Expert: Dr Ian Jackson - please note UK based - 11/14/2009

Question
Hello Sir,

My mom is having extremely painful knees as a result of age-related osteoarthritis.The orthopaedic surgeon has advised to go for a bilateral TKR in which he will be using a spinal anesthesia.
My mom has a history of hypertension, hypothyroidism, COPD, senile brain atrophy. She has been hospitalised twice this year, in Feb for sinusitis with secondary chest infection and Sept for hyponatremia.
Is spinal anesthesia OK for her? What are the potential risks. I am extremely apprehensive, considering her medical history.We live in India.
Thanks for your expertise.  

Answer
Hi there
I am sorry to hear about your mothers problems. I think it is important that she and her family consider the risks carefully before undertaking such a large procedure. She/you have to be convinced that the surgery is going to make her more mobile and ease her pain significantly before it will be worthwhile.
At one end of the spectrum if she has little pain and she isn't going to be very mobile anyway then there is no point - at the other end she is in severe pain with her knees which is stopping her from sleeping at night and stopping her from walking around the house/garden then the surgery may well help and be worth the risks involved.
Now as to the spinal anaesthetic - then that is probably the best anaesthetic for your mother. The risks of the procedure include death, failure of the surgery to give good knee function, blood loss requiring transfusion, stroke, worsening of any confusion, infection of the new knee joints etc. Risks of the anaesthetic include worsening of the confusion, headache, infection in the spine and various neurological problems linked to the spine.
All of the above are fairly low risks but they are all there.
I think your mother has to think carefully about this but the final decision is hers.
Kind regards
Dr Ian Jackson