Surgery

[adventure]

I have severe osteoarthritis of my left hip but I am afraid to have surgery. I am concerned about the possibility of developing Postoperative Cognitive Dysfunction (POCD). I have an ApoE4 gene which I know increases my risk.

[Starfish77]

Hello adventure, I can't tell you anything scientific about the risk, but I can tell you about my own experience. I had my hip replaced when I was 66. I'm about to be 83 and I am a e4/e4. Not being able to move around comfortably, when lack of exercise makes us susceptible to all kinds of ailments, could be a health hazard on its own. I'm sure you will receive some replies from our members with more scientific knowledge who can tell you about what type of anesthetics are better for us e4s. That is an important thing to check into.

[slacker]

I have severe osteoarthritis of my left hip but I am afraid to have surgery. I am concerned about the possibility of developing Postoperative Cognitive Dysfunction (POCD). I have an ApoE4 gene which I know increases my risk.

If you do a search on "anesthesia", you will find prior discussions about this concern. Click on the magnifying glass in the right upper toolbar to search. Hope this helps.

[NF52]

I have severe osteoarthritis of my left hip but I am afraid to have surgery. I am concerned about the possibility of developing Postoperative Cognitive Dysfunction (POCD). I have an ApoE4 gene which I know increases my risk.

Happy New Year, adventure!

Research on how to predict, diagnose and treat post-anesthesia cognitive dysfunction is a hot topic, with articles as recently as this month in scientific journals. You can be sure that your anesthesiologists will be familiar with the topic, even if they are less familiar with ApoE4. As someone with ApoE 4/4 and a history of severe nausea after general anesthesia, I too was concerned when I needed foot surgery in January 2019 with about 90 minutes that I didn't want to be awake to see!

I asked the surgeon ahead of time to note that I wanted a regional block rather than general anesthesia, if possible. That morning, the anesthesiologist came in to talk to me (something that now happens before any surgery). He said it was not a problem to use a regional block that numbed my entire leg from the hip down and it worked like a charm. I also have a friend who is ApOE 4/4 who had a hip replacement in fall 2018; four months later she was enjoying a trip to Europe and is active every week in a community group that was not an option before.

If you do need general anesthesia, this article from 2015 about a well-designed Australian study suggests that if your cognition is okay now, it will be after the surgery also. Neuropsychological testing in hip replacement patients before surgery and at 1-week, 3-month and 12-month intervals after surgery showed a significant relationship between pre-surgery cognitive impairment (PreCI) severe enough to be MCI or early AD and cognitive dysfunction after surgery. About one-third of patients had PreCI; yet only 17% of patients had post-surgery CI and only 10% had it at 3 months.
Preexisting Cognitive Impairment Is Associated with Postoperative Cognitive Dysfunction after Hip Joint Replacement Surgery

Three hundred patients for hip joint replacement and 51 nonsurgical controls aged 60 yr or older were studied in a prospective observational clinical trial. All study participants and controls completed a battery of eight neuropsychological tests before surgery and at 7 days, 3 months, and 12 months afterwards. Preoperative cognitive status was assessed using preexisting cognitive impairment (PreCI) defined as a decline of at least 2 SD on two or more of seven neuropsychological tests compared to population norms. POCD and cognitive decline were assessed using the reliable change index utilizing the results of the control group.

Results:: PreCI [pre-operative cognitive impairment] was classified in 96 of 300 (32%) patients (95% CI, 23 to 43%). After surgery, 49 of 286 (17%) patients (95% CI, 13 to 22%) and 27 of 284 (10%) patients (95% CI, 6 to 13%) demonstrated POCD at 7 days and 3 months, respectively, while 7 of 271 (3%) patients (95% CI, 1 to 4%) demonstrated cognitive decline at 12 months. Patients with PreCI had a significantly increased incidence of POCD at 7 days and 3 months and cognitive decline at 12 months.

My suggestion would be to talk to your surgeon and to call the hospital or surgery center to ask how to talk with the anesthesiology staff before that date about options. Best wishes for a great outcome and speedy recovery!