Total Hip Replacement?

MissyT

My DH is diagnosed with severe hip degeneration and is in need of a hip replacement. DH was always active, but now has little interest in anything but radio and tv and his phone. He started Leqembi 2 weeks ago and I am in a quandry of what to do…

He has had steroid injection and intra articular with no relief. He is now using a cane and walker. He continues to ask whats wrong and why is he using the cane. Sometimes he attempts to go without the cane, but quickly realizes his hip gives out or is so weak he has to hold onto things to walk. His ortho states the only remedy is total hip replacement and he will be in one day and discharged to home….HELP. He seems to not understand that my husband will not remember anything (of course my husband smiles and is agreeable to everything). I stated he just started Leqembi and asked about his thoughts on complications and asked he contact the Neurologist. He brushed it off and stated they would request clearance.

I'm no longer sure Leqembi should be continued if hip replacement is done and I am faced with the fact that I don't think I can do his recovery on my own at home.

Have others had experiences or similar situations? I do have a second opinion orthopedic appointment coming up in July.

cdgbdr

I have no experience but would suggest that you consult with the provider managing his dementia care for input. The doc ordering the infusion should have advice. Orthopedic surgeons don't typically get into anything but the ortho needs. I would have concerns about managing the precautions and rehab at home.

My DH has had both knees and shoulders replaced and at his stage, I will not put him through any more major surgeries.

harshedbuzz

@MissyT

What a miserable situation for you both.

I agree with the previous poster. I would run this by his neurologist or geriatric doctor before considering this. IME, most surgeons have no real experience with the special considerations for PWD. They tend only to see the degeneration rather than the nuance of how this will impact him in the short term.

Concerns I would have are:

Anesthesia could progress the disease. Regional anesthesia with sedation would be less risky for him than general. Pain medication after could raise his risk for falls.

If he's apathetic and hard to engage in physical activity, PT at home will be difficult as he will likely blow you and his exercises off which will result in a poorer outcome.

If he can't remember the need to use the cane/walker now, I expect you'll need to be on him constantly to prompt their use in the recovery period. My aunt had a hip replaced secondary to a fall and break. She could not remember the need to call for assistance or to use her walker while in SNF— a sitter had to be with her, at family's expense 24/7.

HB

saundersss47

my husband just started Leqembi treatments and has to have a valve replacement. Both his neurologist and the heart doctor has told me it won’t be a problem and to just schedule it on the off week of his treatment. My fear is what will the anesthesia do to his memory.

BPS

I don't know how far your husbands is but I know of two people in advanced stages that have broke their hip and had surgery. They both had complications and passed away in a short time. I agree surgeons know surgery but usually don't take the total condition of the patient into consideration or other options. Ask the surgeon what the out come will be if he does not do the therapy (I think he will be stiff and in pain), and he may not be able to do or understand the therapy. It is a hard call but I would try to avoid surgery even if it required pain medication. talk to as many people that know his condition and hip surgery outcomes as possible. In early stages it would probably be OK but in later stages it will be much harder.

Denise1847

https://alzconnected.org/discussion/73379/total-hip-replacement

My DH had his hip replaced in stage 4. He did well, but it was extremely challenging for me. An overnight stay turned into 4 days in which I had to be there to keep him from getting up and falling. Please consult the neuro. When they don't follow instructions, you are facing an impossible job of helping him recover. Also, any anesthesia tends to make their memories worse. Good for you to get a second opinion.

JJ401

I, not DH, just had a total hip replacement. I’d consider how much pain DH is in now. My pain before was severe, and even right after surgery, the pain relief was amazing. I needed very few pain pills afterwards. The pain from his hip won’t get better, so if it’s going to get fixed sooner is better.

Leqembi — his other doctors have to medically sign off. The problem I see is getting him there for the infusion. But, if he’s used to the walker, it’s doable. I’d think about bringing someone with you, if possible.

For those first few nights at home, I’d think about hiring care for the night so you can sleep. A floor alarm by the bed for a while would probably be a good idea too.

It’s a tough choice. There’s the risk of anesthesia. The difficulty of managing afterwards. Vs the increased pain and increased lack of mobility if you don’t.

harshedbuzz

https://alzconnected.org/discussion/comment/246682#Comment_246682

Would your DH be undergoing a TAVR procedure? As amazing the

procedure is

harshedbuzz

This site—Ugh! @saundersss47

As amazing as the procedure is, this is basically a cardiac cath-type procedure, and the anesthesia is generally fairly light sedation. Mom had it done and her anesthesiologist warned her about what would be going on and that she might awaken during the procedure. She was very alert right after, so I suspect it was fairly light.

HB