A few weeks ago, V.S. Padmavati had come back from a function and was changing her sari, when she slipped and fell, breaking her hip bone. The 94-year-old was immediately taken to the hospital. Twenty-four hours later, a hip replacement was performed; nine days later she was home, and now, two weeks on, she is walking with the help of a walker and her family is hopeful of a complete recovery.
Increasingly, said R. Aravindan, chief orthopaedic surgeon, Kauvery Hospital, senior citizens in their 90s, mostly women, are coming in for hip replacement surgeries after minor falls and with better facilities available for their care, these surgeries no longer carry the same risks they used to.
“The life expectancy in the country has increased, which is one reason more people are coming in. More women than men come in for the procedure, as a larger number of women suffer from osteoporosis – a condition in which the bones weaken and become brittle,” he said.
Regional anaesthesia, better pain management after the surgery and use of un-cemented implants, which lower the risk of blood clots in the lung, have all made the procedure less risky than it used to be, said Madan Mohan Reddy, senior consultant orthopaedic surgeon, Apollo Hospitals. He says he sees at least five above 90-year-olds per month. “We also mobilise the patient on day one after the surgery so there are lower chances of a leg infection,” he explained.
There are types of hip replacement procedures – total which involves replacing the ball and the socket, and hemiarthroplasty which involves replacing only the ball.
For over 90-year-old patients, hemiarthroplasty is preferable, said A.B. Govindaraj, head of orthopaedics, Fortis Malar Hospital. “On Saturday morning, I did the procedure on a 99-year-old woman,” he said. This procedure, he explained, had lesser risks than total hip replacement, but would also have slightly lower levels of mobility and the surgery was of a shorter duration than a total hip replacement.
“But we do not say no to a total hip replacement and have done a few for those above 85 who are very mobile. A total hip replacement has a longer life but even with the hemiarthroplasty, patients can function independently, which is the goal,” he said.
Fitness and mobility of the patient as well as the status of the joint are all considered before deciding upon the procedure, said Dr. Aravindan.
There are risks, of course, said Vijay C. Bose, consultant orthopaedic surgeon, SRM Institutes for Medical Science, but not doing the procedure would mean that these patients are bedridden, which carries its own complications such as lung infections and bed sores. “Though it has a risk, the benefit of getting the procedure done is better than the risk of keeping them in bed,” he says.
The hip bone, said Dr. Bose, is the weakest link in the skeleton and fractures are very common. What was important, he said, was to do the surgery as soon as possible, preferably within 24 hours, as the earlier the surgery, the faster the mobility and rehabilitation, and better the outcome.