Update posted in comments - Move forward with hip surgery for DH?

@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