaming on the way out.

Again, surgery for her may be a great option, just go into it with as much info and planning as possible.

[Mr. Jelly]

Originally Posted by XYRN

However, I do know that unplanned things happen, especially in the post-op elderly so i would make sure you've had frank discussions on scenarios such as post-op pneumonia or respiratory failure resulting in extended intubation/ventilation, strokes, heart attack and/or heart failure, kidney failure, and what level or amount of continued treatment she would want if things went that way.

When my 89 year old mother was having CPR done on her in ICU I new that if she lived she would never be the same. Having been trained in CPR I could only imagine her having all her ribs broken. People that old have issue with their bodies thriving and don't come back from damage.

[George6654]

I had a hip replacement 4 years ago, I am 73 and was in a wheel chair till I had the op. The best bit of advice I was given that I would recommend is do the Physio exercises that they tell you to do, it makes a huge difference. I am now fine although my leg is slightly longer than before and I now have a slightly built up shoe for the other foot to compensate for this.

[songz]

I had my left hip replaced in Feb. 2017, and it took me over a year to get back to near normal. I was told today that I need the right one replaced. It is not fun.
Btw, I am 72.

[marty bradbury]

I hear a lot of good things about "stem cell" up in my neck of the woods. They actually take your stem cell and place it in the affected area. Just a thought and something u might research. Best of luck for your mom.

[aknow]

I helped to nurse my neighbor, a 76 y/o female, in excellent mental and physical health, and a degenerated hip. After hip replacement surgery, she fell 4X within 60 days, ultimately died upon the 4th trauma.
In terms of finding out how good a surgeon really is, or how someone will respond to that level of trauma in their 8th decade, you are playing Russian roulette. Usually nurses and staff are silent about this type of thing.
Best of luck to the patient.

[TBman]

How is your mom doing 815?