Managing Post-Surgery Pain in Elderly Patients with Hip Injuries

My father-in-law is 78 years old and has undergone surgery for a second fracture?

Hello Dr.
Zhou, my father-in-law is 78 years old and lives in Penghu.
He used to be a fisherman, and around the age of 40, he underwent surgery on his hip joint.
Unfortunately, early last year, he had a fall that resulted in the dislocation of his previously operated artificial hip joint, necessitating another surgery.
However, his recovery has not been satisfactory; he experiences daily pain in his lower body and is unable to walk.
While he can manage his emotional adjustment to not being able to walk, the pain is almost unbearable, making his quality of life very poor.
Since he cannot walk, he is unable to participate in post-operative rehabilitation.
I would like to ask the doctor: 1.
Why is the pain so severe and persistent? 2.
What could be causing this condition? 3.
What treatments can help alleviate the pain, or could surgery provide relief and allow for rehabilitation and walking afterward? Additionally, he has respiratory issues and is quite elderly.
4.
Since he is unable to walk, traveling to Kaohsiung for medical treatment is a significant challenge, and there are no younger family members at home.
Therefore, I am very grateful to have found this website to seek the doctor's opinion before deciding whether to take him to the hospital for further treatment.
I look forward to your response.
Thank you!

ttg, 30~39 year old female. Ask Date: 2010/10/01

Dr. Li Wenlin reply Orthopedics

Hello, addressing your concerns is similar to maintaining a vehicle; regular check-ups are necessary, and any issues should be examined (preferably at the original facility).
Since your father-in-law has already undergone surgery, please return to the original hospital to consult with the attending physician, as it will be easier to access relevant medical records and X-rays.
If you are still unsatisfied, I recommend seeking a second opinion from another specialist.
Indeed, seeking medical care in Penghu can be inconvenient, but the situation could either be related to hip joint issues or lumbar spine problems.
It is essential for the patient to see a physician who can perform a physical examination along with X-ray assessments to accurately diagnose and treat the issue.
Please take your father-in-law to see a doctor as soon as possible!

Reply Date: 2010/10/01

More Info

Managing post-surgery pain in elderly patients, particularly those who have undergone hip surgeries, can be a complex and challenging process. In the case of your father-in-law, who is 78 years old and has a history of hip injuries and surgeries, it is essential to understand the underlying reasons for his persistent pain and the appropriate management strategies.

Understanding Post-Surgery Pain
1. Nature of Pain: After hip surgery, especially in elderly patients, pain can arise from various sources. This includes surgical trauma, inflammation, muscle spasms, and even nerve irritation. In your father-in-law's case, the "抽痛" (throbbing pain) he experiences could be related to nerve involvement, muscle tension, or even complications from the surgery itself.

2. Chronic Pain Development: Chronic pain can develop post-surgery due to several factors, including inadequate pain management during the initial recovery phase, the presence of pre-existing conditions (like arthritis), and the psychological impact of being unable to walk. The body's response to pain can also be heightened in older adults due to changes in pain perception and processing.

3. Potential Complications: Given your father-in-law's history of hip surgery and the fact that he has experienced a dislocation, there may be complications such as joint instability, improper healing, or even the formation of scar tissue that could contribute to his ongoing pain.

Pain Management Strategies
1. Medication: Effective pain management often starts with medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain. In some cases, stronger pain medications, such as opioids, may be necessary, but these should be used cautiously in elderly patients due to the risk of side effects and dependency.

2. Physical Therapy: Although your father-in-law is currently unable to walk, engaging in physical therapy is crucial. A physical therapist can develop a tailored rehabilitation program that focuses on gentle exercises to improve mobility and strength without exacerbating pain. Techniques such as ultrasound therapy, electrical stimulation, and gentle stretching can also be beneficial.

3. Alternative Therapies: Complementary therapies, such as acupuncture, massage, and mindfulness-based stress reduction, can provide additional pain relief and improve overall well-being. These methods can help manage pain perception and promote relaxation.

4. Surgical Options: If conservative measures fail to alleviate pain, revisiting surgical options may be necessary. This could involve procedures to address any structural issues, such as joint replacement revision or decompression surgery if nerve entrapment is suspected. However, given your father-in-law's age and health status (including his lung condition), a thorough evaluation by a specialist is essential to weigh the risks and benefits of further surgery.

5. Multidisciplinary Approach: Engaging a team of healthcare professionals, including orthopedic surgeons, pain management specialists, and physical therapists, can provide a comprehensive approach to managing your father-in-law's pain. This team can work together to create a coordinated treatment plan that addresses all aspects of his recovery.

Conclusion
In summary, managing post-surgery pain in elderly patients like your father-in-law requires a multifaceted approach that considers the unique challenges posed by age and comorbidities. Understanding the nature of his pain, exploring various pain management strategies, and considering further surgical options if necessary are all critical steps in improving his quality of life. It is advisable to consult with a healthcare provider who specializes in geriatric care to ensure that all treatment options are safe and appropriate for his specific situation.

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