New hip at 90...?

[CosyBungalow]

My 90yr old mum has Osteoporosis. She's been dealing with hip pain for quite a few years. With the Osteoporosis diagnosis came an appt with an Orthopedic Surgeon, who said he would be happy to do a hip replacement - the wait time is approx 10mths.
She lives alone, in a bungalow, with me close by. She is in good health, other than the Osteoporosis, and has no cognitive concerns.
She's concerned about the recovery, and if she would actually benefit long term from having a hip replacement.
We dont know anyone who's had a new hip, so no one really we can ask about recovery.

Yes I think so. He just went floppy and ambulance was called. Announced dead couple of hours later. Old age I assume

surgery for broken hips is very very different to having an elective hip replacement. For a lot of patients a broken hip is a life-threatening injury and unless the patient's expected to die in the next day or two the very vast majority get surgery. For the super high risk but not imminently dying, fixing a broken hip may be done as essentially a palliative operation - it's to reduce the amount of pain they're in and facilitate comfortable care. Broken hips are often also a symptom of something else just starting to go wrong. The 1 month and 1 year mortality after a hip fracture is round about 10% and 25% respectively and a lot of patients will take at least a step reduction in mobility even if everything goes well. This is all very different to elective hip replacements - it's not common to offer elective hip replacements to someone who has a 10% predicted 1 month mortality (and there are risk predictors we can used that are helpful giving a rough idea what the likely outcomes might be) and if a patient that was that high risk was having a hip replacement it would be with proper multi-disciplinary input, properly shared decision making and probably HDU care post op etc.

I’m sorry to about your grandfather @pimpelipom.

My mum had a hip replacement last year at 89 under sedation as it’s deemed safer than anaesthetic. Not an unusual age at all. She stayed in 1 night. Recovery was remarkably quick.

I had a hip replacement on 2nd January but im 47. I can't say what the recovery will be like as everyone is different but for me it has given me my life back abd without pain. I was up and walking within 2 hours of surgery, I had crutches for 2 weeks and for me it's been life changing.

Thanks everyone - its certainly given us food for thought, and it seems its not unusual for someone of her age to have it done, especially as she is otherwise fit and well.

Depends how bad it is and how much pain she’s in. My grandma had one at 90, they got her up and about straight away and she lived another 5 years.

It's all down to the individual. My Nan broke her hip at 101 years old and not only survived the surgery, but was able to use the stairs in her 1930,'s house afterwards.

Do you mean osteoporosis or osteoarthritis?

If it’s osteoporosis then I’d be asking lots of questions as there’s much more skill needed as a result of the poor bone quality.

I’ve not worked in orthopaedics now for several years but from what I can remember, patients with osteoporosis can have slower healing times, and increased risks of fractures and the implant loosening.

if it’s osteoarthritis then it’s much more routine and as long as she’s fit and well to get through the anaesthetic (often done under spinal anaesthetic) and up for committing to doing the rehab then it could be life changing in a good way. Obviously nothing is risk free though.

My grandma had a hip replacement at 90 and lived another five years

I don't care if the Queen Mum had one at 95, I would never have one past the age of 75. JMO. I think she is the exception rather the the rule, I know some people who have had hip replacements in their mid 70s and it has made them quite ill, and their health was worse after it. They were in more pain and discomfort too. (I know it's OK for some by the way!)

I hope I never need one because I really REALLY do not want one! I hate being in hospitals and I make a really bad patient. I love my home, and my bed, and can't STAND hospitals.

I have to say, I know a man who this happened to, but he was 72. Never really recovered and died 4 months later. (Heart attack.)

There are some stories here of success though, where the procedure improved the patient's life, but people do need to know that there's good and bad in everything, and it's a roll of the dice what the result is going to be after a hip replacement operation. It's a big operation! It's not like having a tooth out!

But if it increased your mobility wouldn’t that be a good thing?

Yes of course, but there is a risk it can make it worse, and you can be in more pain. Like with any surgery, it's a risk. Not one I would take personally. Each to their own though.

If it’s a choice between being wheelchair bound and walking properly again surely you’d choose the latter? Yes it is a risk, and many still have pain following an op, but it is usually less pain .Speaking as one waiting for a knee replacement, and in pain most of the time.

A surgeon I spoke to said that recovery can be largely down to the patients attitude.

If they follow the surgeon, physiotherapist advise , do the exercises etc they should have a better result than those that don't.

In my experience surgeons will advise against it if they don’t think it’s worth it. So if he says he’s happy to do it, especially if NHS then I would be happy to go with that.

I wouldn’t risk it. Hip replacements have a high risk of stroke attached which increases as you age. We lost my MIL after a routine replacement and she was only in her 70s. On balance it was worth the risk she could have had 20 years with the new hip and less pain - though sadly that didn’t work out. For someone in their 90s I wouldn’t say it was worth it at all.

i would say it is worth it, if they are offering and she is in good health.
it will bring her a pain free life

Living with a bad hip severely undermines health, leads to faster physical decline. So like others said, if surgeon thinks there is good prospect for quality of life improvement, I'd support this.

My dad had one at 80 but he also has several serious health conditions (heart and lungs). Surgeon was hesitant to do it due to strain it might put on his heart but poor dad was in intolerable pain and was totally housebound. As it turned out, it was the best thing he ever did. The op was done with a spinal anaesthetic, took around 90 minutes and my dad was on his feet the next day. He’d lived in agony for so long he could barely believe how free he now was.

Although classed as major surgery, the op is relatively straightforward in someone of stable health. We were told that the risks tend to come afterwards, risk of chest infections etc. In my dad’s case, because of his heart, they monitored him in ICU for 2 days but he was fine.

Obviously, osteoporosis is degenerative so in time your mum’s hip will get worse. I think if she’s learned to cope with it, then great. I’d still keep her on the waiting list though and see how things are when she’s called for a pre-op. In my dad’s case, he had no choice. In his own words, he’d rather die than continue living in that pain so for him it was a risk worth taking. But he’s so glad he did it.

hip replacement after a fractured neck of femur is a very different thing to one done electively - the risk of mortality and morbidity is significantly higher than after an elective. Men also have higher risk of mortality after fractured NOFs than women.