Post-Surgery Recovery Challenges in Elderly Patients with Hip Fractures

Five months post-surgery for a displaced femoral neck fracture in an elderly patient, there is weakness in the leg and a regression in recovery?

Dear Dr.
Wang,
My father is 82 years old and weighs 40 kg.
Aside from prostate issues, he does not have hypertension, diabetes, or hyperlipidemia.
Before his fall, although he had poor leg strength and easily experienced muscle soreness, he was still able to walk with a cane.
(His bone density test showed -3.5.) In early June of this year, he fell and sustained a displaced femoral neck fracture in his left leg, and he underwent internal fixation surgery with screws at Taipei Veterans General Hospital on the same day.
Since the surgery, he has returned to his original physician for follow-ups four times, but only X-rays were taken.
The doctor mentioned that the bone is healing and appears stable.

In the first two months post-surgery, he still experienced pain and used a walker, relying on his hands and right leg for support, but he felt that his left leg strength was gradually improving.
However, in the following two to three months, his hip joint remained very tight, and he experienced pain on the inner thigh.
His walking has progressively worsened, and both legs seem weaker than before (the injured leg cannot bear weight, and the good leg is also weaker).
Additionally, I am unsure if his poor sitting posture or other factors are contributing to the noticeable outward rotation of the injured leg while walking.
I have several questions:
1.
What could be causing the decline in his walking ability and the increased weakness in both legs? When I asked the doctor during follow-ups, he said the X-rays showed no issues.
2.
Should we be concerned about potential complications such as avascular necrosis, vascular or nerve damage, or joint instability? Or could it be that the surgical fixation angle was not optimal? What additional tests should be conducted?
3.
His weight is currently between 39-40 kg.
Could this indicate muscle loss, and should we focus on improving his nutrition and rehabilitation exercises?
4.
Would it be beneficial to consult both traditional Chinese medicine and Western medicine for his recovery?
I would greatly appreciate your guidance on these matters.
It is quite challenging for my elderly father to travel for medical appointments, and I am hesitant to ask his original doctor again, especially since he seems unaware of my father's osteoporosis and only prescribes pain medication.
Thank you for your time and assistance.
Wishing you good health!

Miss Lin, 80~89 year old female. Ask Date: 2019/12/06

Dr. Yin Xinbei reply Rehabilitation

1.
The description suggests that hip joint and thigh pain and stiffness may discourage the elderly from walking.
Coupled with malnutrition and low body weight, these dual factors can lead to muscle atrophy and weakness, further impairing mobility and creating a vicious cycle.

2.
Conditions such as avascular necrosis, vascular and nerve damage, and joint instability should have been ruled out by an orthopedic specialist.
If there are still concerns or issues related to surgical fixation angles, seeking a second opinion from another orthopedic surgeon is advisable.

3.
Yes.

4.
Yes, nutrition is crucial.
Additionally, rehabilitation is recommended, starting with addressing pain and stiffness, followed by strength and gait training.
Otherwise, the elderly may progressively deteriorate to a bedridden state.

Reply Date: 2019/12/06

More Info

Post-surgery recovery for elderly patients, particularly those who have undergone hip fracture surgery, can be quite challenging due to a variety of factors. In your father's case, at 82 years old and with a history of decreased mobility and osteoporosis, several aspects need to be considered for his recovery.

1. Reasons for Declining Mobility: The decline in your father's mobility and strength could stem from several factors. After hip surgery, it is common for patients to experience pain and stiffness in the hip joint, which can limit movement. Additionally, the muscles surrounding the hip may weaken due to disuse during the recovery period. The fact that he is experiencing tightness in the hip joint and pain in the inner thigh suggests that he may not be engaging in enough physical therapy or rehabilitation exercises to strengthen those muscles and improve flexibility. It's also possible that psychological factors, such as fear of falling again, may contribute to his reluctance to move.

2. Concerns about Bone Health and Stability: While the X-rays indicate that the bone is healing well, it is essential to monitor for potential complications such as avascular necrosis (bone death due to lack of blood supply), nerve or vascular damage, or joint instability. If your father continues to experience significant pain or functional limitations, it may be worth discussing further imaging studies, such as an MRI, to assess the blood supply to the femoral head and the integrity of the surrounding structures.
3. Nutritional and Rehabilitation Needs: Given your father's low body weight (39-40 kg), it is crucial to address his nutritional status. Malnutrition can significantly impact recovery, leading to muscle wasting and decreased strength. A diet rich in protein, calcium, and vitamin D is essential for bone health and muscle recovery. Consulting with a nutritionist may be beneficial to create a tailored meal plan that meets his needs. Additionally, engaging in a structured rehabilitation program that includes physical therapy can help improve his strength, balance, and overall mobility.
4. Alternative Therapies: Exploring both traditional and alternative medicine can be beneficial. While Western medicine focuses on surgical and pharmacological interventions, complementary therapies such as acupuncture, herbal medicine, or physical therapy may provide additional support for pain management and recovery. However, it is crucial to ensure that any alternative treatments do not interfere with his current medications or recovery plan.

5. Follow-Up Care: It is understandable that you may feel frustrated with the current medical care your father is receiving. If you feel that his concerns are not being adequately addressed, seeking a second opinion from another orthopedic specialist or a geriatrician may provide new insights into his condition and recovery plan. A comprehensive assessment that includes a review of his medical history, current medications, and functional status can help tailor a more effective rehabilitation strategy.

In summary, your father's recovery from hip surgery requires a multifaceted approach that includes addressing pain management, nutritional support, physical rehabilitation, and regular follow-up care. Open communication with healthcare providers and a proactive approach to his rehabilitation will be essential in improving his mobility and overall quality of life.

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