We all like to fix things. It’s natural, isn’t it? We hear a strange rumbling on our drive to work, and we want to know what’s wrong with our car. Why? So that we can fix the problem.
[quote]”Hip replacement procedures have shorter recovery times, less reoperation, and a lower rate of readmission to the hospital than hip reconstruction procedures.”[/quote]
We’re no different when it comes to our joints. If something is broken, you need to get it fixed as soon as possible!
This is especially true of elderly patients and their hips. Many people have heard that hip fractures are dangerous for elderly people, and that’s true, sort of–we’ll get to that later, but what many people don’t know is that we’ve come to a point where replacing a broken hip in an elderly patient is a much better idea than repairing the hip or opting for palliative, conservative treatment.
A recent study in the Journal Clinical Orthopaedics and Related Research about hip fractures found that replacement surgery reduces lifetime health costs by more $65,000 per patient. That’s significant, especially as the current data show that by the year 2050, 500,000 hip fractures will occur each year, compared to 300,000 today.
Much of this increase in hip fractures is due to an aging population. It’s also important to note that 90% of all hip fractures occur in people older than age 65.
Fortunately, we’re on track to deal with increased hip fractures in elderly patients. One of the things we have learned is that rather than fixing a fracture, with a plate or a screw, we’ve clearly defined now that replacing the joint is a better outcome and a tremendous economic savings in the long term.
Hip replacement procedures have shorter recovery times, less reoperation, and a lower rate of readmission to the hospital.
This is a major shift in fracture care for elderly patients with hip fractures. We’re moving away from fixing the fractures to replacing them. The surgery to replace the hip is essentially equal in difficulty to a hip reconstruction procedure, but again, chances of readmission for posttraumatic arthritis or hardware failure are lower.
Another fact many people don’t know is that 44% of the cost associated with hip fractures for elderly patients is tied up in rehabilitative care/nursing facility care. I think there are two major factors that determine this percentage.
- Social. Is there a significant other or family member who can care for the patient at home? That plays a big part. Many of the elderly–85 years old and older–don’t have spouses any more, or they live alone. They’re not independent, so they must move in to a rehabilitation center during recovery.
- Weight Bearing: Before if we fixed a fracture, we would protect weight bearing, meaning patients would use walkers or some other assistive device, but that actually requires more nursing care. Replacement is full weight bearing immediately, so patients are able to go through physical therapy at a more rapid rate, which decreases the amount of time in rehabilitation facilities.
This of course assumes the patient is able-bodied to begin with.
Having said that, the research unfortunately shows a high mortality rate with hip fractures among the elderly.
It’s not that octogenarians pass away from hip fractures–the actual orthopedic procedure or the application of the device. It’s that they sometimes lack the strength any longer to deal with something else that may occur, like pneumonia.
As a result of that, we now have hospice for hip fractures among elderly patients, something we never had when I began practicing medicine 20 years ago. We have several patients a year now who already have complications from other conditions. If we can fix the hip within 24-48 hours, they will have a better outcome, but many families are only doing palliative care, so they literally go from the hospital to hospice, and the broken hip is treated with pain medicine.
Our elders deserve excellent care.
Doctors and hospitals are now more responsible for complications. Because Medicare is not going to keep paying for complications, which is causing hospitals to provide a little more due diligence when taking care of elderly patients.
In fact, a clinical pathway, essentially a standard practice, has been developed for total hip replacement. The more we use these best practice clinical pathways across the country, the better care we will be able to provide.
We want to develop clinical pathways, which will improve patient outcomes and reduce costs. Just recently in the last two years, clinical pathways for hip fracture patients are being implemented in hospitals. We have them in the local hospitals here in Crystal Lake. These procedures/pathways improve outcomes, decrease readmission, and ultimately improve quality of life for our patients.
So saving $65,000 per patient is significant, but so is excellent care. Here, with hip fractures among the elderly, we see that the two go hand in hand, which means patients can lead better lives after hip replacement surgery.