Move forward with hip surgery for DH?

shiawase12

I'm still not positive what stage my DH is in, but guessing stage 4 with some symptoms on 5 creeping in. Some days he seems close to "normal" and then there are days that are the opposite. He's still able to care for himself and even fixes dinner for us now and again. Still does his usual chores around the house.

Withthat said, his hip has been painful of an on for the past 6 months or so and progressively getting worse. He's popping advil several times a day now.

Dr. Visit with xray was done and they gave us the option of going to PT, hormone injection or talking to an orthopedic surgeon. They did say they could see from the xray that the joint is showing alot of wear and cartillage loss.

I opted for speaking to the surgeon with the thought that if a hip replacement is coming down the road it would be better to get it done now before his Alz. progresses any further.

Of course I'm reading all the dr. Info and giving my DH a simplified version. He wants surgery if it will take the pain away.

I know that surgery and a hospital stay will most likely escalate his Alz progression and that there may even be some hallucinations etc. During all of it.

Has anyone faced a similar situation? How did you handle it and prepare for it?

Is it wrong to push surgery? It just seems like the best option. I know he wouldn't keep up with PT and injections are not something that could be kept up either.

Maybe I'm getting ahead of myself and should just wait to talk to the surgeon first.

Hate being the sole decider, this would have been something my husband and I talked about and made a decision on together. Ughhhh

harshedbuzz

@shiawase12 I feel you on the 100% responsibility of decision-making on behalf of someone who doesn't have the capacity to make the choice for themselves.

A couple of thoughts from someone who has experienced joint replacement as a patient and also as the family member of 2 aunts in stage 5-ish of dementia.

A gentle reminder that a PWD is considered to be in the latest stage for which they have symptoms.

Hospitalizations and anesthesia events do tend to impact how a PWD functions. This may be temporary with a return to baseline once home and settled or there might not be a return to his cognitive baseline. When my aunt w/VD had hip surgery after a fall she went from stage 5-ish living in AL to stage 7 in a SNF with a 24/7 sitter because she couldn't participate in PT or remember to wait for assistance getting out of bed.

That said, many surgeons, especially at the well-regarded specialty surgery centers use regional rather than general anesthesia for hip replacement. I would discuss this.

Unless he has some sort of cardiovascular condition that requires a hospital stay, this will likely be a "same-day" surgery. With my first knee, I did stay overnight but with the one I'll be having in February I'll be home around dinner time.

If you're opting for surgery in lieu of PT because you know he won't cooperate, think again. He will need to follow a schedule of consistent PT post-op, likely outpatient with homework assigned. Even when it hurts or he thinks he already did it. I had a formal PT program homework after my TKR for 12 weeks. It will be your job to make sure this happens or he will have a poor outcome and could end up less mobile than he is now.

It will also be on you to make sure he is compliant (using it not just consistently but also properly) with the use of a walker or crutches in the weeks after the surgery. He'll also have restrictions around things like bending that he might not recall or understand. This can be surprisingly difficult as many PWD don't recall the need because of poor short-term memory and anosognosia.

There are risks to both doing nothing and having the surgery. My second aunt had a planned knee replacement for a very painful knee. She'd had issues with it for years and it was terrible swollen and painful. She and her DH were very private people, and I suspect her DH had recognized her memory issues and decided against the surgery for her. A few years after his sudden death, her sister became guardian and arranged the surgery. It went well, but she had a stroke in surgery and never walked on the new knee. She went into a SNF for rehab which mostly concentrated on passive rehab to minimize scar tissue and maximize range of motion. The surgery was a success in that it did relieve the pain she was living with and she did adapt well to using a wheelchair. Her guardian still has guilt over this decision even though it did improve her sister's QOL. Despite the anesthesia, hospitalization and stroke, her dementia did not seem to progress, and she lived another 10 years.

Related to rehab, I wonder if it makes sense given his current stage of dementia, for him to go to a SNF for a rehab program. My dad had rehab twice in the middle stages of dementia. The first time he was in a SNF/rehab for 6 weeks where he was cooperative with the PTs. When he did outpatient PT less than a year later, he refused to do the exercises assigned at home and fought mightily with mom when she tried to coerce him. The PT "fired" him after 3 visits.

It might be useful to write down your questions. I would focus on what sort of anesthesia options are available, what the day-of surgery and post-op rehab will look like. Most orthos have some sort of physician-extender, a CNP or PA. These folks are generally your support ahead of and after surgery— speaking with this person without your DH present might be very helpful to you. They'd likely have considerable experience with how dementia and surgery overlap.

Good luck. This is a hard decision.
HB

Quilting brings calm

I would do this: call the doctor back and get him in PT, see how well he does in terms of actually doing the exercises as often as he is told to. Keep the appointment with the surgeon.

1. You need to know if he is capable of doing the PT and it might relieve the pain.
2. It may take take some time to get an appointment with the surgeon, and some time after that before the surgery
3. Some insurance companies require a series of steps - including PT or injections- before they will approve surgery.

shiawase12

https://alzconnected.org/discussion/comment/260554#Comment_260554

Thank you for taking the time to respond with all this insight.

My mother also had Alz. She also had two hip replacements so I know some of what can happen and relate to some of the experiences you mention.

I'mgoing to take it slow and consult with the doctors.

Thanks for listening.

shiawase12

Thank you for your comments. Makes total sense.

I am taking it slow and consulting with the doctors before making any decisions.

Appreciate the info. Thank goodness for this site.

sandwichone123

Taking it slow makes sense. When you consult with the doctors keep in mind that surgery is their job and also their business. When listening to their advice be aware that they almost always think surgery is the best answer.