Health: Crucial days in Queen Mother's fight for mobility

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Hip replacements have long been routine but the Queen Mother, who had emergency surgery yesterday, is among the oldest patients to undergo the operation. Jeremy Laurance, Health Editor, looks at what lies ahead.

The chances of the Queen Mother cutting a dash on the dance floor again will depend critically on what happens in the next two weeks.

After emergency surgery to replace her fractured left hip in the early hours yesterday, the Queen Mother was recovering well, according to Buckingham Palace. She is expected to receive her first visitors today since she slipped and fell at Sandringham on Sunday, and may take her first tentative steps.

The speed with which she can be mobile again will determine the pace and the extent of her recovery. Early mobilisation is essential for older people whose joints stiffen and whose muscles become wasted rapidly if they lie in bed.

After the operation to replace her right hip in November 1995, the Queen Mother made an impressive recovery and, according to Prince Charles, took up dancing again. In the past year or so, she has seemed frailer, walking with the aid of a stick, sometimes two, or taking to a wheelchair or golf buggy. There was speculation last year that she was so pleased with the improvement in her right hip that she wanted the left done as well - an operation that has now happened unplanned.

Michael Pearse, head of orthopaedic trauma at Charing Cross Hospital, London, said: "The main thing following a hip replacement operation is to get the patient on their feet as quickly as possible. Prolonged periods in bed can lead to pneumonia, bed sores, clots in the veins and confusion. Restoring mobility and therefore their health is a priority."

Thrombosis caused by blood clots and infection pose the biggest risk over the next few days. Although fewer than six patients per thousand die after hip surgery, the danger is greater for those in their late nineties. The Queen Mother will have been given anti-coagulant drugs to reduce the risk of blood clots forming in the legs while the patient is immobile which can travel to the lungs causing an embolism which can be fatal.

Roger Vickers, the orthopaedic surgeon who led the Queen Mother's surgical team, created a row some years ago as co-author of an editorial in the British Medical Journal which argued that any surgeon who performed a hip replacement without giving anti-coagulants to a patient who later died would be unlikely to escape the courts.

The medical team will also be anxious to avoid allowing the wound to become infected. Provided these hurdles can be overcome, surgeons say age is irrelevant in cases of this kind so long as the patient is fit and able to benefit from the surgery.

Mr Pearse said: "The Queen Mother would have been treated as a 65-year- old not a 95-year-old because she is quite fit. In cases like this, age is relatively unimportant."

Hip fractures are extremely common in the over-70s as the bones soften with advancing age. The chances double every seven years after 65 and one women in four has suffered a broken hip by the age of 90.

About 50,000 hip replacements are carried out each year and there are long waiting lists up to 18 months on the National Health Service. The operation, which requires a stay of about two weeks in hospital, costs pounds 5,000 to pounds 10,000 privately.