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Topic Parkinson's and hip replacement Go to previous topic Go to next topic Go to higher level

By junipersage On 2019.10.03 20:21
Has anyone here had experience with hip replacement for their PWP? My husband is 61, and was diagnosed with PD about five years ago. He's doing fairly well, his tremor is well controlled by medication but he does have issues with gait and freezing (his tremor is not much of an issue even during "off" times, but his gait definitely gets worse).

He's still working full time, and although I do think he has mild cognitive impairment, he can work around it pretty well.

Currently he has quite a bit of hip pain. The diagnosis is osteoarthritis of the hip. He's had a steroid injection in the past, which gave him about six months of relief, and then a second one recently which only gave him about three or four weeks of relief. Apparently hip replacement would be next, or we can keep trying to manage with oral painkillers, but he's needing to take Advil every day and usually a Vicodin at night.

On the one hand, studies seem to be saying that PD patients have more complications than others when they do hip replacement surgery. He already has gait issues, so it seems like post-op hip dislocation would be a risk. And I'm worried about the anesthesia, too.

On the other hand, he's in pain every day, his arthritis is likely to get worse, not better, and PWP seem to do worse with recovery the more advanced their symptoms are, so maybe sooner is better while he is still walking fairly well and can do more rehab then he may be able to do in the future.

I have explained all this to him, but he has always looked to me to give him recommendations about this kind of thing (I'm a health educator, and he hates thinking about health). We've talked to his orthopedist and his neuro, but both have basically said "it's up to you".

Anyone have experience with this? How did your PWP do?

By Lynnie2 On 2019.10.06 12:32
My husband was diagnosed with PD at age 59 and at age 66 he was diagnosed with Stage 1 lung cancer in the lower right lobe.
He had the lung removed and since it was contained, he didn't have to have chemo or radiation.
He was given anesthesia for the operation, as I was afraid about a spinal. The surgery went well but 4 months later he started hallucinating. I don't know if it was from the results of the anesthesia, but he was never the same.

Now it could have been from progression of PD and the medication, but we'll never know.
He was giving medication to make him sleep better so the hallucinating gradually stopped.

As PD progresses, the mobility becomes worse and affects different areas of the body, as you probably know. My husband had no pain, but the mobility became worse and in the end he couldn't swallow.
I know it's a hard decision to know what is the best for him.
As you said, maybe doing it sooner than later would be better for him in the long run.

By 839Ellen On 2019.10.08 18:38
My husband with PD fell when he was 80 and broke his hip. He had hip replacement and did have hallucinations and was combative. We and doctors decided that it seemed to be from the pain medications so all that was stopped and they just gave him tylenol. Those problems disappeared after the meds got out of his system. He did well with PT but he fell a couple of times while not using the walker he was given during rehab so he became leery of not using it. This all happened 3 years ago and now his PD has worsened but not from the hip replacement. If he has surgery, just be careful of the pain medications. My husband's hip is great and has no pain. Good luck.

By VioletV On 2019.10.08 21:36
My PWP, at age 84, was on schedule to have a second major hip operation to replace a joint repair that failed because of loss of blood supply, despite successful surgery and excellent response to rehab. His excellent hip replacement surgeon (who did mine a few years ago) planned to do the anterior hip replacement under a spinal block, and was confident that he would have a good surgical outcome. However, my husband died before the second surgery could take place.

Ask if your surgeon is willing to do a spinal block instead of general anesthesia.

In my limited experience the most important thing with hip replacement is to have a surgeon who is highly experienced (my surgeon does 600 of them a year) and to opt for the anterior approach incision, which allows for easier recovery and eliminates the need for hip precautions and mades dislocation extremely unlikely. (Of course I'm not a doc, but this is my experience.)

By junipersage On 2020.02.24 22:06
Thanks, all. My husband did have the anterior approach and they were able to do it under "twilight sedation" rather than general. In fact, the whole thing was done essentially outpatient - he had surgery around 11 am and we were home again by 7 pm, which I wasn't expecting.

The first two weeks were really rough but it has now been a month and he has been getting better. Less pain and more "himself" - more talkative and has more energy. Wednesday is his first outpatient physical therapy visit (the first two weeks we had home visits).

He's still having some trouble at night, when his Parkinson's-related leg cramps and muscle tightening pull on the new joint and surgical site. We are trying to reconfigure his medication schedule to accommodate a middle-of-the-night dose without pushing his daily total too high.

Thanks to all for your advice and care.


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