Is it normal for an 89 yr old woman who had fractured hip surgery to be in such pain she cannot walk yet with rehab 2 weeks after surgery?

Different people have different pain thresholds and the fact that she led a sedentary lifestyle could have something to with her not being successful in rehab. However, if she is screaming out in pain, the facility’s doctor needs to be contacted to make certain everything is ok. Speak with her therapists and ask their opinion on whether they feel she is really in so much pain or just has a low pain threshold.

Please start thinking about the future. Your profile states that your mother lives in Independent Living. She may not be able to continue there. What would be the next step (no pun intended)?

You know her best so if you feel that this isn't a case of malingering then do press hard to look for a physical cause of her extreme pain, perhaps asking for a second opinion. I can not help but think of my grandmother - after a fall she was made to walk for weeks on a hip whose break failed to show up in the initial x-ray. Doctors, physical therapists etc tend to be much too blind in their belief that they can't have missed a real problem.

If she's that insistent that she still has incredible pain, I'd insist on her doctor's evaluation. I know it can take a while to get another appointment back with that doctor, but, their office should be able to have someone there, see a person who has significant pain after surgery. There are ways they can evaluate if it's anticipation of pain upon bearing weight or if there is a real problem. Does she seem okay otherwise, like any fever, infection, etc?

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.

If it were me, I think I would push for an xray just to be sure there isn't anything else going on -- mistakes happen, maybe surgery looked like it went well, but something has slipped or cracked after the surgery.

Once you have the xray, if it is clean, then I would believe the PT who are thinking she is anticipating the pain - and work to help her through that.

Best of luck, it is no fun to see our loved ones suffering!

It is common for people to not want to do their rehab. They might resist but when coaxed into doing the exercises, it should not be painful. Whenever my grandparents were having pain with rehab, there was an underlying issue and the follow-up person would tell us the therapist should have stopped when they expressed being in pain.
Make sure she is x-rayed and examined again. It's possible they missed another hairline fracture or that there's some other complication. Medical staff tend to disregard what older people say. If she's getting rehab in the hospital it is no problem for them to get her x-rayed again. Talk to the nurse and her orthopedic surgeon. Do not leave it up to PT to handle. It can be intimidating especially because everyone is in a hurry and no one wants to take responsibility. But again, it's easier to take care of this now while she's still in the hospital.

The biggest contributing factor here is how dedicated to physical therapy she is. Not getting up and walking every chance she gets will lengthen the time to recovery..including the pain.

different people have different levels of pain the can handle,,,but the only way forward is to get up, power thru it, and walk.

You don't mention if she has dementia which could be a contributing factor as they can become stubborn and an unwilling participate.....especially since living a sedentary lifestyle. With that said, there would still be cracks that would reveal a window of the obvious. Was the procedure done under general anesthesia or an epidural? This could weigh in on her mental state. My mom broke her hip earlier this year and had a three week rehab stint. In the hospital before transfer she was given Tramadol because she was resistant to PT as well (not really suggesting this, but it did get us through the rough patches) and she would scream in pain and refuse to bear weight on her right side. The motivator for us was the threat she would remain in a facility until she was mobile. Enough said. A remarkable recovery at 89.

With us it was straight forward....it was a mind game. If your mom maintains clarity I would pursue further investigation. Could be a bad surgery in general, a stress fracture resulting from the surgery, infection, etc. I would think imaging would be the next step along with blood work.

Recalling Dmanbro' s mother screaming out in pain @rehab, everyone thought she was faking or resisting P.T.
An x-Ray revealed a fractured pelvis.

Do not allow, imo. discharge from the acute care if she is in this condition.
The doctor should find out what it is and not rely only on P.T. staff's accounts.

Good for you! This does not seem a normal course after hip surgery (to me), for patients in general. The proof for that is she is not progressing as expected, and will not be ready for discharge as staff expects.

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.

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.

PK, another thought has occurred.    The therapy she's being given might not be appropriate for her, i.e., if she has to be weight bearing on that leg, it might be too much to put pressure on it.

There are other exercises an experienced and compassionate therapist can give her to build up her leg strength before putting pressure on it. 

We had a similar problem when my mother fractured her leg.    I wrote about it on another thread, but don't remember which one, so, just briefly, Mom was in a non weight bearing situation, but the therapist prescribed exercises that required standing and were too aggressive.  We intervened, the therapist was transferred, and Mom got another very sensitive and compassionate therapist...and improved.

So sometimes the therapist just isn't compatible with a particular patient.

I think getting another x-ray is absolutely the best way to go to sort out the situation.   And I would raise the pain issue with the doctor as well.    There may be other issues in play.

I would request an xray. I had a good friend who had a total hip. She got up on the commode, got off and had instant pain. They ignored her two days and then went to xrays and it had dislocated. They knew eventually by the spasms of muscles in the whole leg. I would try for an xray before discharge. This doesn't seem right to me. What do the PT people tell you? They are the BEST diagnositicians on something like this, SO MUCH BETTER than doctors or anyone else.

Thanks Barb! Its been so very stressful. I am heading to the hospital and just a little bit and we are moving my mom today. I will let everyone know how this plays out thank you all for your advice and concern it means a lot!

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!!

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...

No

PK, please find out if there is a geriatric psychiatrist who visits at the subactute rehab facility. If this is truly anticipation of pain and not "actual" pain, then mom might benefit from meds for anxiety/depression/agitation that will get her over the hump.

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.

My 86-year-old mom fractured her hip last July. After being in a nursing facility for a while they sent her home with some pain medication which did not really give her relief for the pain (Norco). A couple of weeks later she was in horrible pain again and could not even stand. She was transported by ambulance back to the nursing facility. This time the physician prescribed Percocet for pain, and Cymbalta for depression/anxiety/pain management. The combination of the stronger pain med and the anti-depressant helped her. Two months later she is walking pain free and without pain meds. She still takes the Cymbalta. I hope our story might be of some help to you.

A replaced hip might be weight bearing right away, but a pinned hip needs at least 6-8 weeks of partial weight bearing first. I had a hip "pinned" and was not permitted full weight bearing for 6 weeks. I had PT and OT and CT in a Rehab facility for 30 days then continued PT and OT at home until doctor re-xrayed at 6 weeks and approved full weight bearing. There was severe pain during the entire 30 days of Rehab and for some weeks after getting home.
Rehab exercises will increase the pain beyond what it might have been the first few days after surgery in the hospital, and some of that is normal, but you need to be sure there is not still an unrepaired fracture or crack in the hip or pelvis. Would an MRI be called for if x-ray does not find anything?

Thank you for your update: that shows that they have done what I was going to suggest you ask about, which is to check that all was well with the surgical repair - and it is.

All the same, this isn't exactly *normal*, but then where the pain is coming from does depend on what condition your mother was in before the fall-and-fracture, and it sounds as if the bruising that can't be helped with such major surgery, and her bone frailty, and her being unused to exercise put together could mean that she's rediscovering muscles she'd forgotten she had - and they hurt! Poor lady.

I should encourage her to persevere, because with time and good, consistent rehab things should improve tremendously.

What does the doctor have to say about this? How about the surgeon? Are you in contact with the P.T.? She may be a slow healer, or she might need another scan to see if something needs to be changed, or a repair surgery. I would asking the above people for answers.

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.

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.

I had two hips that were beyond destroyed. I entered the hospital and one week apart had both hips fixed. I spent about three weeks in the hospital and another three weeks in rehab before I went home - but for unknown reasons, I did NOT have any pain. Maybe for once I was lucky. Someone has to get to the root of the problem and do something and it may take more than one doctor to figure this out and fix it.

She may be better suited for postacute rather than subacute of course comorbid sequelae notwith standing.

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.

First off, I am really sorry to see what you are experiencing with your Mom. The reason I’m responding is because I have seen both parents at different times suffer with pain. My first question would be are you happy with how her surgery went? My mom has osteoporosis and has fallen and broken bones upon numerous occasions. Is there any way to get your mom an X-ray or second opinion? I know how delicate our mom’s bones can feel at that age and their pain is no joke and so unbearable and I know how heartbreaking it is to see a
parent suffer. My mother suffered with pain for many years and now she is at a point in her life where I’m grateful to God she is pain free. She has been in physical therapy on and off for many years for the fractures she has had. The best thing for pain has been Advil Liquid gels. She has a high pain tolerance and never wanted to take RX pain meds unless absolutely necessary. Hip pain from what I’ve heard is an absolute nightmare and from bottom of my heart I hope she comes out of this pain soon. They can do a lot in rehab, I’ve been very involved with my mom’s treatment teams. They do send them to the rehabs in pain, but they do function like a hospital with the nursing care and the physical therapists can do a lot and move her towards wellness. God Bless!!