It’s hard to imagine when you’re young and healthy, but the single biggest cause of death among otherwise healthy elderly people is falling. Hence, fall prevention is a big deal. Researchers recently set out to discover whether getting your hip replaced would help reduce falls. What they found makes sense.
I live in a Victorian neighborhood where many of my neighbors are elderly. One house across the street used to have an elderly (90+ years old) couple. My wife and I spent a number of nights helping the husband up as he began to increasingly fall. For the uninitiated, it’s hard to understand the impact of falls, so let me lay it out from a physician’s perspective.
The problem with falls in the elderly is that they usually break something. In the case of the guy across the street, it was a subdural hematoma (bleeding on the brain from a fractured skull due to a fall) that was the beginning of the end. For others, like my dad, it was a fractured hip that began a new disease that ultimately started his long slow deterioration toward the end of life. Hence, an elderly person who never or rarely falls can literally prolong life.
Risks Associated with Hip Replacement
I recently shared a study finding that pseudotumors are common after hip replacement regardless of the materials used to make the artificial hip device. Pseudotumors are associated with pain, decreased function and range of motion, and just generally poorer hip replacement outcomes. Pseudotumor or not, another study suggested that 67% of hip replacement patients are still in pain, which is disturbing as most patients are under the impression that hip replacement is the answer to their pain!
If you had low-back issues before your hip replacement, there is a good chance you’ll still have pain after the surgery. The musculoskeletal system is one connected unit, not individual parts and pieces. If there is a pinched nerve in your low back, for example, this can refer pain to any point along the nerve branch (e.g., hip, knee, ankle, foot, etc.).
Other risks associated with hip replacements include hip dislocation, particularly if you’ve also had a lumbar fusion. This risk increases with the number of fusion levels. In other words, if you’ve had three levels fused in your back, there is greater risk of hip dislocation after a hip replacement than with one or no back levels fused. Nothing artificial can function exactly like your own hip is supposed to, so this is why your hip alignment can suffer following a hip replacement. And because the biomechanics of the hip and knee work together, disruptions in hip alignment following hip replacement can also impact the alignment of the knee.
If this isn’t enough, here are a few more problems that can stem from hip replacement (and this list isn’t exhaustive): Genetic defects can result from damage done to the chromosomes by debris that wears off of the metal used in the hip device. Wear particles can cause metal ions in the blood, which can lead to metal toxicity. Hip replacement increases stroke risk, and heart attack risk doubles in men following hip replacement.
Does Hip Replacement Lower Fall Risk?
The purpose of the new study was to investigate falls by women (n=140) with severe hip arthritis both before and after hip replacement. The findings were then compared to a control group of healthy women (n=319). The results? Researchers found that within a year of hip replacement, 30% of patients experienced at least one fall (13.5% of the healthy control group experienced falls). Additionally, In the hip replacement group, there was no significant difference found in falls before (31.4%) and after (30%) surgery. And of those who fell after hip replacement, injuries occurred in nearly 38%, with 6% experiencing fractures.
So while we might not expect an invasive hip replacement to lower the risk of falls to the healthy control-group level, we should expect it to at least significantly lower the risk of falls compared to the before-surgery levels. This study, however, suggests that isn’t happening, and not only are post hip replacement patients still falling but many are also experiencing injuries when they fall.
The upshot? Avoiding falls in the elderly can literally save a life. Turns out hip replacement isn’t one of those things that will help reduce these deadly accidents. In the meantime, more reliable ways to help reduce falls are the easy fixes like getting rid of area rugs and obstacles on the floor and using a walker.