Do you think dementia should prevent my father from having a total hip replacement? He is still in good health and otherwise mobile. But we are worried he'll get up and walk on it when he shouldn't.
Quality of life is an important issue at any age and in any circumstance. The presence of Alzheimer's, dementia, or other neurologic problem must be considered but isn't a reason to withhold treatment.
In the case of hip replacements, an assessment of need should be done. An orthopedic surgeon is the best one to consult for this. There may be other less invasive treatments that can make a difference. Physical therapy to help restore motion and strength can help. If they haven't been tried yet, cortisone injections and/or antiinflammatory medications may provide some effective relief.
And if it turns out that surgery really is the best option, the surgeon will modify treatment to take the cognitive condition of the patient into account. For example, there are minimally invasive surgical techniques that can be used to take the old joint out and put the new implant in. The postoperative protocol allows for early weight-bearing. There are fewer restrictions on movements and positions.
The type of implant used can be chosen based on the patient's specific needs. A larger femoral head component helps reduce the risk of dislocation. Cementing the prosthesis in place also makes for a more stable joint. Preventing complications is a key factor in cases like this. Having a team approach with family, patient, and health care providers will go a long way to provide a good result.
John J. Callaghan, MD, and Steve S. Liu, MD. The Chronic Dislocator: Early and Late. In Orthopedics. September 2008. Vol. 31. No. 9. Pp. 903-904.
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