Post-Surgery Concerns: Managing Swelling After Hip Replacement in Elderly Patients

Postoperative care for right femoral neck fracture?

Hello Doctor,
My mother is 90 years old.
On March 8th of this year, she fell and sustained a displaced fracture of the right femoral neck.
The orthopedic surgeon recommended a right hemiarthroplasty of the hip.
She was hospitalized for six days and discharged on March 14th.
During her hospital stay, there was swelling observed, which the doctor said was normal and would gradually subside over time.

Four days after discharge (March 18th), she had her first follow-up appointment, where she reported the swelling.
The doctor reassured her that it was normal and only prescribed pain medication.
Twelve days after discharge (March 26th), during her second follow-up, she again reported swelling, and the doctor reiterated that it was normal, providing only pain medication.
Nineteen days after discharge (April 2nd), at her third follow-up, the stitches were removed, and an X-ray was taken.
She again reported swelling, and the doctor confirmed it was normal, prescribing only pain medication.

Her fourth follow-up appointment is scheduled for April 23rd, 40 days post-discharge, where another X-ray will be performed.
However, during the waiting period for this appointment, her legs have been quite swollen, causing significant concern, especially with various opinions from friends and family.
There are worries that the swelling could indicate heart issues, and that prolonged swelling could harm the kidneys, among other negative implications.
Despite multiple reports to her attending physician, he has casually reassured her that it is fine and that the swelling will naturally resolve over time.

Today, I would like to seek a second opinion from another physician on the following questions:
1.
Can swelling really harm the kidneys, and is it indicative of heart problems?
2.
Is it normal for a right hemiarthroplasty of the hip to cause swelling for a period of time?
3.
If the swelling is a normal phenomenon, approximately how long will it take to return to normal?
4.
Are there any methods to reduce the swelling?
Note: My mother’s diet is normal, and her urination and bowel movements are relatively normal, although she does experience frequent urination at night, about 4 to 5 times.

Thank you, Doctor.

LKK, 60~69 year old female. Ask Date: 2024/04/04

Dr. Shen Boquan reply Orthopedics

Hello, the user.
Your mother has suffered a right femoral neck fracture with displacement and has undergone a right hip hemiarthroplasty.
Postoperatively, if there is swelling only in the right lower limb that decreases after sleeping, it is likely related to her position (such as sitting more and walking less).
However, if the right lower limb remains significantly swollen after sleeping, it may be necessary to consider the possibility of a thrombus.
If both lower limbs are swollen, it should also be considered in relation to her position (such as sitting more and walking less).
Of course, if you suspect heart or kidney issues, it would be advisable to have an internist evaluate how long the swelling may persist, as it varies from person to person.
If it is not related to heart or kidney problems, it should gradually improve.
Wishing you good health.
Sincerely, Shen Boquan.

Reply Date: 2024/04/04

More Info

Post-surgery swelling is a common concern for patients who have undergone hip replacement surgery, especially in elderly individuals. Your mother's situation, following her right femoral neck fracture and subsequent partial hip replacement, is not unusual. Let's address your questions one by one, while also providing some context regarding post-operative care and recovery.

1. Can swelling harm the kidneys or indicate heart problems?
Swelling, or edema, after surgery can be a normal response to trauma and the surgical procedure itself. It occurs due to increased fluid accumulation in the tissues as part of the healing process. While persistent swelling can sometimes indicate underlying issues, such as heart or kidney problems, it is essential to consider the context. In the case of post-operative swelling, if your mother is otherwise stable, with normal vital signs and no signs of heart failure (such as shortness of breath or significant weight gain), it is less likely that her swelling is due to heart issues. However, if you have concerns about her kidney function or heart health, it would be prudent to discuss these with her healthcare provider.

2. Is swelling a typical occurrence after a partial hip replacement?
Yes, swelling is a common occurrence after hip replacement surgery. The body responds to surgical trauma with inflammation, which can lead to swelling in the affected limb. This is particularly true in elderly patients, whose bodies may take longer to heal. The swelling typically peaks within the first few weeks post-surgery and gradually decreases as the healing progresses. It is not uncommon for some patients to experience swelling for several weeks or even months after surgery.

3. How long does it take for swelling to resolve?
The duration of swelling can vary significantly from patient to patient. Generally, most patients notice a reduction in swelling within 4 to 6 weeks post-surgery, but for some, it may take longer. Factors influencing recovery include the patient's age, overall health, the extent of the surgery, and adherence to rehabilitation protocols. It is essential to monitor the swelling and report any significant changes to the healthcare provider, especially if it worsens or is accompanied by other symptoms.

4. What methods can help reduce swelling?
There are several strategies to manage and reduce swelling after hip replacement surgery:
- Elevation: Keeping the affected leg elevated above the level of the heart can help reduce swelling. Using pillows to prop up the leg while resting can be beneficial.

- Compression: Wearing compression stockings or wraps can help minimize swelling by promoting fluid return from the extremities.

- Movement: Gentle movement and physical therapy exercises can help improve circulation and reduce swelling. It is essential to follow the rehabilitation plan provided by the healthcare team.

- Hydration: Staying well-hydrated can help the body manage fluid balance more effectively.

- Diet: A balanced diet low in sodium can help prevent fluid retention. Encouraging your mother to eat a diet rich in fruits, vegetables, and lean proteins can support her recovery.

In conclusion, while post-operative swelling can be concerning, it is often a normal part of the healing process after hip replacement surgery. It is crucial to maintain open communication with her healthcare providers, who can provide reassurance and monitor her recovery closely. If the swelling persists or worsens, or if new symptoms arise, seeking further evaluation is advisable. Your mother's overall health, including her kidney and heart function, should be regularly assessed to ensure her well-being during the recovery process.

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