Terrible experience so far hip op recovery - will it get better?

[Dougt]

Hello, new to this board as mum has been independent and coping well so far but at 83 has just had a hip replacement. Otherwise well and reasonably active.

i just wanted to find out what other people’s experience of the immediate and longer term recovery is at this age.

It was done at a private hospital but NHS funded. She woke from the op at about 2pm on Friday and was discharged the following day at 11 Saturday. So less than 12 hours after op.

I understand it was decided she was suitable for this “enhanced recovery”, and she saw physio who said she was ok to be discharged. She was apparently confused and they thought this was the oxycodone so she was sent home with codeine and and paracetamol only.

my sister collected her and has been caring for her and it’s been a nightmare. She didn’t sleep, can’t move, is extremely tearful, has crutches only which are no good and was told she does not need a walking frame. 2nd night post op at home she was cold and feverish and called the hospital who told her to call 111, who told them to call and ambulance who have taken her back to hospital (NHS of course) my sister is terrified they will try to discharge her today but I hope the NHS will realise she is unsafe to be at home.

Does any of this sound normal? My sister feels she needs a proper electric hospital bed if she’s to cope at home and a walking frame so will the hospital help organise this? We were really unprepared, despite trying to do my research, the private hospital said she’d need someone with her for the first 24 hours only, that she would not need a frame (even when they discharged her) and would be fine with sticks. Even knowing about things like bed risers which might help would have been helpful!

Sorry I mean less than 24 hours post op!

I think you need to talk to the physiotherapist on her ward ASAP.

How was her mobility before the op?

A hip replacement is major surgery. But the less time she is in hospital the better. Talk to the physio and either ask for her to be back to baseline mobility before coming home, or if that's not going to happen, ask for her to be assessed for equipment by the occupational therapist.

My step dad had his hip replaced in January, aged 92. He was released less than 24 hours later with just two sticks. He was able to climb the stairs and use his normal bed but needed a higher chair to sit in and a riser on the loo, both of which we had to collect from the hospital stores. He was fastidious about doing all the exercises and has made a good recovery. It was scary going behind him up the stairs initially and watching him walk but we coped. I’d make sure your mum was seen by physio before leaving hospital as they are vital in supporting recovery. Hope it goes well for you all.

I am a physio working with older people. The discharge from the private hospital sounds appalling and unsafe. It’s common for older people to need to use a walking frame for a while post-op and to need help in and out of bed and to need a period of rehab before they are able to manage independently at home. Ask the new hospital if they offer “rehab beds” or “intermediate care beds”, often these are nhs funded in a non-hospital setting where physios and OTs will work with the patient to rehab them until get to return home.

Thanks. I wonder if it’s the lack of pain meds as they didn’t send her home with oxycodon just paracetamol and codeine. So she’s in too much pain to do anything. Ambulance people thought she might have a UTI.

@Jellylover that’s good to know.
Shes got the loo seat and the raised chair but that’s all.

@teaandcake123 thank you. it def feels in her case it was.

My mum had a hip replacement a couple of years ago and got sent home fairly quickly. The NHS said she was ok to go home and manage on her own, which was bollocks because she could barely walk even with crutches, and she needed help with dressing and getting in the shower. She certainly couldn’t stand at the hob or bend down to lift anything out of the oven, or carry a plate or cup. So basically they were talking a load of shit and just wanted rid of her, because she absolutely couldn’t cope on her own.

She needed a carer 4x a day for the first month, which meant I had to use my holidays from work (impossible to get a paid carer at such short notice, especially when they were only needed for four weeks). I had to wash and dress her and bring her stuff. I cooked for her for two months, until she was able to cook and use only one stick so she had a hand free to carry her plate.

A year on she is able to walk half a mile with a stick and she goes out shopping and cooks for herself. Which is only possible because she worked so hard at physiotherapy. Apparently half of hip patients never get back on their feet?

Has she been offered physio, and equipment at home? Definitely sort out the pain relief

Apparently half of hip patients never get back on their feet?
Very different data depending on hip replacement as a planned procedure compared to emergency surgery after a fall.

I've just had my second hip replacement (I'm in my 40s). Mine was private so I left at the end of day four (some of the more elderly patients were still there).

I was sent home with dihydrocodeine (which I'm still taking nine weeks later as and when needed) plus a month's work of blood thinners. Also compression socks for a month.

It's a surprisingly painful op. I couldn't walk unaided without crutches until four weeks and still needed one crutch until a couple of weeks ago.

Other things I found very useful were the raised loo seats and the litter picker grippers you get on Amazon which were a life saver.

I agree with others that the pain relief seems poor. My step dad had a large bag of meds and I had to create a spreadsheet so mum and he could keep up with the doses and times.
another thing that helped further down the line was an waist pinny with a large pocket in the front that stored glasses, mobile phone, newspaper etc. definitely helped with carrying stuff when using crutches.

@teaandcake123 i think you may be confusing two different groups of patients here: Patients with hip fractures and those patients having elective hip replacements. They are incredibly different.

a hip fracture carries significant risk of mortality and often there is a decline in mobility (if patient frail to start with). So if a patient was independently mobile before then may require a stick, if used two sticks may need frame etc.

elective hip replacements are an entirely different ball game and shouldn’t really be discussed in conjunction with hip fractures. There is a lot of work going on around length of stay with one to days “standard” with an entirely reasonable aim for some patients to go home on the day of surgery. It is a very successful operation with mobility improving for almost all patients (and certainly pain improvement). Intermediate care is incredibly unusual in these patients unless there are indications known about pre-op. We used to “rest” people post op and delayed the push for return home and to activities and patients did worse. Higher risk of complications, higher risk of poor outcome.

@Dougt Im sorry your mom is struggling post op. If she’s gone to the hospital she is likely to be reassessed by physio and be provided with frame as needs be. She’s also likely to be checked over by an orthopaedic team to make sure they have no concerns. They may decide to keep her but equally if she passes safety checks they may let her go home. There’s pros and cons to each one and particularly as to which specialty admits her. I must admit I find private hospitals (even if on the NHS) quite enthusiastic in discharging patients as they normally have very fit and well (and younger) patients and seem very reluctant to keep patients beyond post op day one.

My ILs have had a selection of emergency and elective hip replacements between them, and I don't think they had crutches at all. They used walking frames and sticks. I don't believe they'd have felt secure on crutches. They were very conscientious about their exercises, and made good physical recoveries each time.
A lot of post-discharge care is involved, especially with elderly people. It boggles my mind to think of patients being sent home the next day without proper arrangements in place for them.

My reasonably fit and active 84 year old dad had a hip surgery after falling off a ladder. From memory he had a partial replacement about 24 hours after falling and was kept in hospital for a while. Sorry can't remember exact times but I'm sure it was at least a week they kept him in.

He was on morphine and other painkillers that made him feel very sick and he couldn't eat at all. After about a week we asked doctor to stop morphine as he was losing loads of weight.

Sent home with carers and physio but despite this went from being fit and mobile to using a frame and really struggling with everything. Getting into bed or out a chair or turning over became really difficult.

Usually my dad was busy all the time and used to help out his neighbours with their gardens etc

When he came out of hospital he he seemed to be making a slow recovery but died 4 weeks later. (sorry probably not what you want to hear)

He had help from me, physio and carers. Unfortunately he also had my mother screaming at him and abusing him so much that he got removed from the toxic environment by a gp who witnessed it and put into a local hospital. Hard to say if he would have recovered with a loving supportive partner to help rather than an abusive one who I'm sure contributed to his decline. (He also fell off the ladder because she was meant to be holding it but went and sat down but that's another story).

For me it was a horrible 4 weeks trying to look after him and watching him getting frailer and thinner. He had several more falls in that time (again caused by trying to do too much due to his toxic environment/partner). He was in and out of hospital over those 4 weeks as he couldn't eat all at. He never regained his appetite despite my best care and died skin and bones.

I hope your mother has a better experience. Like i said I truly believe with a peaceful home life and support from my mum he may have recovered so my experience may not be typical.

So sorry for your mum. It's heartbreaking when (nice) parents that you love are ill.

My Mum had a planned hip replacement (not for a fall/accident), and was discharged from our local NHS hospital the following day. It was ridiculous, she was in extreme pain, could barely move, and hadn't had any "training" in using the crutches they thrust in her hands as discharged her. No after care was put in place - we phoned her GP and they'd not had their copy of the discharge letter, so wouldn't prescribe painkillers, etc.

She was back in hospital the next day as she'd had a "hyper" or "hypo" (can't remember which) as her diabetes was way out of control (apparently an operation and drugs they give etc can destabilise your blood sugar levels so diabetes are at higher risk - no one said that and the ward nurses didn't seem to know how to deal with diabetes. It took them a few days in hospital to stabilise the diabetes, during which time, they actually gave her physio sessions and did a proper discharge/care plan.

Thing was the op was on a Friday, so presumably they were rushing out as many patients as possible to avoid them being in over the weekend!

Friend in her fifties had a hip replacement unfortunately had an infection which meant readmission. I'm wondering if your mum has an infection

Sadly familiar. MIL paid for a private hip replacement and ended up back in an NHS hospital where they picked up the pieces. It seems they're happy to take the money for the op but not interested in recovery.
Crutches are extremely difficult to use. My 20 year old fit DS found them very hard work. No way a frail elderly person could manage, they require a lot of strength.

I'm sorry to hear about your mother OP, to me that certainly sounds like an unsafe discharge from the private hospital.

My mother fell and broke her hip four years ago, she was 83. She was already frail and in a care home, but had been able to walk around fairly comfortably. She had a hip replacement and was kept in the (NHS) hospital for ten days. The nurse in charge said 10 days was the average for her age group. She was on a ward with others who had had the same op - they ALL used walking frames to mobilise the whole time they were on the ward. In fact to move my mother to the loo for a few days after surgery, they used a Sara Stedy.

Rehabbing her wasn't easy because she has cognitive problems, but her care home did a brilliant job, and within 4 weeks she had regained mobility and had stopped using walking aids. Obviously the care home had all the necessary kit - wheelchair, walking frames, a lift to take her upstairs - and a team of carers.

Hopefully now your mother is under NHS care she will have better pain relief and will be able to start mobilising successfully over the next week or two - and hopefully they will send her home with a walking frame.

Thanks so much for all the responses. I couldn’t find much about the realities of hip ops online esp at an older age and there was one thread on mumsnet saying the recovery was nothing compared to a knee replacement, which she had a few years back. The surgeon also filled her with hope (she was going to get a mobility scooter on hire for the recovery so she could still get out and about and walk her dog and he told her she wouldn’t need it!!).

Just wasn’t sure if she was unlucky!

I actually tried to get an OT assessment months ago whilst she has been waiting for the op and the council basically fobbed her off.

I couldn’t find much about the realities of hip ops online esp at an older age and there was one thread on mumsnet saying the recovery was nothing compared to a knee replacement, which she had a few years back.

Funnily enough, I had this chat with my surgeon a few weeks ago as I was questioning why his older patients seemed to be recovering more quickly than I was. (Not that I begrudge them in any way).

He said that hip replacements often bring more immediate relief to his older patients and they're in a better position than before surgery a month or so later. (Whereas the younger patients often have a history of childhood arthritis which can slow their recovery).

The physios say that knee replacements are more painful than hips but definitely worth getting sufficient painkillers. The lack of sleep can be really hard to handle too (I was given sleeping tablets reluctantly after a month of broken sleep).

I feel for her, it is really tough for the first few weeks.

as per @LeroyJenkinssss , enhanced recovery hips are often achievable (inc same day becoming more common). There are definite benefits to getting out quickly, particularly for older folk, however, occasionally it won’t go to plan and people will need readmitting. A UTI would be hard to predict unless a pre-op sample grew something. Enhanced recovery arthroplasty and GA is an unusual combination unless there was a particular reason to avoid a spinal.

Also worth reiterating that hip surgery for fractures is not at all comparable with elective hip replacement. Hip fractures are often multi-factorial injuries that have high morbidity and mortality even when managed really well.

Hope she’s back on track soon.

Update she’ll be in for tonight. Sounds like it was a UTI. They also did an X-ray so hopefully the hip is fine but it’s a bit of a confused picture as the information is coming via mum to my sister then to me. Doesn’t sound like she’s seen a physio yet hopefully tomorrow.

I am sorry people had such terrible experiences. I don’t know how they can’t warn family members that people will need more support at home.

Hi, Yes I was quoting another contributor and making the same point as you about the differences.

Can I just ask those who have experienced successful enhanced recovery hips/know about the evidence, do those people who do well have near constant care at home, to help being pulled out and helped into bed, and helped out of chairs, to go to loo, cook meals (as can’t walk with plate etc)? How long for? As we certainly weren’t warned about this being needed beyond the first 24 hours. Naive we now seem.

And does enhanced recovery work without effective pain relief (eg they didn’t give her the really effective stuff!)

And should a hospital ever discharge someone on this enhanced pathway who they noticed was confused?

From what I was told, most people have at least some help at home. But obviously not everyone.

A friend's mum in her 80s recently had a hip revision (which is a bigger operation) and the family dropped in to help with meals a couple of times a day. It's carrying hot drinks in mugs and food on plates that's hard. I have a sock device but needed help to remove the compression socks for a shower (people who live on their own don't have to wear these as you're not allowed to bend over).

You're not usually discharged until you're able to walk up and down stairs with crutches. You're encouraged to get up the same day in hospital so you should be able to manage the loo on your own using a frame or crutches (and a raised loo seat). Getting out of bed can be trickier if the bed is low so they advise to put it on blocks. And having a high-ish chair with arms to sit in during the day.

Cutting a long answer short, I think you can get by if someone makes you a hot meal a day. But the pain medication should be adequate to cope.