Houston Methodist. Leading Medicine

Hip FAQ

Question:

It's been a year and I'm still heart broken but finally coming out of my shell of grief to ask the question. How often does a 72-year-old man in good health die after having a routine hip replacement? That's what happened to my husband. Lots of our other friends have had this done with no problems. Why my husband?

Answer:

Many more older adults are choosing joint replacements in order to stay active longer. In fact, it is anticipated that there will be an almost 200 per cent increase in the number of hip replacements done in the United States over the next 20 years. But not everyone who wants a new hip is a good candidate for surgery or in particular, hip replacement surgery. In a recent review article, surgeons from Ohio State University presented what is currently known about risks related to total hip arthroplasty (THA, another name for total hip replacement). The information they presented may help you better understand what may have happened in your husband's case. First, studies show there is up to a 7.4 per cent risk of major problems during or after surgery. And more significantly, there is even a 0.8 per cent risk of death after joint replacement (hip or knee). Patient selection (choosing patients likely to have the best results) is always important in any surgical procedure. And the opposite is true, too -- identifying patients at increased risk for complications with surgery will dictate who should be turned away. Just what are the risk factors that put patients in danger of complications, problems, and adverse events associated with total hip arthroplasty (THA)? Heart disease is the number one health problem that complicates elective surgery. Three-fourths of all major problems after joint replacement surgery (hip or knee) are directly linked with the cardiovascular system. High blood pressure, blood clots, valve disease, heart attacks, previous history or heart surgery such as the implantation of a stent or balloon angioplasty top the list of significant (and potentially life-threatening) risk factors. Other health conditions surgeons must watch for in patients considering total hip replacement include rheumatoid arthritis (RA) with psoriasis (skin lesions increase risk of infection, drugs for poor wound healing), organ transplantation, alcohol abuse, HIV, obesity, blood clotting disorders, and eating disorders or malnutrition. Even things like dental disease (cavities, abscesses, gingivitis) can put a person on the sidelines. And there's more! Tobacco use (especially smoking), kidney disease, sleep apnea, history of cancer, long-term use of steroid medications, diseases of the blood vessels in the legs, diabetes, and lung diseases must all be taken into consideration as potential risk factors. Finally, it may seem like anyone of any age can get a hip replacement. But older age does put adults at increased risk for medical complications (and death) associated with joint replacement. Sixty-five years of age seems to be the cut-off point for low-to-high risk. Risk starts to increase after age 65 to the point that by age 85, the risk of death after hip replacement is nine times higher in adults 85 and older. Paying attention to risks before agreeing to perform surgery is called risk stratification. This is something surgeons are giving more and more attention to as older adults who have multiple health problems ask for joint replacements. Patient safety is everyone's concern. But less than half of all patients who end up with life-threatening complications after surgery have any obvious risk factors beforehand. To use a gambling term -- that certainly "ups the ante." More studies are needed to provide an evidence-based risk stratification model that can be used to prevent and reduce all post-operative problems, but especially life-threatening complications such as your husband suffered. We offer our sincere condolences and hope this information may help you. Vincent Y. Ng, MD, et al. Preoperative Risk Stratification and Risk Reduction for Total Joint Reconstruction. In The Journal of Bone and Joint Surgery. February 20, 2013. Vol. 95-A. No. 4. Pp. e19(1)-e19(15).

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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