FAQ Category: Hip

Some say you are as old as you feel. Still, there’s a biologic age that defines “old.” With the continued aging of America, the term “elderly” is being replaced with the word “aging.”

People who study aging adults are trying to define new age categories. This will help researchers identify risk for illnesses and injuries (like hip fractures) at each age level. Prevention programs can begin before adults reach the age with the greatest risk.

At the present time, the National Institute on Aging (http://www.nih.gov/nia/) has identified the following age categories. These may change slightly with more research:

Pre-elderly: 55-64 years
Young-old: 65-74 years
Middle-old: 75-84 years
Old: 75-84 years (Note: Whether someone is “old” or “middle-old” depends on health status.)
Frail-old: 75 years and up
Oldest-old: 85 years and up
Elite-old: 95 years and up
Centenarians: 100 years and up

Basic transfers include moving from a lying down position to sitting up, and from sitting to standing. These movements are necessary for using the toilet. “Independent transfers” mean the person can do these movements without help of any kind. “Assisted transfers” mean the person can get up with the help of a device or person.

Assistance varies from having someone standing nearby to having one person on each side lifting and holding. Assistance may be in the form of a walker, or a vertical pole attached to the side of the bed.

After hip fracture, patients who can transfer and walk without any assistance are the most successful taking care of themselves at home. Patients who cannot transfer or walk without help may require family assistance or a short stay in a rehab center.

There are a few ways to predict how a patient will do after surgery for hip fracture. Age, mental status, and the ability to get around before the fracture are three factors that predict outcome. In addition, patients who can get out of bed and walk 50 feet by the second day after surgery are more likely to do well at home. Those who can’t get up and walk may need extra help at home, or they may need to stay in a nursing home for a little while.

The hospital staff is available to help you make this decision. In addition to your mother’s doctor, you may want to consult nurses, physical and occupational therapists, and social workers.

You probably need shoes specifically for walking. Despite the advertising claims of many shoe companies, today’s soft sole materials do not fully absorb the force of impact from walking. Although flexible shoes are more comfortable, they do not provide the stability you need.

After age 50, the force of impact during walking increases dramatically. This can contribute to the development of hip and knee arthritis. Thin but firm-soled shoes are recommended. These will reduce the impact and improve your stability.

Until the late 1990s, it was still thought that osteoarthritis could be caused by “wear and tear.” This could mean daily activities, repetitive motions, or exercise. Scientists are getting closer to understanding the mechanisms behind this kind of arthritis, but the exact processes remain unknown.

It is known that impact from sports activities usually doesn’t cause osteoarthritis of the weight-bearing joints (hip and knee). The exception to this may be in high-performance runners, those who train and compete at high intensities and long distances. These athletes are exposed to much more impact over a longer period of time. Slower, noncompetitive runners do not have the same risk.

Probably not. Canes and other walking aids actually dampen forces that act on the joints. It is more likely that the low back area has absorbed some of the stress normally taken by the hip.

When the hip is painful, it is not always possible to put full weight through the joint. The body compensates for this by transferring some of the normal forces generated through the hip to the pelvis (the bones between the hips). Pelvic motion is altered to help the hip. This in turn increases the load on the low back.

You should report your symptoms to your doctor. It may be that exercises prescribed by a physical therapist can help you balance out the stress on the back, pelvis, hip, and knee. Dealing with your symptoms now can help prevent other injuries.

The natural aging process does cause increased stiffness throughout the body, but usually this is equal on both sides. When you have pain or symptoms in one joint, you may be experiencing more than just natural aging.

Early degenerative arthritis of the hip, called osteoarthritis, can bring about changes in the way a person walks. The body compensates in order to take pressure off the problem joint. The stride gets shorter, so the person takes shorter steps at a slower speed. Sometimes the number of steps taken per minute decreases, too.

It may be wise to bring these changes to your doctor’s attention. He or she will evaluate you and determine if anything more serious is going on. If you have early arthritis, it is important to keep up exercise and physical activity. Your doctor may recommend a physical therapist who can help you find just the right program for your condition.

Research has shown that patients have better outcomes from hip replacement when their surgeons do many of these procedures per year. This may be especially important in smaller hospitals, where there are fewer hip surgeries overall.

A recent study looked at 59,000 Medicare patients who had hip replacements. Researchers examined the results 90 days later. Complications were rare. But patients whose hip replacements were done by surgeons who did more than 50 procedures a year had fewer dislocations than those operated on by surgeons who did fewer than five procedures a year. Patients with “high load” surgeons also had less infection and pulmonary embolism.

It’s important that you’re comfortable with your surgical care. Talk with your doctor about your options.

Possibly. Studies have shown that patients fare better when they have surgery in hospitals that treat lots of similar cases. Bigger hospitals tend to see more cases and may have the advantage in this regard.

A recent study looked at the 90-day results of nearly 59,000 Medicare patients. Patients who had hip replacements in “high load” hospitals (more than 100 procedures a year) had lower rates of death and dislocation than those in “low load” hospitals (fewer than ten procedures a year). Patients in “high load” hospitals were also a little less likely to have deep infections.

With this in mind, you may want to travel to the bigger hospital. But bear in mind that, overall, your risk of complications after surgery is low. Above all, it’s important to choose the center you feel will provide the best care. There are many factors that go into patient care. Talk with your doctor about your options. He or she may be able to provide information to help with your decision.

Be careful about where you have the surgery–and who does it. A recent study looked at the results of 59,000 Medicare patients 90 days after surgery. The number of hip replacements done by hospitals and surgeons made a difference in patients’ results. Patients were less likely to dislocate the new hip when they had surgery in hospitals that did a lot of hip replacements. Patients whose surgeons did a lot of hip replacements also had fewer dislocations.

There is no “magic number” of surgeries per hospital/surgeon that will guarantee your new hip. The number of complications goes up as the number of surgeries goes down. Happily, dislocations are rare (three percent in one study). Talk with your doctor about the measures you need to take after surgery to protect your new hip.

You will have to ask your doctor this question. If either of your joint replacements were cemented with a substance containing polymethylmethacrylate, you may be advised to avoid breast-feeding.

Improved materials and technology have made it possible for younger women to have hip joints replaced. In 1996, 138,000 total hip replacements were done in the United States. Three thousand of them were in women under 45 years of age.

It appears safe to have one or more pregnancies after a hip replacement. In the small group of women studied, no damage to the replaced hip was observed after pregnancy.

The number of people with arthritis of the hip (called primary osteoarthritis) is not related to latitude or longitude. Ethnic background and genetics (passed down in families) seem to be much stronger factors. Compared to Blacks, Hispanics, Native Americans, and Asians, Whites (Caucasians) are much more likely to have hip osteoarthritis. Specifically, if you are white and have a mother, father, sister, or brother with primary osteoarthritis, your chances of getting hip osteoarthritis are much greater than those of other groups.

If your doctor does your surgery from the back part of the hip, called a posterior approach, you need to avoid bending your hip more than 90 degrees. You can kneel down, but try to avoid kneeling directly onto the operated side. If you must kneel, keep your weight even on each side. While kneeling, avoid bending too far forward at the hip because you could bend your hip past the safe limit of 90 degrees.

Do not get onto your hands and knees. This position immediately puts your hip at a 90-degree angle, and the added pressure of your body weight on your hip could force the hip to dislocate out of the socket.

The answer usually is “as soon as you are ready.” However, this depends on the activities you have in mind. Some activities, like high-impact sports and recreation, are not recommended after hip replacement surgery. Other activities, like walking, swimming, and cycling, can usually be started once your pain is controlled and your strength improves. It is generally just a matter of getting warmed up and used to doing those kinds of activities again. You should begin these activities in a gradual, guided manner to avoid injury and complications. Be sure to ask your doctor if you have questions about the activities you’d like to do.

Sometimes people who have knee or hip pain from osteoarthritis are hesitant to do exercise. Along with weakening of the joints and the muscles around these joints, inactivity also leads to poor fitness. Exercise is a way to ease pain and improve ability to do daily activities, even for people who have knee or hip osteoarthritis. 

It can be, depending on how great the difference is and what physical condition the person is in. Researchers recently attempted to determine how much discrepancy could become a problem using a set of healthy participants age 55 to 86.

Small shoe lifts of varing heights were placed in the participant’s shoes. Then they walked on a treadmill. Heart rate, muscle activity, oxygen use, and air exchange were monitored.

Researchers found that a 2 cm of leg-length difference had a considerable effect on oxygen use and how hard the walkers felt they were working. Between 2 and 3 cm of difference in leg length made a big difference in most of the factors tested.

This led researchers to conclude that elderly patients with significant cardiac, pulmonary, or musculoskeletal problems might have trouble walking with even 2 cm of difference in leg length.

It isn’t uncommon for total hip arthroplasty and other surgical procedures to result in one slightly shorter limb. The authors of a recent study tried to determine how much of a problem leg length discrepancy is in the elderly by studying 44 healthy men and women age 55 to 86.

Small shoe lifts of varing heights were placed in the participant’s shoes. Then they walked on a treadmill. Heart rate, muscle activity, oxygen use, and air exchange were monitored. 

Researchers found that a 2 cm of leg-length difference had a considerable effect on oxygen use and how hard the walkers felt they were working. Between 2 and 3 cm of difference in leg length made a big difference in most of the factors tested.

This led researchers to conclude that elderly patients with significant cardiac, pulmonary, or musculoskeletal problems might have trouble walking with even 2 cm of difference in leg length.

Many people have a slight difference in the length of their legs. Researchers estimate that 40 to 70 percent of the population has one slightly shorter leg.

Whether a slight difference in leg length is a problem tends to depend on the individual. For example, in athletes, a small difference in leg length may make a big difference in performance. Similarly, in an elderly person with heart trouble, a small discrepancy may make a big difference in walking, since even a 3 cm limb-length difference has been shown to increase an elderly person’s heart rate while walking.

You should talk to your doctor about your concerns. Your doctor is in the best position to determine any individual problems you may have.

There is evidence that limitations in hip flexibility could impair walking ability in the elderly. This increases the risk of falling. As you walk, the hip extends in the back leg. A new study showed that the hip joint doesn’t extend as far back in the elderly as in younger people. Elderly people at a high risk for falls showed even less hip extension.

So a stretching program that helps improve hip extension could potentially help elderly people avoid falling–and the pain and hospital stays that falling can cause. Before starting any form of treatment, your mother should talk to her doctor. She also needs to address any other problems that may put her at risk for falling. These can include balance, strength, or vision problems.