Hip displacement/dysplasia

Discussion in 'I care for a person with dementia' started by helenm250, Jul 22, 2015.

  1. helenm250

    helenm250 Registered User

    Jul 22, 2015
    9
    Hi all,

    New to this forum, so please bear with me if this is an 'old' question. Quick background: MIL is 81, and was diagnosed with early stage dementia earlier this year (my husband and I think perhaps it's been going on for some time but hey....). She had a hip replacement 12-15 years ago. It 'went' three weeks ago and she is now in hospital. It dislocated a further two times whilst she's been there - not their fault at all, just one of those things. Long story short, they are going to replace the broken part (the 'cup' part) but there is a possibility that because of her age and general condition (and the fact that she won't listen do/can't grasp the nature of what she can/can't do after the op) that it may displace again. In this case, they will not renew it and it will be left permanently displaced.

    In addition, he consultant has said that if when he 'gets in', the muscles, ligaments etc are in a very bad way (due to age or the trauma of it having dislocated and being put back in three times within a week, followed by two weeks of loss of strength), then he will abort the revision op, cut off the metal ball and leave the hip permanently displaced. We've had to argue hard to get him to do the revision in the first place (she's had a good innings, so he tells us!!!!!!!!), so it really does sound as if this is the Last Chance Saloon.

    My question is, what does his actualy mean on a day to day basis? MIL has always lived at home, alone since FIL died about 18 years ago. She is (understandably) absolutely gagging to get home, but because we know that she won't follow instructions, and has thus far refused all help at home, the hip may well displace again.

    We don't know whether this will leave her in pain, whether she would be wheelchair bound or what; all the consultant said was that mobility would be severely affected and she would be housebound. We live in London, her daughter lives in Cheshire and MIL is in Lincoln, so it's not ideal!

    Does anyone have experience of a permanent hip displacement? Both first hand experience and any professional advice would be appreciated!

    It hasn't happened yet of course (the revision op is on Sunday, MIL having been prepped yeserday and then the op cancelled - all very distressing), but I'm trying to look ahead....

    Thanks in advance.

    Helen
     
  2. Cat27

    Cat27 Volunteer Moderator

    Feb 27, 2015
    10,303
    Merseyside
    Hello Helen
    I've no idea sorry but just wanted to say welcome to TP :)
     
  3. helenm250

    helenm250 Registered User

    Jul 22, 2015
    9
    Thanks Cat!
     
  4. 2jays

    2jays Registered User

    Jun 4, 2010
    11,598
    West Midlands
    #4 2jays, Jul 22, 2015
    Last edited: Jul 22, 2015
    Welcome to TP

    I have no experience of this, but my thoughts are that maybe you are going to have to think of some form of full time care, possibly a care home, as I would not advise her moving in to live with a member of the family

    Which area to move her is a complicated one isn't it

    And who pays? Would she be considered self funding or would she get financial support from the social services? In some ways, self funding is easier.... look into it but don't do anything without speaking to the hospital social workers. The hospital have A DUTY OF CARE to make sure she is discharged into a safe environment as she is a VULNERABLE ADULT. Capital letters as those statement are Buzz Words that they "listen" to.

    I'm sure others will have ideas and will be along when they can

    Keep posting. You are not alone now you have joined TP. Always loads of listening ears offering support and there is often someone who has experience and total understanding of what you are talking about

    xxxx






    Sent from my iPhone using Talking Point
     
  5. helenm250

    helenm250 Registered User

    Jul 22, 2015
    9
    Thanks 2jays - unfortunately my father had PSP and my mum was his carer for seven years, so am rather more used to the system than I'd like, and know that forums such as this are an absolute lifeline!!!

    At the moment, it's really a question of trying to determine what MIL's day to day situation would be if she ends up with a permanently displaced hip (level of pain, level of mobility etc), in order to come to terms with exactly what type of care would be required in terms of medical assistance and care assistance - never mind the dementia element of it. Whilst I think the whole thing could be utterly ghastly (and in some ways hope that no-one else has any experience!), all I can find online is real ly todo with congenital dysplasia, mainly in infants, and hip displacement in dogs! Neither being particularly appropriate!!!!

    Thanks again for your post and believe me, I'll bend everyone's ears whenever the need comes upon me!

    H.
     
  6. chrisdee

    chrisdee Registered User

    Nov 23, 2014
    171
    Yorkshire
    #6 chrisdee, Jul 22, 2015
    Last edited: Jul 22, 2015
    Can't answer your question exactly- but Mum had a 'pin and screw' operation when she was alive. I think the main problem is that hospitals very quickly withdraw scarce services like physio. Sadly, its likely that whatever op she has, she would more than likely not be able to cope with the post-op exercise and therefore would not benefit partly/fully thus putting her at risk. My mum ended up very disabled after being very mobile for this reason. It may be time to start looking at care homes but certainly do not give SS any indication of this in case they leave you to it! The Vulnerable adult is the route to go - and 81 does not seem so very old these days does it? I used to live in north London, imagine care homes cost a fortune, so its a case of travelling distance for those involved I would think.
     
  7. susy

    susy Registered User

    Jul 29, 2013
    801
    North East
    The first thing I would be asking would be "how experienced in revision operations is the surgeon" yes all surgeons can have patients with dislocations but an experienced one will only have a small percentage. I would imagine that they would remove the cup (plastic I'm guessing) and replace it. I'm guessing that the stem is well fixed so that can be left alone. Are they replacing the ball? This can be lengthened if needs be to improve stability.
    Good luck to you mum. I hope that all will be fine and she recovers well. To be honest, with her already having lived for years with a hip replacement hopefully her movements will be naturally ok as regards to looking after it.
     
  8. helenm250

    helenm250 Registered User

    Jul 22, 2015
    9
    Thanks for this, Susy. Good point about the experience of the surgeon. Don't know the answer, however our very strong impression that he knew what he was talking about, and indeed several of the nurses on the ward have discussed 'revisions' as if they were everyday ops. Yes indeed, it is the plastic cup that has broken which, we assume, caused the first fall in her home. Equally, with the cup gone, the next two dislocations (whilst in hospital) make a whole lot more sense. He has also said that if the metal ball looks damaged he'll replace that too.

    He has also explained that this is a more intrusive op than the original replacement precisely because there is the broken part to be removed (and he has to be sure that he finds even last piece of it) plus the insertion of the new part. She'll be in hospital for at least a further ten days, of which hopefully the latter half will be in the rehab ward. After that we'll have the lovely 'Home or care' decision to discuss......

    The op's tomorrow so not long to go to find out how things go. After the three 'replacements' following the three dislocations, MIL had delusions and hallucinations. We believe this was probably caused by the anaesthetic, as she has stopped having them now. So we're interested to see if it happens again.

    Also a good point about the 'movement memory'. Our concerns are that her muscles, ligaments etc were that much younger and healthier first time around. Now, her body is older and there's no knowing what damage has been done by her trying to stand up after the initial fall followed by the trauma (if any) caused by the three relocations. Plus, back then, she didn't have dementia and was more able to grasp the relevance and importance of the instructions she was given. Finally, her sister, who died last year, was around to look after her post op and make sure she stayed on the old straight and narrow. This time, who knows how it will be! We shall see!
     
  9. Spamar

    Spamar Registered User

    Oct 5, 2013
    6,984
    Suffolk
    She can have the op done under epidural with only light anaesthesia, so she's not aware during the op. As I'm sure you know, anaesthesia of any type does not suit dementia patients.
    Note that physio , or the exercises should go on for at least 6 weeks, so things like not bending the hip too much ie not sitting on low chairs, or leaning forward, lying on your back or operated side are all important and need to be observed, or the hip might dislocate again. Not easy in someone with dementia. You're not clear until 3 months, but the first 6 weeks are vital.

    Good luck!
     
  10. helenm250

    helenm250 Registered User

    Jul 22, 2015
    9
    Many thanks Spamar, particularly as I can see that you have your hands very full! I didn't know about the epidural; we're currently at home in London, and mil's daughter is with her today....she may well be in surgery now, so I guess it'should too late to check...... Yes, we'very been advised about what she shouldn'the do (including not crossing her legs.....very difficult!). We're concerned that because she'said currently in a trauma ward there simply won'the be the level of staffing to help her ( they also have around 50% of staff who are drafted in or agency and are often only in the ward for one day!). If she recovers reasonably well and is moved into a rehab ward it should be better and we understand that the next move should be into a home, for rehab, for 4 to 6 weeks. Mil doesn'the know about that bit yet, she just wants to go home. As I now realise from this forum, the fact that she doesn't realise that she can'take cope is very normal, and that's the difficult bit.....

    The reason for posting originally was to see if anyone knew what happens if the surgeon finds that mil is physically unable to take the new cup, and is therefore left with a 'permanent dislocation'. It sounds ghastly, and frankly verging on inhumane, however we'very been warned that it is a possibility. Guess we'lll just have to cross that particular bridge if and when it presentstarts itself.... We're back up in Lincoln tomorrow so we'll soon see.....
     

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