Hip replacement and dementia
Hi everyone, I don't know if anyone has experience of this, but my Lovely Mum in Law has severe and painful Osteoarthritis of the hip and would really benefit from a Hip replacement. However she also has mild dementia and is in cognitive decline ( She still lives independently at home with our support) She has seen two Rheumatologists, both of whom have been really quite dismissive of the idea of an operation based on potential post operative behaviour . however they have not really been specific about exactly what she should and shouldn't''t do. I know that plenty of people with quite advanced dementia have had joint replacements. Does anyone have any advice - what questions should we ask ? has anyone seen any information around this ?- Full disclosure I am am a member of staff here at Versus Arthritis!
Chris_R Moderator Posts: 597
Welcome to the online community,so glad you have found us and are asking questions.
You say your Lovely Mum has severe and painful Osteoarthritis and would benifit from a hip replacement but the Rhumatologists have been quite dismissive of the idea because of your mums mild dementia.Have you been to your GP so she can be referred to a Orthopaidic surgeon? Also a Geriatrition might be helpful too as they may refer aswell as she is in so much pain,chair exercises may help as well.
Please go to the forums to chat to others it may help and they may have some advice to offer you.Everyone on the forum have some form of Arthritis so know what your lovely mum is going through.
Hope all goes well,all the best Christine0
What a tough call! I'm not sure who you are wanting to ask questions of but several things come to my mind that might need taking into consideration. I should add that I've had two THRs and that my mother-in-law had dementia.
Firstly, I'-m wondering why your mother saw one rheumatologist let alone two. Does she have an inflammatory form of arthritis? Are other joints involved? Is she on DMARDS? Or any other meds which might have to be stopped pre-op? If Mum has other arthritic joints could she manage crutches? I couldn't (mine is rheumatoid) so I came home with a zimmer then walked round furniture. That does demand (a)room and (b)care
How well and regularly would she cope with the essential exercises? You could try now for nothing. They are important.
Could she remember not to try to walk/get out of bed without walking aids? A lovely neighbour of mine didn't and fell on her first night post-op trying to get to the loo.
Would there be someone with her permanently for some time after she gets home? None of us are much good at cooking and cleaning for a while. Even brewing up is taxing. Qnd extremely difficult when using walking aids
Post op we have to use a chair high enough to safely get out of. For most,of us a raised loo seat is needed. Some surgeons (this might depend on anterior or posterior incisions, I'm not sure) still insist on 6 weeks sleeping on the back. Could your Mum manage that? Many struggle with it.
A vital need is to avoid dislocation. This means not bending beyond 90 degrees. No picking anything up from the floor except with a pick-up stick. No reaching down to low drawers or cupboards. It only takes one mistake, especially until exercises have strengthened the muscles.
I think I must sound very negative but I do believe forewarned is forearmed. Post op is a tricky period.
Thè normal route to a THR is via an orthopaedic surgeon not a rheumatologist. You could ask your Mum's GP to refer her. Some insist on physio or a musculoskeletal clinic first. Either might give you a better idea of how Mum would cope.
My best wishes to both of you.3
Lovely to meet you but awful to hear how your poor MIL is suffering.I also wondered why not an orthopedic surgeon and instead a rheumatologist, but possibly she has rheumatoid arthritis as well as Osteoarthritis?
You must read Stickywicket's post from end to end it really is helpful. What a great idea to do some of the exercises to check whether your MIL would be able to do them and not damage her new hip if you can get someone to go ahead with the surgery.
I tried to find you some exercises and found this
which is printable.
My own daughter had to have a shoulder replacement at 19 and 'they' were concerned that she might have a seizure (she has epilepsy) and dislocate it. Luckily she never did. In your shoes I would do your best to do some sensible (careful) exercises and assess for yourself how your MIL might cope.
Stickywicket is so sensible to talk about post operation support she can have from you all so that she doesn't accidentally harm her new joint and end up in a worse position. You could even consider a commode in the short term so that she wouldn't have far to go for the loo.
Please do let us know how you get on too this is such an important subject. People with cognitive decline or learning disabilities and joint replacement surgery should not be overlooked.
and don't forget you can always ring the helpline at Versus Arthritis
Best of luck
Thank You to both Stickywicket and Frogmorton. Apologies for the confusion - I should know better as a Versus Arthritis Staff member that there is a difference between a rheumatologist and an Orthopaedic Surgeon! ( I'm a fundraiser but that's no excuse) So MIL has seen two Orthopaedic surgeons One would not go any further than saying hello until she had a firm diagnosis ( The neurologists will only say generalised cognitive decline) and the other actually said that if she was my mother I wouldn't operate because of the potential for post operative problems.
We would be able to be there to support her post operatively and she would be able to remember about using walking aids. The main issue would be that she has a habit of trying to get on her hands and knees to clean but we can find interventions to remind her not to. She also finds following exercise guidelines difficult mainly because she loses concentration easily but we can help her with these. As Stickywicket says dislocation is the main risk but she is already has a raised loo seat electronic Riser recliner, walk in bath and electric bed so a lot of the aids are in place . We really appreciate the support here and we will definitely take up the opportunity to revisit the orthopaedic surgeon with a list of the ways that we will support MIL post op( and preparation before
Thanks for your quick responses
It sounds as if your MIL is comfortable with the adaptions she already has. That's great.
I'm wondering for how long she'd have someone with her, both in days/weeks and hours. Getting out of bed (and back in) to go to the loo is really tricky at first. Getting down on hands and knees is, I imagine, (I haven't managed that in years!) probably a permanent no-no as it sounds a quick route to dislocation.
The exercises are really important. I can't stress that enough, both before and after the op. Here's an NHS page on it that you might find useful (note the 'don'ts) https://www.nhs.uk/conditions/hip-replacement/recovery/
You could also try contacting Alzheimers UK for advice.0
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