Valvuloplasty before hip replacement?

[deck1434]

I have to have a hip replacement because of avascular necrosis, so I saw a hip surgeon at the Hospital for Special Surgery (NYC) on Wednesday.

I ran into an unanticipated stumbling block, my heart condition. You see, my Cardio told me to have my hip replaced ASAP while my aortic valve is .80cm and I have little to no symptoms.

The hip surgeon is going to review my Echo and call my cardiologist. HSS prefers heart patient's address their heart issues prior to joint surgery. He said some heart patients have Valvuloplasty as a temporary fix prior to joint surgeries to avoid the possibility of the patient suffering heart failure during the joint surgery...

At this time I've been labeled a "Complex Case" at HSS, and a Complex Case "Review" will be done based on all information gathered to determine if HSS will perform the hip surgery (prior to my aortic valve replacement).

 

[bvdr]

That is quite a situation to find yourself in, isn't it? I really question what skills the ortho surgeon has to read your echo. Was he a cardiovascular surgeon in his recent history. I know of one such incidence so it isn't real far fetched.

I think your cardio and ortho-surgeon need to talk. How would you feel about getting your valve replaced prior to having your hip done?

 

[deck1434]

Hi Betty,
Actually, HSS has a staff of Cardiologists who are supposed to review my case once the hip surgeon has spoken to my Cardio...My Cardio wanted the hip done first to reduce the risk of bacterial endocarditis to my heart if the heart was done first...Thank you for your reply!

Best,
Dianne

 

[Lynlw]

Hi Betty,
Actually, HSS has a staff of Cardiologists who are supposed to review my case once the hip surgeon has spoken to my Cardio...My Cardio wanted the hip done first to reduce the risk of bacterial endocarditis to my heart if the heart was done first...Thank you for your reply!

Best,
Dianne

I could see another concern being your recovery, if you have trouble walking, I know people DO recover who can't walk, but it is usually harder and takes longer.
I'm sorry you are in such a tough spot. Have you gotten opions from more than 1 heart surgeon or ortho?

 

[hensylee]

what a spot to be in - what came first? egg or chicken... The surgeons must be scratchin their heads. hoping they come up with the logical reason for which comes first. sorry you are having to go through this. it must be really tough and I remember you were concerned with that in your first post, I believe.

 

[Jkm7]

Please pardon my ignorance but the only way to learn is to ask....

What does HSS stand for?

I hope your doctors get it sorted out and you can proceed with the replacement.
Best wishes.

 

[JeffM]

That's a tough one. I can kind of relate. I needed lumbar surgery a year ago as a nerve root was being impinged and causing weakness in my left quad and numbness in my lower left leg. The longer a nerve root is compressed, the more permanent the nerve damage. BUT, I needed my valve replaced at the same time. I did that and was able to exercise enough (and then some) to aid my recovery from the heart surgery. 6 months later (the soonest my orth surgeon would touch me) I had my lumbar surgery. While my leg will never be 100%, I'm happy to report my quad is getting stronger although my lower leg will probably always be numb. I can live with that....literally. Sometimes our options are not optimal and we just need to get the best info and advice and then decide. Obviously, you want to first give yourself the best chance at living. Will your hip allow you to exercise on a stationary bike post heart surgery if you can't walk for exercise?

 

[deck1434]

I'm sorry!! Hospital for Special Surgery in NYC! They are 32 in the U.S. for joint replacement surgery. - Di

 

[deck1434]

"Obviously, you want to first give yourself the best chance at living. Will your hip allow you to exercise on a stationary bike post heart surgery if you can't walk for exercise?"

Jeff, yes, my priorities have certainly changed since my latest heart update...and yes, with the hip replacement I'll actually be having therapy 3xs a week and will be walking within days of that surgery...

Thank you ALL for your kind responses!!! - Dianne

 

[barb]

Hi Dianne,

I had total hip replacement surgery in 2008 about a year and a half before my OHS. I had aortic stenosis and a family history at the time of my hip surgery. Ironically it was my ortho surgeon who insisted that I be cleared by cardiology with an MRI and that was when my aneurysm was found. I was still cleared for hip surgery. The concern about endocarditis is real but I know that I was well covered with antibiotics for this. I had no problems post hip surgery and was up and walking the next day. I was on crutches for almost 6 weeks and recovered beautifully from there. My hip problem was congenital hip dysplaysia so I had never NOT been in some degree of pain. So the hip surgery was amazing and well worth the 6 weeks on crutches. Recovery from that was not painful for me but inconvenient since I have small children. Now I can tell you that following ohs I was very glad to be able to walk pain free. I think it is pretty typical for ortho surgeons to want clearance in writing from the cardio when heart issues are involved.

My heart and hip have gone hand in hand since I was a kid. My AS was diagnosed at age 11 during my pre surgery ekg on the day of my childhood hip surgery. Btw I am also 1961 birthday Are you in a lot of pain from your hip? I pray that you can get the cooperation you need from docs to get both issues adressed at the right time.