Three days after I learned my aunt Kathleen, 99, had fallen and broken her hip, the phone rang. ďIíve had an accident,Ē he said. My husband, Bob, was calling from a cell phone borrowed from the good samaritans who stopped on CR 2015 to rescue him after he had fallen from his bicycle and squarely onto his hip.
Hoping for a dislocation, he arrived at Glen Rose Medical Center where a wonderful staff took over his initial care. When Dr. Hoffman informed us his films showed a fractured hip and the necessity for surgery, we envisioned a set bone and a cast. Instead, Dr. Dollahite, the surgeon on call at Baylor All-Saints in Fort Worth issued the news that this fracture Ė the ball of the femur had essentially snapped off Ė would require a hip replacement.
Hip replacements for Baby Boomers
Bob had worried over the last few years his 92-year-old parents would fall and break a hip. Instead, he was facing the injury at age 64. He is not alone. The federal Agency for Healthcare Research and Quality tracked 288,471 hip replacements in the U.S. in 2009, with nearly half in people younger than 65. The Organization for Economic Cooperation and Development reports the number of hip replacements in the nation doubled since 2000.
Bob essentially had no choice in his hip replacement. His surgeon advised that repair with his type injury has a two in three chance of failure, resulting in hip replacement following the failed fix. But the majority of hip replacements are elective to relieve pain and loss of mobility from osteoarthritis. Therefore, it is important to know the risks and rewards of this intervention.
Performance and longevity of prosthesis
The performance studies on hip implants were conducted with folks who anticipated watching soccer not playing it, warns Dr. Nicholas DiNubile, a spokesman for the American Academy of Orthopedic Surgeons. Thus, no one knows how a hip prosthesis will perform in active baby boomers, like my husband, and in even younger individuals. However, most people will experience less pain, greater flexibility and mobility following replacement.
Prosthesis come in various materials - all metal, metal with plastic components, all plastic and most recently ceramic. Recent studies ordered by the Federal Drug Administration revealed no significant improvement by using one over another.
Bobís surgeon installed a replacement called a DonJoy Linear which has a metal ball and cup with a plastic insert between.
ďI read online we expect Bobís hip to last about fifteen years, is that about right?Ē I asked Dr. Dollahite.
His reply left me cautiously optimistic. Replacements are so much more durable than they were years ago, he is hopeful Bobís will last his lifetime. Dr. Dollahite further encouraged me that Bob should expect to be back on his bike and riding again, as well as resuming other routine activities (except vacuuming and dusting, of course, long known to be harmful to hips), within a minimal rehabilitation period due to his overall fitness.
Still, the experts caution against overdoing activity after a joint replacement even when the result is a good one.
Risks of surgery
The Mayo Clinic lists the risks or potential complications of hip replacement as infection, blood clots resulting in embolisms, fracture of healthy portions of the hip joint during surgery, dislocation of the joint following surgery, loosening of the new joint over time, breakage of the prosthesis, change of the leg length, joint stiffening and wear and tear of the replacement over time.
Frequently, patients will be put on an antibiotic before, during and after surgery to prevent infection. Additionally, physicians will prescribe a blood thinner to cut down the potential for clotting, and the hospital will place compression devices on patients' ankles to increase blood flow. To prevent dislocation following surgery, patients are instructed to not bend more than 90 degrees from the hip and not to cross their legs over the midline and not to twist their bodies.
Bobís physical therapist taught him an anagram - TLC - to help him remember not to twist, lean (bend) or cross.
Loosening and breakage are rare and when they occur are usually some years after installation. Those deemed susceptible to joint stiffening from ossification of the soft tissue around the joint can be treated with medication or radiation therapy to help prevent it. The surgeon takes steps during the procedure to prevent differing leg length.
Most surgeons want the patient up and moving, walker assisted, as soon as possible. Bobís surgery began at 4:30 p.m. on Wednesday, and he returned to his hospital room from recovery at 9:30 pm. By 11:30 a.m. the following day, physical therapist had him traversing the hall outside his room (via walker, of course).
The rehabilitation process generally takes 6 to 12 months, with the TLC restrictions continuing throughout that time. Individuals should look to their surgeons for instructions on when to return to driving, sexual activity and exercise beyond therapy.
Occupational and physical therapists assist the patient in how to safely perform daily activities and avoid accident during rehabilitation. Older, weaker patients or those with additional physical restrictions may be moved to rehabilitation units within the hospital or at a separate facility. Younger, fitter patients may opt for outpatient service or even services provided at home.
Bobís therapist was scheduled to provide an initial assessment and set up his program on Tuesday, just one day shy of a week following his surgery.
It is important to clear the home from hazards that could result in falls. Before Bob came home from the hospital, I removed all the throw rugs in the paths he would have to travel, and Iíve been advised to keep clutter picked up at all times.
To adhere to the 90 degree angle rule, the patient may sit in straight chairs, preferably with arms, but recliners should be avoided. An elevated toilet seat will help prevent bending too far at the hips. I installed one with arms downstairs for Bob to use while heís recuperating. It has proved essential. Showers with grab bars, seats and a hand held sprayer offer added protection.
Keep overly enthusiastic pets away from the patient until he or she has completely healed. Fortunately, our American Dingo, Addie, excited at Bobís return home, calmed rapidly enough to be allowed access to Bob within a few minutes after his arrival home.
Hip replacements offer miraculous resumption of function to debilitated or traumatized patients. However, if a patient has a choice, Dr. Anthony Kamaroff of Harvard Medical School encourages delaying replacement as long as possible. The younger the patient, the greater likelihood of needing revision surgery from outliving the life span of the implant.
Sandra W. Reed is an attorney with Katten & Benson, an elder law firm in Fort Worth. She lives in Somervell County, near Chalk Mountain. If you have questions about this column or wish to suggest a topic of interest, she may be contacted at (254) 797-0211 or email@example.com.