Post-Surgery Complications After Hip Fracture in Elderly Patients

Postoperative care after hip joint fracture surgery?

My grandfather is 82 years old.
He fell before the Lunar New Year and had a large bruise on his buttocks.
An X-ray taken at a clinic showed no bone injury, but as the pain became more pronounced, he was unable to bear weight while walking.
Later, he went to a larger hospital for another X-ray, which revealed a fracture in the left hip bone.
After the fall, my grandfather was not allergic to anti-inflammatory medication, but after the incident, he developed bilateral leg edema whenever he took such medication.
Currently, he is post-surgery and has not taken any anti-inflammatory drugs, but starting on the fourth day, he experienced swelling in the left leg.
On the fifth day, in addition to the left leg swelling, his left knee became red, swollen, and warm.
By the sixth day, the swelling extended to his calf, which also showed signs of warmth and redness.
My grandfather reports that the thigh of the operated leg has intermittent sharp pain and soreness.
His attending physician is unable to determine the cause.
What could this situation be, and what should be done? Thank you.

Ms. Chen, 30~39 year old female. Ask Date: 2020/02/09

Dr. Shi Guozheng reply Orthopedics

After surgery for fractures near the hip joint, there is often poor blood circulation, so it is necessary to elevate the lower leg.
Additionally, rehabilitation exercises for the knee and ankle joints should be performed.
If there is redness, swelling, heat, or pain, one should suspect a bacterial infection that requires treatment.
Furthermore, it is possible that bruising from the fracture has caused swelling near the knee joint.
Taking anti-inflammatory medications may lead to edema, which is also related to kidney function, so it is important to choose medications that do not adversely affect renal function.

Reply Date: 2020/02/09

More Info

Post-surgery complications after hip fractures in elderly patients can be quite complex and multifaceted. Given the scenario you described regarding your grandfather, who is 82 years old and has experienced a hip fracture, it is essential to understand the potential complications and the appropriate steps to take.

Firstly, it is not uncommon for elderly patients to experience swelling (edema) after hip surgery. This can be due to a variety of factors, including the body's inflammatory response to surgery, immobilization, and the effects of anesthesia. In your grandfather's case, the swelling in his left leg and knee, along with the redness and warmth, could indicate a few potential issues:
1. Postoperative Edema: After surgery, it is typical for the affected limb to swell. This is often due to fluid accumulation and the body's healing process. Elevating the leg can help reduce this swelling.

2. Infection: The redness, warmth, and swelling in the knee and calf could suggest an infection. Post-surgical infections can occur, especially in older adults, and may require prompt medical evaluation and treatment. Signs of infection include increased pain, fever, and drainage from the surgical site.

3. Deep Vein Thrombosis (DVT): Another serious concern in postoperative patients, especially the elderly, is the risk of DVT, which is a blood clot that can form in the deep veins of the legs. Symptoms may include swelling, pain, and warmth in the affected leg. DVT can lead to more severe complications, such as pulmonary embolism, if the clot dislodges and travels to the lungs.

4. Nerve or Muscle Pain: The "pulling" or aching sensation your grandfather is experiencing in his thigh could be related to nerve irritation or muscle strain due to changes in mobility and activity levels post-surgery. This type of pain can be common as the body adjusts to the surgical intervention.

Given these possibilities, it is crucial to communicate these symptoms to your grandfather's healthcare provider. They may recommend further evaluation, which could include imaging studies (like an ultrasound to check for DVT or an MRI to assess for infection) or blood tests to check for signs of infection or other complications.

In the meantime, here are some general recommendations for managing postoperative care in elderly patients:
- Elevation: Encourage your grandfather to keep his leg elevated to help reduce swelling.

- Mobility: Gradual mobilization is essential. Physical therapy may be beneficial to help him regain strength and mobility safely.

- Pain Management: Ensure that he is receiving appropriate pain management. If over-the-counter anti-inflammatory medications are not suitable, discuss alternatives with his doctor.

- Monitoring: Keep a close eye on any changes in his symptoms, such as increased swelling, redness, warmth, or fever, and report these to his healthcare provider immediately.

In conclusion, while some swelling and discomfort can be expected after hip surgery, the symptoms your grandfather is experiencing warrant further investigation. Prompt communication with his healthcare team is vital to ensure that any potential complications are addressed swiftly and effectively.

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