Dad age 86 private elective hip replacement

[Apple04]

My Dad has been a very active man his entire life but his arthritis has got significantly worse over the last year. He has been on an NHS waiting list for 6 months for the assessment appointment and it would likely be another few months wait for the procedure. He has decided to go privately and they have offered him a slot in 3 weeks. He is desperate to get it done. I’m really concerned about the aftercare. As it’s private I suspect they won’t provide it the way the NHS does? This hasn’t been discussed with him. He lives with my mum who also has mobility issues. There house has bedrooms upstairs. I’m an hour away with a full time job and young child. Can anyone provide advice on care in the private sector?

I think what was more likely was “half a hip replacement” or hemiarthroplasty. While some patients do get a full hip replacement it is generally much younger fitter patients. Recovering from a fracture and operation is far more problematic hence rehab hospitals/placements.

@Apple04 its incredibly difficult to predict how someone recovers post THR, some bounce back surprisingly quickly as their pain is gone and others need significant assistance afterwards. It’s also variable in the private sector. I’m only NHS so I am not 100% sure if the same happens privately, but we have a separate ‘joint school’ appt where both physio and OT assess beforehand to ensure home environment suitable? Might be worth asking if there’s something similar.

The NHS wouldn't offer aftercare either. He needs to sort out his house before going in. He will be able to climb stairs with one crutch when back home, but check the bannisters are good enough. He will need a high loo seat wuth space round it to sit with one straight leg. It's all online. Some help with cooking and cleaning the house would help, but nursing isn't necessary usually.

I know from having two very elderly parents and also friends who have the same that it is really up to the parents to prepare their house, and DO the exercises. Whether that means them sorting it or allowing it to sorted doesnt matter. My late Mum claimed she did the exercises and clearly didnt. This meant recovery was much much longer and took a lot out of the family to manage her.

My Father had let his own house get into such a state that when he broke his hip he had to go straight into a care home. His house was unihabitable and there was no way carers could come in and dodge the horrible state it was in.

For many many older people when this happens they are unprepared. They wont allow any changes, refuse to engage and recovery is much longer

Exactly @PinkMicrowave, he wouldn't be able to walk otherwise and @LeroyJenkinssss is correct that it was the partial replacement as that's less major than full replacement. He already had limited mobility (uses a rollator) and he really doesn't want to end up in a wheelchair, so he was prepared to take the risk.

The surgeon did confirm privately with me that I was aware that my Dad had a DNR on file so if anything went wrong, he wouldn't be resuscitated. But it didn't and he's walking again - v. slowly, but he gets there :-) I suspect he'll make it into his 90's, he's a tough old bird.

You need to be careful not to offer too much post-op care. The person needs to keep mobile, which means getting up to fetch something from another room, or from upstairs, or to make a sandwich, rather than sitting in a chair being waited on.

Neither Fil nor mil really recovered - I think the general anaesthetic messes with the brain in older people.

A lot of help is needed: someone to organise raised toilet seat, shower stool, basin seat etc (all available from Red Cross but you need someone to fetch them.)

An elderly spouse is not much help; buying in assistance is the best option if someone lacks dutiful offspring!

Is he having anterior/posterior/lateral incision?
It will make a big difference to the rate of recovery.
Anterior is what I had and recovery was very easy.
https://www.osmc.com/blog/anterior-vs-lateral-vs-posterior-hip-replacement-what-does-it-all-mean/

Based on family experience, please check who will be doing the op. In the private sector surgeons can be operating after they have stopped doing them on the NHS (even if they are still there as consultants). Ideally, you want a surgeon with very up-to-date skills.

I can't see why paying would get you worse aftercare? They keep you in the hospital til they can see/prove you're physically well enough and mobile enough to leave. In private they'll probably be in less of a rush to get their bed back so I'd imagine in that respect it'd be better not worse than using the NHS.

He can go to a rehab or get home carers to help while he recovers? If it isn't smooth sailing.

FIL had his done age 80 ish, he did it privately and paid for some sort of convalesence home for 2 weeks after, the physio saw him everyday and 2 years down the line it's really improved his quality of life,

I agree, the main difference is the wait time and you get tuna sandwiches with the NHS and prawn in private hospitals. The surgeon may well be the same person in either setting.
He will need a plan for afterwards wherever he gets it done.

My mum was looking into having hers done privately - she'd got as far as ringing the hospital and asking how much it would cost and was on the verge of making an appointment - when the nhs contacted her and said could she come in next week, because a lot of people were cancelling and they had space.

My mum is 90 and has just had her NHS appt through for her hip replacement, its next month.
She lives in a bungalow, and i live 2 doors away. We're waiting for the pre-op appt.
She well definitely do all the pre & post op exercises.
She recovered really well from a full hysterectomy when she was 86, having found an ovarian cyst that was 17cm x 11cm.
I work part time and have taken some time off to be around, although she'll be keen to be up and about as soon as she can

Surely the biggest factor is own room and bathroom?

The wait time is the biggest factor.

Sorry, I meant in terms of actual facilities at the hospital

I’m 80, and had a full knee replacement a few months ago. No GA, i had an epidural and deep sedation, far fewer nasty after effects. NHS overnight stay, walked and climbed stairs with physio before I was discharged the next day. I had DH at home for support. We have no downstairs bathroom, but I managed the stairs with a crutch and banister.

Follow up physio appointments at hospital, and within a few weeks the lack of pain when I walked meant throwing away the walking stick. Following the exercise instructions was important for a full recovery.

You don’t need a plan for downstairs living. I had my right hip done by the NHS, they didn’t discharge me until I could use the stairs which is surprisingly easy. In fact, the physios are pleased if you have stairs!

Yeah I'm having surgery soon and my surgeon also works privately.

I'd think the surgery itself to be identical just you get a private room, nicer food, and you're not necessarily urged to leave the moment you're physically capable. It could even be in the same building/ campus.

It’s common for very old people to have an elective hip replacement in old age, many are in their nineties.As long as they are otherwise fit, there is no reason not to have one, as it improves their quality of life.

@AlexandraCarrington Absolutely agree with this.

My mum had two ops at different points in her 70s, my dad just one (do not live together)

I either went and stayed for a few days or they came to me. I was purely there as a safety valve/ motivation/ nagging. NHS arranged equipment - toilet riser, zimmer frames.

If they wanted to return to independent living they needed to manage their recovery themselves - and they did. They did it slowly and carefully but they did it themselves. They washed themselves, they mobilised, they sat down to prep food.

It took a bit of facilitation but 99% of it was their own motivation and work.

They continue to live independently now, 5-10 years later.

I think you are right to ask the question. Private care doesn't cover ICU should things go wrong they hand you back to the NHS. MIL paid for a hip replacement privately and ended up with a DVT so moved to NHS hospital.

Some good advice here. I wonder if it's worth a discussion with the GP about what the NHS could offer with aftercare? It's not an uncommon situation and he would be saving the NHS some cost.
Either way the mobility and physio after the surgery is crucial for the best long term outcome.

Does he have any significant underlying health conditions? The main difference is that private services cherry pick the healthy punters with a low anaesthetic list, and anyone complex is safer done on the NHS due to more back up. If well, private likely to be fine.

There's a lot of misinformation about elderly people having such surgery. If the benefit outweighs the risk and you're fit and well enough to undergo surgery you'll get a hip replacement at any age.

In private they'll probably be in less of a rush to get their bed back so I'd imagine in that respect it'd be better not worse than using the NHS.

I wouldn't bank on it. Four years ago, I had a self-funded total complex hip replacement carried out in a private hospital. I was 69, so not as old as the OP's relative. I had posterior approach and through my choice, I elected to have it done under spinal block, not GA.

I was booked in for two nights with the expectation of discharge on the morning of the third day but I managed to get an extra night as I did not feel well enough to be discharged after just two nights. Had I wanted to stay beyond the extra night, I would have had to have paid extra for the room and for the nursing care as I was considered fit enough to be discharged.