THR for the elderly?

Shine533

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Hi everyone, my 90-year-old dad was recently diagnosed with bone-on-bone OA in his left hip. What manifested as knee pain was, after new xrays, discovered to be coming from the hip; both knees show a good amount of cartilage. He's had pain in and around the leg for years but only in the last month or so has it really ramped up.

He is in good general health except for OA and an irregular heartbeat, for which he is on medicine. We are proceeding with getting him the xray-guided injection, which may or may not offer some relief.

For pain management he has been on Dicoflenac topical cream applied 4x/day, Gabopentin 1x/day, and Tylenol as needed up to 3x/day. He was also prescribed hydrocodone 2x/day, but after taking two, said they didn't do anything and has discontinued it.

Does anyone have any comments about someone his age having a THR? I assume it's not common, and I also assume most surgeons would not take this on, but want to explore all possible options.

Any other meds we might ask his doctor about?

He is using a heating pad with some relief. Should he be icing the area also?

Also, should he focus the cream/heat/icing on the hip or the knee, where the pain is actually felt?

Thank you very much for any advice!
 
@Shine533 Welcome to BoneSmart! What does the surgeon say about your father's condition? It would be the surgeon and any supporting consultants (such as cardiac) to indicate whether your father could tolerate the procedure. Is he fairly active?

I am afraid all that topical cream and the injection will probably do nothing. The only real relief from bone on bone pain is THR. Unfortunately there are no meds that really address pre-op pain.
 
For pain management he has been on Dicoflenac topical cream applied 4x/day, Gabapentin 1x/day, and Tylenol as needed up to 3x/day. He was also prescribed hydrocodone 2x/day, but after taking two, said they didn't do anything and has discontinued it.
Well, it's true that these topical gels don't work.
Gabapentin isn't appropriate for this situation. It's for nerve pain and that's not where his pain is coming from.
Tylenol can actually be take up to 4,000mg per 24hrs provided he is not taking anything else with acetaminophen in it. It should be 1,000mg 4 times a day at 6hrly intervals.
And I agree about the hydrocodone, it's a bit too much for a man of his age.
But as Jaycey said, there are no painkillers that will lessen his pain. He needs the surgery.
Does anyone have any comments about someone his age having a THR? I assume it's not common
I've known a number of elderly patients this age had hip operations. It's not that uncommon. And I even helped with the surgery on a patient who was 105!
He is using a heating pad with some relief. Should he be icing the area also?
He should use whatever gives him relief. That's the only rule!
 
My grandfather had a hip replacement at 90 years and went on to live another 7 years. He wasn't as active with his golf by that time but did play a few 9 hole rounds following surgery. (and that was about 35 years ago! - procedures and sedation options are better now) I also know a lady in my area who had her hip replaced at 86 years and was walking up a storm post-op like she'd been reborn.
:flwrysmile:
 
Thank you all for the encouraging responses. My dad still plays piano professionally, and his biggest concern is being able to get up to the piano and then return to his table after playing...
I'm wondering now if the injection would be a waste of time and money, and if we should just discuss having the surgery with his doctors.
 
@Shine533 The injections did nothing for me, are quite painful and almost feel like you've been kicked by a steel toed boot for a few days. Once that settles, it's 'wait and see' to find out if they help. They certainly help some people. When I met my surgeon, he wanted them stopped immediately stating they break down muscle mass which would interfere with THR recovery.
 
Is the injection generally a steriod or hyaluronic acid? I've seen both mentioned online, but apparently the hyaluronic acid injections are not FDA approved?
I just spoke with the nurse where my dad was seen on Friday. Apparently in her notes, the OS wrote he was "not a good candidate for hip replacement surgery"--I'm assuming because he's been on a blood thinner for years (Warfarin, which he would have to stop before surgery) and because he has some heart issues (irregular heartbeat, for which he's on digoxin).
So I guess we try the injection and hope he gets some relief.
Thanks again, and hope everyone has a good week!
 
I would ask for a detailed explanation about why he's not a candidate and seek a second opinion as well. Some doctors will avoid surgery just because they feel the patient is not age appropriate (too young or too old). You can't put an age on quality of life.

Injections don't come without risk either....
 
Is the injection generally a steriod or hyaluronic acid?
Could be either.
the OS wrote he was "not a good candidate for hip replacement surgery"--I'm assuming because he's been on a blood thinner for years or because he has some heart issues (irregular heartbeat, for which he's on digoxin).
It shouldn't be. As you can see from my signature, I've been in this business for donkey's years and cannot count the number of such issues my patients have had. The important hing is that the doctors know about it beforehand.

But I agree with the previous poster - here is not the place to be getting this information as it is specific to your father. You need to get it from the surgeon.

I'd also say that with injections he might still have problems walking. With a THR he won't!
 
Thank you, Josephine and Lola115. I will get more detailed information. The plan now is to try the injection end of this month and if that doesn't offer relief, look into the possibility of surgery. I know there is a (3 month?) gap between the injection and having surgery, but it might take that long just to schedule it and the pre-op appts.
As always, I appreciate the feedback I get from everyone on this forum!
 
Update: My dad had the injection on 3/22. Based on what I've heard I was worried it would be painful for him, but the doctor numbed the area very well, and he said it went fine. He was sent home with a scrip for Tramadol, but because it made him a little dizzy, the doctor said to take it at night as needed, not during the day. So far he hasn't taken much besides Tylenol. The acute pain is much better--thankfully!--so in his case, at least, it is working. We're hoping he gets several months out of it, but we'll see. I'm just happy he has some relief.
 
So far, so good... Thanks, @Carriemay60. Hope you have a good week. I'll be thinking of you and sending best wishes! :flwrysmile:
 
:fingersx::fingersx:
Double fingers crossed he gets long relief!
 
The injections were of no real help for me. After about 2 weeks my pain was much worse than before the injections and then I had to wait 3 months to have the surgery due to infection concerns. I tried heat which gave me a little relief. Hope all goes well. It really stinks to be in pain all the time
 
It seems to be different for everybody... I've heard all kinds of things. Wishing you the best, @paticake!
 

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