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Caring for a senior after hip replacement surgery

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Michelle Llamas
Michelle Llamas

In the United States, nearly half a million hip replacement surgeries are performed every year because of trauma and various forms of arthritis. These conditions tend to affect older adults, and as a long-term care provider, there is a good chance that you will care for a senior who has had a hip replacement. Some of the most important concerns that you should be aware of regarding hip replacements include surgical complications, managing pain, avoiding falls and maintaining bone health. There are some precautions you can take to help protect the health of those in your care.

What are Some of the Most Common Complications?

If you care for seniors, dislocation of the hip and fracture at the implant site are more common and may occur even several years after surgery, and the risk is even greater for those older than 80. One of the causes of fracture and dislocation can be a failed implant. For instance, a number of people who received the DePuy ASR hip device suffer higher than normal fractures and dislocations that require a second surgery to fix because of faulty implant design. Pain, swelling and difficulty moving the joint are some of the warning signs of fracture or dislocation. Immediately after hip replacement surgery, patients should be careful of how far they bend the hip joint and you should assist them in standing and sitting to avoid dislocation. Muscle-strengthening exercises are an important part of preventing dislocation.

Some other complications that may occur after surgery are infection and blood clots. Infection is rare and only occurs in 2% of individuals. Some of the warning signs of a possible clot include swelling and tenderness in the thigh, calf, foot or ankle, as well as pain or discomfort in the calf and leg not related to the incision.

In addition, controlling pain will help patients recover after surgery faster, stick to their physical therapy regimen and increase their quality of life. You should constantly evaluate the patient for any pain that may be present in or around the joint. If the patient has difficulty performing certain movements, or if you notice behavioral changes, fidgeting, irritability or other signs of discomfort, you may have to re-evaluate physical therapy exercises or the effectiveness of pain medications. Make sure you communicate with the patient regarding their pain level and any options available to them for controlling it.

Ensuring Good Bone Health to Reduce Risk of Falls

Seniors who have had a hip replacement can be more prone to falls and hip fractures. While there are several factors that contribute to falls, including impaired vision, medications and environmental hazards, poor bone health greatly contributes to the risk. Osteoporosis occurs frequently in the elderly and makes the bones more porous and fragile. In long-term care facilities, people who are frail, malnourished and those who have decreased activity levels are at the greatest risk.

Studies conducted in long-term care facilities have shown that calcium and vitamin D supplements can reduce risk of hip fracture by almost 50%. Maintaining a healthy diet with calcium- and vitamin-D-rich foods and doing strengthening exercises can help seniors maintain good bone health. Good bone health correlates with a lower rate of falls. Walking or swimming can also help improve bone health.

Michelle Y. Llamas researches and writes about dangerous drugs and medical devices for Drugwatch.com, a consumer advocacy website.

 

Sources:

Ogino, D., Kwaji, H., Konttinen, L., Lehto, M., Rantanen, P., Malmivaara, A., Konttinen, Y. T., & Salo, J. (2008). Total hip replacement in patients eighty years of age and older. The Journal of Bone and Joint Surgery, 90(9): 1884–1890. Retrieved from jbjs.org/article.aspx?articleid=28811

American Academy of Orthopaedic Surgeons. (2010). Total hip replacement. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00377

American Medical Directors Association (AMDA). (2009). Pain management in the long-term care setting. Retrieved from http://guidelines.gov/content.aspx?id=15593

Francism R. M., Baillie, S. P., Chuck, A.J., Crook, P.R., Daymond, T., Dunn, N., Fordham, J. N., Kelly, C. & Rodgers, A. (2000). Management of osteoporosis in patients with hip fractures. QJM, 93(8): 501–506. Retrieved from http://qjmed.oxfordjournals.org/content/93/8/501.long

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