Hip replacement rehab

DoninNC

DW has been in Memory Care facility since March. Has been a fall risk since coming out of her psych evaluation. Talks in word salad and has difficulty following instructions. On Wednesday morning she fell and broke her right hip and they did a partial hip replacement that evening. The doctors and I are concerned that she won't be able to perform the needed therapy to strengthen the muscles to ensure that the surgery will be successful. I have no idea what type of facility would be able to help her. Does anyone have suggestions?

Ed1937

Hi Don. I had a hip replacement around 6 or 7 years ago. I went to PT for little more than a week. It helped, but I don't think it was something that had to be done. When I had mine done, I walked 3 miles a day (before surgery). After surgery I did a lot of walking, but not as much as before. I think the walking helped more than the PT, and I've heard of others who did no PT, but did a lot of walking to heal. If she can walk quite a bit with a walker, I really think it could help her. Best of luck to both of you. Sorry it's another thing to overcome.

Cynbar

I had a hip replacement about a year and a half ago (great result, by the way.) She will need a physical therapist to set up her exercise plan, and adjust it as she gets stronger. She will also need someone to help her do the exercises, a couple times a day. If the plan is for her to go for short term rehab, their staff will work with her twice a day (usually excepting Sundays.) The hospital can set that up for her and her regular insurance will pay. If you choose for her to go right back to her MC, the doctor can arrange for a home health agency to send in a physical therapist probably twice a week, to set up the plan. But she would need someone to lead her through the exercises a couple times a day. You would need to find out if the MC staff would do that (perhaps for an extra fee), or if you need to hire an additional person (insurance will pay for the therapist but not the aide.) You don't say if she is ambulatory, but the exercise program is well worth doing tp strengthen her muscles around the hip and decrease pain. I think improvement is possible even for someone with advanced dementia, the helper will have to lead her every step of the way and even provide some physical assist, stretching and lifting her leg for example as the therapist has directed.

DoninNC

Thank you for the advice.

Jane Smith

In the area where I live, there are rehab facilities that do exactly this. They take a patient straight from the hospital after surgery (or can admit from home or a facility) and the patient stays there for days to weeks to months. You want one that can deal with a dementia patient as well as one that has a full staff of therapists and needed equipment on site and can do physical, occupational, and perhaps even speech therapy. 

We did this for my mother several years ago after she fell at her memory care facility and broke her kneecap. She did make a full recovery but it was hard for her to do the PT, even with guidance.  They were very patient with her. Outside of PT, her care was…adequate. She improved more after going back to her regular memory care unit with residents and staff she knew. 

I found the facility by taking the list the hospital gave me and asking the nurse manager of her memory care unit and building which ones to consider. They gave me a short list of three and also a short list of places NOT to send her. 

Be warned that hospitals will sometimes surprise you by saying, by he way, we are going to discharge your person right now so where are they going???

Do NOT let them pressure you into a discharge if you’re not ready.  And have a long talk with whoever at Memory Care you are most confident/comfortable with. Another option may be for her to return to her memory care and bring in therapists.  She will almost certainly not be able to do exercises alone on her own and will need help.  

Also remember that surgery and a hospital stay can be disorienting for someone with dementia, as can anesthesia, medication changes, pain, and everything else about hospitals and surgery.  Don’t be discouraged if she doesn’t bounce back right away. 

Wishing you all the best.

M1

Don, ask for a bit more detail about what surgery was done.  One of the big risks with full hip replacement done from a traditional posterior approach is dislocation; you cannot bend over/move the wrong way for about six-eight weeks postop.  Hopefully they didn't do that, but I would ask.  Her ability to cooperate will be key.

ElaineD

Can the PT be done in the MC facility?  Our MC has a contract with a PT company that comes in and has a special room for PT, in the facility.  The therapists are terrific.

Or perhaps you can contract with a private PT to come in?

Just a thought.

Elaine

Ed1937

M1 wrote:

One of the big risks with full hip replacement done from a traditional posterior approach is dislocation; you cannot bend over/move the wrong way for about six-eight weeks postop.  

That is what I had. While I was in the hospital, I was talking to a doctor who had the same surgery. He told me that when he started healing, he forgot about bending at the knee. He put his foot up on a coffee table, while he was sitting on a couch. He dislocated his hip. He told me that was the worst pain imaginable. Much worse than anything he had before or after surgery. I became much more focused on what I was doing, and my recovery went very well.

JJAz

Rehab facilities are not set up very well for dementia patients.  I stayed with my husband 24/7 at the rehab facility to ensure his safety and his compliance with rehab. 

Blessings,

Jamie

zauberflote

Don, I think it depends on how mobile she was before, and how mobile you'd like her to be after. I've had both hips done, with minimal PT for the first, and zero PT for the second. The rehab came some years later when I started barre exercise classes!

Mom's hip sheared and displaced some months shy of her 92nd birthday. She was mobile before, and was on hospice. Long story short, we chose to go off hospice for a partial replacement, she came straight back to MC and hospice. I had meantime found a mobile self-pay geriatric orthopedic dementia-experienced PT, who was perfect for her case. She did walk after, as far as she needed to go. I personally would avoid rehab for almost anybody. It is boot camp, they expect you to be self-directed, and to be able to tolerate 4 hours of hard exercise/day. MIL was sooooo miserable in hers. Mom was miserable in hers on a previous occasion. 

Another thing we were able to find for Mom after that rehab stint was a geriatric Personal Trainer. She was a jewel! Worked with Mom twice/week for over a year, had her doing 2-lb weights and obstacle courses. If you can find something like that, a few months after the surgery, that could be all you need. 

I recommend a joint replacement forum called BoneSmart. You'll find your DW may not be the only one in her situation. 

Donr

There is a new procedure out for hip replacement.  It is done with small incisions. Some patients go home the same day or the next day. PT is still required.  There are a couple of videos on YouTube and I read about first in our newspaper.

Cynbar

Yes, I had the anterior approach which involved small incisions, short or no hospital stay, and much lower risk of dislocation. The posterior approach has been around longer and some doctors still do it that way. Anyone considering hip replacement should do the research in advance.

I also want to say that some short term rehab facilities (often nursing homes with a rehab floor) specialize more in seniors and therefore have more experience with dementia patients. My DH went to STR a couple years ago after a popliteal aneurism repair in his leg. The staff there worked with him patiently twice a day, he made good progress and it wasn't unpleasant for him at all. In our area, there is a stand-alone rehab hospital that specializes in younger patients, many of them sports injuries. Their approach is more aggressive, from what I've been told. So, ask questions and choose wisely before sending a dementia patient for rehab. The advantage is that they will get a lot more therapy than if they return home or to their MCC with outpatient visits.

vtgsell

Hi.  My mother, 83, fell about 2 months ago and broke her hip.  Prior she was mobile but with very little stamina, roughly stage 4 dementia.  She went to an acute rehab that was both wonderful and awful for her.  The quality of care was wonderful, and they sent her home walking everywhere she needed to go.  They supported her dementia as well.  For her it was very confusing to be in an unfamiliar place, especially in the evening.   She came home probablly a stage 6 but has recovered to perhaps a stage 5.  Very hard to seperate the dementia challenges and the mobility challenges right now.  Bottom line, she walks and I credit the facility and her continuing therapy.  She does very well with instructions from someone she likes and is very compliant with therapy when it is happening.

The hard part are the hip restrictions.  She retains no big picture memory that she even broke her hip, never mind that there are several ways she should not move her body.  For weeks, I watched her like a hawk and corrected/monitored her motions and reminded her.  But, it's just not able to sink in.  The past 2 weeks, she's 10 weeks past surgery, I have just been watching as she crosses her leg to put on her socks and shoes.  Correcting her just diminished the self confidence and initiative she had, allowing her to act independantly encourages less apathy but puts her at risk.  

She was living alone before this happened, with a lot of help, but next week she is moving to an assisted living/memory care facility.  

I hope your loved one heals well.   My mother also retains no memory of doing exersizes, her doctor said as long as she's walking, she's getting stronger.  So I find as many ways I can each day to encourage more walking.