Discover ways to work through hip injuries and what to expect from replacement surgery.
A broken-hip diagnosis can be emotionally devastating, but with proper rehab and encouragement, hip-replacement patients can return to their previous mobility.
More than 300,00 people age 65 and up are hospitalized each year with hip fractures, according to national statistics from the Centers for Disease Control and Prevention. Falls are to blame for 95 percent of those injuries.
Hip joints can also be damaged by arthritis or years of use. Dr. Abraham Lin, assistant chief of orthopedics at Kaiser Permanente Downey Medical Center in California, says the first indication of impaired joint health is pain. Hip injuries are best examined by X-ray.
The hip joint is located where the upper end of the femur, or thigh bone, meets the pelvis. The end of the femur, called the femoral head, fits in a socket in the pelvis. Depending on the severity of the fracture, the femoral head is repaired either with pins or by replacing the entire stem.
For a hip fracture, stem replacement involves drilling into the bone and placing a new stem in the femur where the “neck” was broken.
Lin says a full hip replacement is performed when the socket is damaged from wear and tear. Typically, full replacements are performed when a patient also suffers from osteoarthritis or a severe loss in bone density.
Patients are usually hospitalized a few days, Lin says. Depending on overall condition, they will need to go to a rehabilitation facility for 3-6 weeks to ensure mobility, flexibility and coordination needs are met before they return home.
“In general, the sooner you start mobilizing, the safer patients are,” Lin says. “Moving also helps fight blood clots and infections. As a caregiver, it’s important to provide that support — to give them hope that they can get back to their previous function. Especially if it’s an unplanned surgery due to a fall.”
Post-surgery game plan
The exercises involved in rehabilitation are meant to strengthen the hip abductor muscle.
Lin says he recommends patients do the exercises they learn in rehab to help maintain their strength, balance and to protect against future falls and injuries.
Lin says it’s in post-op when caregivers and their positive support are most needed.
“The caregivers play a big part in providing patients with encouragement in recovery and the therapy that follows,” he says. “I think these types of injuries can seem kind of traumatic, especially for elderly patients. I feel like maybe they think their overall health is declining and that they won’t be able to get to their previous level of activity.”
In general, once the surgery is performed and the joint has healed, the hips are better protected from the general wear of day-to-day activity. Lin warns there is potential for breaks below the implant.
“Technically, it can be a ‘Stress-Riser’ having metal transitioning into the bone, so it’s not uncommon to see people who fall suffer a break below what was fixed. But once you have the surgery, you can’t really have a hip fracture in the same place.”
One critical thing caregivers can do is address and remove any fall hazards in a loved one’s home. Something as simple as removing a rug from the kitchen or installing grab bars inside the bathroom can go a long way toward preventing an accident.
Lin says the caregiver can also be an advocate for their loved one if there is an issue with post-operative pain or infection.
While most patients suffer a decline in function after a hip fracture, there are some patients that can really bounce back,” he says. “Encouragement from their loved ones is very helpful. We definitely see some patients that get back to that same level of activity with rehabilitation and encouragement from family members and caregivers.”
In the rare case where a surgery is not indicated, Lin says it is important for patients to be active. Being active is also important in prevention. Where a pool is available, water exercise helps maintain joint and cardiovascular health. Lin also recommends using a stationary bike, treadmill or simply walking on at, even surfaces.
“Low-impact activities can help preserve the joints while maintaining cardiovascular fitness,” Lin says. “Higher- impact activities that involve planting or twisting the hips and legs can lead to a higher rate of injury. In general, staying active with exercise — which also helps balance, coordination, muscle strength and overall health — will preserve the joints and can help prevent future falls.”
Dr. Abraham Lin is the Assistant Chief of Orthopaedics, Department of Orthopaedic Surgery for the Kaiser Permanente Downey Medical Center in Southern California.
Chad Eiler is the senior copywriter for Healthy Living Made Simple.