Total hip replacement with severe bilateral hip osteoarthritis

garychleung

PIG Meeting: 18th February 2021

  • Elderly man seen in perioperative clinic for THR.
  • Requiring arthroplasty to both hips.

Background

  • Longstanding severe OA. Now wheelchair bound and sleeping in a chair
  • Significant bilateral peripheral oedema both legs, likely due to inability to mobilise/raise legs
  • Difficult social circumstances
  • Orthopaedic team consulted in perioperative clinic and discussed possibility of bilateral THR

Issues

  • Surgeon decided not suitable for bilateral hip arthroplasty. Likely due to frailty.
  • Discussion around optimal timing for the second joint replacement taking into VTE risk
  • No evidence but consensus was sensible to leave 6 weeks between surgeries
  • Update on case provided by procedural anaesthetist.
    • Unable to attempt neuraxial block due to difficulty in positioning
    • Significant post-operative delirium
    • Would have likely been a poor candidate for bilateral joint replacements
    • Predicted difficultly with rehab and post-operative mobilization due to severity of OA in other hip