Delaying hip surgery, skipping exercise put Malaysian seniors at risk of fracture and death

KUALA LUMPUR – After more than a decade of severe arthritis and osteoporosis, 72-year-old pensioner Nancy Koh regrets that she delayed having a total hip replacement.

She finally underwent surgery at Kuala Lumpur Hospital in early January, after years of pain left her unable to stand or walk without agony, forcing her to miss out on bonding with her grandchildren.

“I wanted to walk with them to the park and play with them, but instead, I had to sit and watch them grow up,” Madam Koh told The Straits Times, lamenting how she had been robbed of a fulfilling life.

“Now I am able to walk slowly with a crutch, and the pain went away almost overnight.”

Like Madam Koh, many Malaysian seniors delay undergoing hip replacement surgery and neglect mobility exercises, even as ageing-related bone loss and muscle loss and declining mobility put them at high risk of falls, fractures and long-term disability.

The consequences can be severe: Statistics show that one in three people who suffer a hip fracture may die within one year of injury.

As Malaysia becomes an ageing nation, such risks are expected to increase exponentially, say doctors. Yet, many continue to delay getting hip replacement surgery, or arthroplasty, despite its 95 per cent success rate globally in relieving pain and restoring mobility.

The dangers of falls and hip fractures were thrust into the spotlight in January after former prime minister Mahathir Mohamad, 100,

fractured his hip when he fell

at home in Kuala Lumpur.

Tun Dr Mahathir’s injury was described as serious but his advanced age prompted his doctors to avoid taking the surgical route and instead

have him undergo lengthy physiotherapy treatment

, which is ongoing.

While hip replacements are increasingly being performed on patients in their 50s in the developed world, clinical data in Malaysia shows that most procedures are carried out on patients in their 70s – often after fractures or advanced joint degeneration.

Increasing risks, high reluctance

By United Nations standards, Malaysia is already an ageing society, with about 7 per cent of its population aged 65 and above as at 2021. It is projected to become an aged nation by 2048, when seniors are expected to make up 14 per cent of the population.

In the Asia-Pacific region, Singapore, Thailand and South Korea have already reached aged nation status, while Japan is now considered super-aged, with nearly 29 per cent of its population aged 65 and above. Singapore trails closely at 20.7 per cent in 2025, according to government statistics.

With ageing comes an elevated risk of falls, hip fractures and declining mobility.

Dr Khairul Anwar Ayob, an orthopaedic surgeon at UM Specialist Centre, said a 2020 survey in Malaysia showed that 15 per cent of those aged 65 and above had experienced a fall in the past year.

“A study by the Malaysian Osteoporosis Society in 2007 said that the incidence of hip fractures was 90 per 100,000 in individuals aged 50 and above,” Dr Khairul told ST.

“Through extrapolating data, we expect the number of hip fractures to increase as the average life expectancy increases.”

Dr Khairul shared a recent case of his 74-year-old patient who fractured her hip while playing with her grandchild. The youngster playfully pushed her, causing her to lose balance and fall.

“It is surprisingly common to see a fall from playing with grandkids,” Dr Khairul said.

Despite these risks, many Malaysians remain reluctant to seek surgery.

Dr Mohamed Ashraff Ariff, a consultant orthopaedic surgeon at Pantai Hospital Kuala Lumpur, said people still see surgery as taboo.

“Malaysians tend to delay or abstain from it if possible,” he said. “It is very different from places like South Korea where I’ve seen patients who expect to be operated on for the slightest pain.”

For Madam Koh, she had feared that the operation would leave her bedridden for weeks, or worse, unable to walk at all afterwards.

“But my doctor promised that the pain would go away overnight after the operation, and he was right,” she said.

Seek help early

Early signs that hip surgery may be needed often stem from arthritis, which causes inflammation in the joints, leading to pain, swelling, stiffness and reduced range of motion.

For those experiencing constant, debilitating pain that impedes daily activities, as well as worsening limb deformity, it is important that they discuss these concerns with their doctors.

In hospitals, radiography can reveal the state of joint degradation, which will guide the next steps in arthroplasty.

In Malaysia, most government and private hospitals offer dedicated arthroplasty services, with the price highly dependent on the extent of the procedure, the type of implant, and whether robotic assistance is utilised.

Costs can range from RM10,000 (S$3,200) at government hospitals to around RM40,000 at private hospitals. These operations are generally considered straightforward, requiring minimal hospitalisation.

Building strength to hold back time

While early surgery can help those in pain to live a better life, growing awareness of the risks that come from falling has encouraged more families to send their elderly parents for mobility training to strengthen their muscles and joints.

As muscle mass naturally declines with age, even simple daily movements can become harder, increasing vulnerability to injury. Strength training, experts say, can slow the loss of muscle, improve joint stability and protect bone health, allowing older adults to remain active and independent longer.

Mr Jerald Kang, who specialises in senior fitness, said many of his clients were brought in by their children who wanted them to lead a more active, independent lifestyle.

Speaking to ST, Mr Kang highlighted a paradox: Elderly Malaysians are often overprotected by family members, which inadvertently accelerates muscle loss.

“The intention is good but the execution needs to be better,” he said. “We can’t reverse ageing but we can dampen its effect and slow it down.”

One of his clients, a 71-year-old woman with osteoporosis and “no experience in the gym”, progressed from limited mobility to deadlifting 15kg for eight repetitions and squatting with the same weight.

“She only started one year ago, at 70. Now she can plank for one minute and 15 seconds, where previously she could only do 30 seconds,” Mr Kang said.

“The muscles are a fountain of youth. You can actually age well.”