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My Mom is 89, fell and fractured her hip almost 2 weeks ago and is in acute rehab. She is hurting and can barely stand or walk without pain. One day she takes 4 steps with coaxing and today no steps we could barely get her to stand and she screams out in pain. Acute Hospital is discharging her Friday and we have her going to a sub-acute rehab with hopes that if she keeps moving it the pain will eventually subside enough for her to walk on it. She basically is a strong woman but her lifestyle was very sedentary prior to breaking her hip bone.

I had total right hip replacement four weeks ago. I’ve had total hip previously on my other hip. This time, very different, agonizing pain the moment I was coming out from anesthesia. When PT got me up a few hours later, wanted me to walk the hall, excruciating pain upon weight bearing. Every single time, and pretty rough pain when not standing. Nursing staff wasn’t properly documenting the horrible pain, particularly on standing. Pain meds did not help. They discharged me home two days after surgery anyhow, to languish in pain, take care of myself, and pets. I hired help to do pet care. Languished first two weeks in pain. Demanded surgeon investigate, as the pain was so abnormal, compared to three prior hip surgeries. He ordered fluid aspiration, pain medication into the new hip joint area. Absolutely no relief. Cultured aspirated fluid, no bacterial infection, thankfully. Next he had me come in for XRay, hip looked fine. Prescribed muscle relaxer, plus steroid pack for inflammation. Bingo! Stretched muscles, spasms, from the hip replacement surgery. I was seen by pain management this past week, and she wants me to stay on the muscle relaxer several weeks, at least. My surgeon lengthened the operative leg slightly, to level out my pelvis, and give enough length, anticipating my old left hip replacement is wearing out. He wants to be able to use a decent thickness cup liner when he revises the old left hip.
Is it at all possible the joint is fine but the muscle has been overstretched, causing horrible pain spasms? There is a tendon, the Iliopsoas tendon, that can cause horrible pain after hip surgery, which is what happened to me. Some surgeons have had to go back in and release that tendon. Would the doc consider a trial of a muscle relaxer?
I feel so bad for your mom. And, yes, anticipating pain makes things worse, but frankly, I don’t blame her, if she’s hurting like I was. My pain was so unnecessary. If only the nurses and doc would have been willing to listen to me complaints of horrible pain.
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Harpcat Oct 12, 2019
This is good to know as I'm having hip replacement in a few weeks and they will be lengthening my leg as well.
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My mother had a broken hip for about 2 weeks before the PT finally ordered another xray.

Jane Brody, science writer for the NY Times was in excruciating pain after a knee replacement and was laughed off by her surgeon. It turned out she had a massive infection within her knee.

Please get your mother to a doctor and INSIST on imaging. Women get miserable health care; older women get worse.

Please advocate for her. Today.
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gdaughter Oct 12, 2019
EXACTLY. No one knows us as well as ourselves and we know when something is not right. I fear for those of us who will age without someone to be our advocates...
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Others have said this; I just want to emphasize it.

Contact the PA, NP or ortho surgeon who performed the surgery and ask if she should be non weight bearing.  This is critical.   My mother experienced a similar situation; the therapist said she wasn't cooperating and discharge was discussed.

We contacted her surgeon, got a letter attesting to the need for non weight bearing status, and took it to the rehab facility and presented it at a status update meeting.  In fact, the surgeon was angry that the therapist wasn't addressing this issue but was pushing for standing exercises.

We prevailed.   The therapist was moved to another facility; a new therapist was provided; non weight bearing exercises were introduced, and Mom healed and got better.
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PK1111 Oct 10, 2019
The surgeon told us right after the surgery that she can put weight on her left (surgery side) right away if she felt ready.
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I was able to review the results of the xray on her medical portal and here is what the results said:
HISTORY: Prior fracture status post repair, increasing pain.
Frontal view of the pelvis as well as AP and frog-leg images of left hip are
provided.
COMPARISON: September 29, 2019.
Bone mineralization is diminished. There is left-sided hip nail in place. No
new fracture. No evidence of hardware displacement. Pelvic ring is symmetric.
IMPRESSION: No new abnormality identified.

They said she can bear as much weight as possible. We are seeing very small changes as to how she moves with less screaming and moaning...she still seems afraid of the pain however...I pray her new therapy will help...

I pray that the pain subsides for her soon...
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AlvaDeer Oct 12, 2019
Thank you for the update on this. At least this looks good for now. Girlsaylor has great information above, and I am a bit heartened not to hear she had such pain, but to know that this "can" happen. So sorry your Mom is going through this.
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I have read your X-ray results so at least that is negative. When my dad had his various fractures (both pelvic and hip), we found it was very important that he be given his narcotic an hour before the PT so he could tolerate it. Be sure they are managing her pain before she goes to therapy. When they feel she is no longer progressing, then she will be discharged. But first you will have a care conference with the staff involved in her care. From there they will decide where her next move is. I.E., back to IL or into a higher level of care. I would not suggest you take her into your home. They have the facilities there for those whose mobility is limited and are fall risks. You can depend on her probably having another fall at another point. As we always said, it's not if but when dad falls again.
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Tedfosu Oct 14, 2019
Yes! Forgot to mention that it was imperative that my mom took her narcotic pain killer about 1 hour before physical therapy. Without that she was in too much pain to accomplish much in PT. Much of that pain was due to a pre-existing neck deformity and not the fractured hip but regardless—pain is pain and without meds she was unable to tolerate PT. You’’ll need to stay on top of staff to make sure this is actually being done. My mom was too confused to remember exactly when or even if she had received her pain meds and I wasn’t able to be physically present at the time she needed to take them prior to PT. When I was lucky enough to get hold of her nursing notes (which all 3 facilities were very reluctant to share), I saw that it was very hit or miss. You need to know exactly when these meds are administered in order to make a good assessment of her progress or to understand why problems are occurring. In my case I had to become very militant and annoying in order for her to get the meds when she was supposed to. They also kept playing games with the orders—changing the pain meds to PRN instead of as a standing order. My mom was way too confused to ask for the pain medication at the right time even if she was in pain and she often couldn’t remember if she’d gotten it or even what medication she took since she took several other meds as well. It required more battles to get the pain med put on standing order before PT and then just when I was satisfied she was receiving it regularly at the correct time they would arbitrarily change it back to PRN without notifying anyone. (They seemed to think that if the meds were working and she was actually comfortable for a day or two then it was time to withdraw them.) After a couple days of her complaining of too much pain to participate in PT, the nurses would tell me she hadn’t asked for it... and the cycle would began again. Hopefully others haven’t had such bad experiences but I mention these things because all the poor-performing facilities appear to follow the same game book—which I knew nothing about until it happened to her. If you’re aware of how the game is played you have a better chance of preventing problems.
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Thanks everyone I have asked the nurse to get the Drs to approve an Xray just to make sure. She is scheduled to leave here tomorrow but my hopes are that they do the Xray and let us know the outcome by morning. I would feel terrible if I keep pushing her and there was something else wrong. Thanks everyone for the suggestions! Ps. She does have a touch of dementia so if the Xray comes back ok I am going to place much emphasis on her having to do that therapy so she gets to go home.
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BarbBrooklyn Oct 10, 2019
PK, I can't tell you how awful I felt when I found out that my mom's hip was broken and we'd been assuming that she was malingering! She'd had a stroke, had aphasia so couldn't really talk and thank G-d the PT noticed that she wasn't bearing weight on one leg. As Alva says, most PTs are better diagnosticians of this sort of thing than docs.

Please let us know how this works out.
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Well we moved my Mom to the sub-acute today. She was agitated because she is in a shared room with her room-mate in a bed directly across from her so we just pulled the curtain. I have never seen my Mom like this she usually is light hearted and friendly. We did have the hospital give her an xray before we left and they said it came back ok and everything looked fine with her surgery and no other probelms. I guess at 89 years old you just don't pop back and this pain is really hard on her. I truly feel she is in the right place now with a team of therapists that specialize in geriatric patients and they will with time help my Mom get back on her feet. Right now though she is still totally dependent and it's so hard to watch her in pain. Thanks everyone for listening!!
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BarbBrooklyn Oct 11, 2019
Pk, did you look at the xray with one of the docs?

Did you ask why she might be experiencing so much pain? Have they considered that there might be a pelvis fracture?
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When my friend broke his femur at his hip, he had to have major surgery to have pins and rod put in. The pain was excruciating. The Drs said it was completely weight bearing. They had to use the sling for the first couple weeks in rehab before graduating to a sit and stand. The problem I figured out is the nursing/Cna staff are really busing in rehab and the PT’s would come get him before the nurse would give him his pain pills. I absolutely forbid the PT’s to take him to therapy without his pain meds given a half hour prior. I sat on their backs every single day. Bottom line is he went from AL memory care to skilled care when rehab was finished. He continued to get some rehab in SNF but not enough to go back to AL. Anesthesia caused his memory test score to go from a 14 to 6. So what I am trying to say is make sure she is getting enough pain meds and that they are given a good half hour or more prior to PT. Best of luck.
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gdaughter Oct 12, 2019
Not to mention attention to cognitive functioning after anesthesia. Check out SAIDO. if interested...
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My 83 yr old mom fell in our apartment (very minor fall) and couldn’t get up. After surgery for a broken hip and 1 week in the hospital she went to a short term rehab for what was supposed to be 4-6 weeks. Long story short—it’s been 8 months, 3 nursing homes and 4 short hospital stays later and she still can’t walk or stand on her own and doctors can’t find a reason. She became incontinent and acquired rapid onset moderate dementia. (It’s assumed a vascular incident is at the root of her fall and subsequent deline but scans are negative for stroke.). She’s obsessed with learning to walk again and intensely interested in physical therapy so has approached any therapy with a super positive attitude. She really didn’t complain of pain in the hip but had pre-existing chronic pain condition which does play a part. One of the doctors told me that the life expectancy of someone her age who fractured a hip 2 yrs at most.

In your mom’s case I would not rule out fear and/or poor management of pain being a factor because it certainly was/is a component of my mom’s inability to walk. Another possible issue is quality of the facility she’s in. Prior to my mom’s recent transfer to her current outstanding nursing home she was terrified, depressed and mistreated. She was offered no encouragement to walk and wasn’t even given the required minimum number of physical therapy sessions. The longer she went without walking the worse her fear of falling became.

My advice is to address any fears surrounding falls and to check on pain medications she may be receiving. Although pain medication should be given with caution to the elderly, it sometimes does need to be given. In all 3 nursing homes my mom was in prior to the one she finally ended up in, they arbitrarily reduced or cut off her pain medication every chance they had—usually without even telling me although I’m the HC proxy.

Another issue I’ll raise as a potential factor is treatment she’s receiving at the nursing home. I had no idea how badly the elderly are being treated in nursing homes. I live in a major urban city and without exception all of the skilled care facilities were awful —It was just a matter of some being slightly less awful than others. If there’s any doubt about quality of the facility—follow up on it. What was supposed to be 30 minutes of physical therapy daily for my mom turned out in reality to be 10 to 15 minutes daily maybe 3-5 days a week with no additional exercises or encouragement to walk. Nursing notes documented what she SHOULD be receiving—not what actually took place. Maybe I experienced an extreme case but poor treatment at the facilities most definitely impacted my mom’s physical & mental condition. To end on a positive note, I’m her only family member and since we can’t afford private pay, I looked for the highest rated facility accepting Medicaid and moved her 5 hours away from where we lived. Despite considerable hardship to myself I’d say it’s been totally worth it. She describes it as like being in heaven or Disneyland and has already shown improvement. Although I sacrificed a lot to put her there I can now go to sleep with a smile on my face because it’s the happiest she’s been since even before her fall.

Whether my mom walks again or not doesn’t really matter anymore. Quality of life is everything and I believe my mom will reach her full potential now—regardless of what that turns out to be. She knows that she’s finally receiving adequate physical therapy and all the help that she requires and the result so far has been incredible to witness. She knew that she wasn’t receiving good care and it resulted in an obsession with her failure to walk. She still hopes to walk but no longer focuses on what she can’t do. Her days are now filled with things that she has enjoyed and succeeded in doing as well as the future things she looks forward to doing and learning. That’s all one can ask for really.
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My dad "severely bruised" (Dr. diagnosis) a hip at age 82; went to the E.R. he preferred. Back at home he continued to complain about severe pain. The same night I called the E.R. and spoke to a nurse who said she didn't tell me this, but "Take him to another hospital E.R.". I did. He had fractured that hip and the first E.R. Dr. missed it. Off to re-hab, where he greatly improved, but could not live in independent living again. The gist of this: seek another opinion. Personally I have learned not to discount another person's pain. We simply don't know how much pain another may be in and how their pain tolerance differs from our own. Good luck.
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Girlsaylor Oct 15, 2019
So glad you persisted in getting Dad properly diagnosed and the care he should have had first time around. It infuriates me when somebody discounts another person’s pain. If it’s a medically trained person, it is unconscionable.
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