Navigating Joint Replacement Surgery Risks in Elderly Patients with Complications

My father wants to undergo joint replacement surgery, but his physical condition seems to be unsuitable?

Hello Doctor! My father, born in 1970, suffers from ankylosing spondylitis and, due to severe pulmonary tuberculosis many years ago, has almost lost function in his left lung, leaving only his right lung functioning normally.
He now has severe cartilage wear in his hip joint and requires surgery.
However, the doctor at Cathay assessed that the risk of general anesthesia is too high and is unwilling to perform the surgery.
Additionally, due to his ankylosing spondylitis, he cannot undergo regional anesthesia.
My father is finding it increasingly difficult to walk, which is causing me great concern and affecting his mood.
He has considered whether ECMO (extracorporeal membrane oxygenation) could assist during the surgery.
I hope the doctor can help my father or provide us with any good suggestions.
Thank you very much!

Mr. Chen, 20~29 year old female. Ask Date: 2016/03/07

Dr. Shi Guozheng reply Orthopedics

Patients with ankylosing spondylitis are generally less suitable for lumbar anesthesia; however, a regional femoral nerve block can be used for surgical procedures near the hip joint on one side.
This approach eliminates the need for spinal anesthesia.
We have had numerous cases in the past that can serve as references for you.

Reply Date: 2016/03/07

More Info

Navigating joint replacement surgery, especially in elderly patients with complex medical histories, can be quite challenging. Your father's situation is particularly intricate due to his history of ankylosing spondylitis and significant pulmonary issues stemming from past tuberculosis. These factors complicate the decision-making process regarding surgery, especially concerning anesthesia options and overall surgical risks.

Risks of Joint Replacement Surgery in Elderly Patients
1. Anesthesia Risks: Given your father's severe lung condition, the risks associated with general anesthesia are heightened. Patients with compromised pulmonary function may face respiratory complications, such as hypoxia or respiratory failure, during and after surgery. The inability to use regional anesthesia (like spinal or epidural anesthesia) due to ankylosing spondylitis further limits options. This situation necessitates a thorough evaluation by an anesthesiologist who specializes in high-risk patients.

2. Surgical Risks: Joint replacement surgeries carry inherent risks, including infection, blood clots, and complications related to the prosthetic joint itself. In elderly patients, the risk of postoperative complications, such as delirium, pneumonia, and prolonged recovery times, is significantly increased. The presence of multiple comorbidities, like your father's lung issues, further elevates these risks.

3. Functional Recovery: Post-surgery, the recovery process can be prolonged, especially in elderly patients with pre-existing health conditions. Rehabilitation may be more challenging, and the risk of complications can delay the return to baseline function.

Considerations for Surgery
1. Multidisciplinary Approach: In cases like your father's, a multidisciplinary team approach is crucial. This team should include orthopedic surgeons, anesthesiologists, pulmonologists, and rehabilitation specialists. They can collaboratively assess the risks and benefits of proceeding with surgery versus exploring alternative treatments.

2. Alternative Treatments: If surgery is deemed too risky, consider non-surgical options such as physical therapy, pain management strategies, or medications to improve joint function and reduce discomfort. These options may help improve mobility and quality of life without the risks associated with surgery.

3. Use of ECMO: The idea of using Extracorporeal Membrane Oxygenation (ECMO) during surgery is generally reserved for critically ill patients who cannot maintain adequate oxygenation or perfusion. While ECMO can support patients with severe respiratory failure, it is a complex intervention with its own risks and is typically not used for elective surgeries like joint replacements. Discussing this option with a critical care specialist may provide more clarity on its feasibility and appropriateness for your father's situation.

Moving Forward
1. Second Opinion: If you feel uncertain about the recommendations from the current medical team, seeking a second opinion from a specialized orthopedic center or a hospital with a robust geriatric care program may provide additional insights and options.

2. Patient-Centered Care: It's essential to involve your father in the decision-making process. Understanding his preferences, concerns, and goals for treatment can help guide the discussion with healthcare providers.

3. Emotional Support: Given the emotional toll that declining mobility can have on your father, consider engaging with mental health professionals or support groups for patients with chronic conditions. This support can help improve his outlook and overall well-being during this challenging time.

In conclusion, while joint replacement surgery can significantly improve quality of life, the risks in elderly patients with complex medical histories must be carefully weighed. A thorough evaluation by a multidisciplinary team, consideration of alternative treatments, and open communication with your father about his preferences will be key in navigating this difficult decision.

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