Most Hip Patients Make at Least Partial Recoveries
Any surgery is serious for the elderly, and hip surgery such as that undergone Saturday morning by former President Ronald Reagan is a major procedure. But most people--even if they are older than 80--recover at least some mobility, especially if they were in good health before their accidents.
An estimated 350,000 Americans are hospitalized for hip fractures each year, with women accounting for 75% to 80% of all cases. The primary cause of hip fractures is the loss of minerals in the bone associated with osteoporosis, which is a big problem among women, but which also affects men.
And it is a problem of aging. Beginning at age 50, the risk of hip fracture doubles every five to six years, according to the American Academy of Orthopedic Surgeons. People who are 85 or older are 10 to 15 times more likely to experience hip fractures than those between the ages of 60 and 65, according to the Centers for Disease Control and Prevention.
Dementia and other types of mental impairment, including Alzheimer’s disease, increase the risk of falling, which raises the risk of fractures.
Dr. Kevin Ehrhart, who performed the surgery, said the operation was helped because Reagan’s “tissue and especially the muscle and the bone were that of a much younger man.”
Hip fractures are actually a break in the femur, the long bone in the upper portion of the leg. Most commonly, the break occurs in the neck attaching the femur to the ball-shaped portion of the femur that fits into the socket of the pelvis. In that case, surgeons simply insert one to three metal pins through the neck to hold the two halves together while the break heals.
The former president suffered the less common and more serious form of fracture in which the break occurs below the neck, in what is called the intertrochanteric region. In these cases, a larger pin is inserted through the neck and into the ball, with a bent section protruding and lying alongside the femur, where it is screwed into place. This procedure takes longer than the simple insertion of a pin, and it takes longer for the fracture to heal.
A fracture lower down on the femur is a broken leg.
If the joint itself is already deteriorated as a result of arthritis or other bone disease, surgeons may choose to insert an artificial ball made of metal, or in more serious cases, an entire ball and socket.
Reagan Could Be in Hospital 10 Days
If the patient was mobile before the fall, as Reagan was, medical personnel will have him sitting or standing up the day after the surgery and walking in another day or so. Hospitalization can be as short as three or four days, but a week is more common, and for patients with other health issues, it can stretch to two weeks. Reagan’s doctors said he could be in the hospital for a week to 10 days.
Complete healing of the bone may require a year and will require physical therapy. The biggest potential complication caused by Reagan’s underlying Alzheimer’s would be difficulties in adhering to the therapeutic regimen, but he has a wife and other caretakers to ensure that he follows physicians’ orders.
About 40% to 50% of people older than 65 who break hips enter convalescent homes or other extended care facilities after they are released from the hospital because they have no one at home to care for them. Most of those people never leave the extended care facilities.
Only about 25% of those with hip fractures recover the full mobility they had before their falls. A full 50% will require canes or a walker to get around.
Death rates associated with hip fractures range from 15% to 35% after one year. Some are the result of complications from the surgery, such as blood clots, infections and pneumonia, but many are linked to the underlying physical infirmities that were present before the fall.
Age is not necessarily a factor in recovery. Two recent studies, one by Dr. Kenneth J. Koval of the Hospital for Joint Diseases in New York City and one by Dr. Heidi Michelson of New York Presbyterian Hospital, found that healthy 90-year-olds were as likely to recover completely as younger people if they receive adequate care.
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Repairing the Hip
Former President Reagan suffered a type of hip fracture in which the break occurs below the neck of the femur. In these cases, a large pin is inserted through the neck and into the ball, with a plate protruding and lying alongside the femur, where it is screwed into place. An example of this type of surgery:
Source: Mayo Clinic
