Fracture of the hip fundamentals
A hip fracture occurs when there is a break in the hipbone, usually in the upper part of the femur or the pelvic bone. Hip fractures are also a concern for women who have gone through menopause. Approximately one out of every seven women will experience a hip fracture. A hip fracture may also lead to hip replacement surgery when an artificial prosthesis is used to replace the broken hipbone.
Most people who have had a hip fracture do not regain the level of independence they had before the injury. And, approximately half of those who have had a hip fracture require some kind of assisting device, such as a walker, to ease movement after recovery.
What causes hip fractures?
Hip fractures are typically caused by a fall. They are considered an orthopaedic emergency and require immediate attention and emergency treatment. For people who suffer from osteoporosis, since their bones are less dense and more brittle and prone to injury, fractures can even be caused by simple weight-bearing activities. Although some fractures are minor and cause only pain, other fractures can be more severe. It is important to alert your physician if you experience any of the following hip conditions: extreme hip pain that may radiate to the knee; an inability to walk without a device such as a crutch or cane; low back pain an inability to put any weight on the leg; and/or stiffness, bruising or swelling in the hip.
What are the benefits of treatment for hip fractures?
Since hip fractures are considered an orthopaedic emergency, a benefit of treatment is relief of pain that results from the injury. Patients applying initial treatment for a hip fracture can control the movement of the painful limb. Applying ice to the injured area can also reduce swelling.
Based on your general health and current medications, your doctor will plan the best form of treatment for you. X-rays and CAT scans or Magnetic Resonance Imaging (MRI) tests enable your doctor to make an informed decision regarding treatment. Hip fractures most commonly require emergency surgery by an orthopaedic surgeon to restore bones to their original positions. During surgery, a surgeon may use metal devices to stabilize the bone and hold it in place. Metal rods and bone grafts may also be needed.
Total hip replacements are sometimes performed for hip fractures if pain is severe enough to restrict daily activity, pain is not relieved by anti-inflammatory medicine for arthritis, and the patient has advanced arthritis or significant stiffness of the hip. Based on your medical condition, your physician will determine if total replacement is the best treatment option for your hip condition. Total hip replacement may offer relief for patients who suffer pain and the loss of motion in the hip.
What are the risks for hip fractures?
Age is a significant risk for hip fractures. Other risks may include the following: osteoporosis, alcoholism, dementia and an inactive lifestyle. For individuals with osteoporosis, their bones are so brittle that a fracture may occur simply from weight-bearing activity. Patients who are underweight, such as people with anorexia nervosa, usually have bones that are less dense, which makes repair and recovery from a hip fracture much more difficult.
Depending on the patient’s health and medical condition, there may be unforeseen complications associated with hip fracture surgery. These problems may include: anesthesia, including respiratory or cardiac malfunction. In addition, surgical procedures may result in infection, injury to nerves and blood vessels, weakness and stiffness of the joint, pain, or the need for additional surgeries.
Keep in mind that some types of hip fracture may never heal sufficiently to bear the body’s weight. Especially among the elderly, a hip fracture may represent a great loss of mobility. According to chartlogic.com, it is estimated that approximately 20 percent of all patients treated for hip fracture will require ongoing nursing home care after injury. And, only about one in three people who have a hip fracture in later life regain enough function to return to the level of independence and mobility they had prior to injury.
It is also important to note that for patients who require a total hip replacement the average life expectancy for an artificial hip joint (prosthesis) is approximately 10-15 years, after which hip revision surgery may become necessary. The most common causes for revision surgery include looseness in the joint and/or infection.
What is the rehabilitation for hip fracture surgery?
If patients require surgery, a physical therapist will meet with patients shortly after their procedure to start exercising the hip joint, primarily with gentle movements and then with crutches or a walker. Every patient’s unique hip conditions are evaluated by their physical therapist to develop the best course of post-operative treatment and care.
In the event of total hip replacement, hip precautions and the prevention of hip dislocation will be emphasized in physical therapy so patients can learn to live most effectively with their new hip.
How can I manage at home during recovery from the procedure?
Depending on their treatment plan, patients will receive specific instructions from their physician and physical therapist as to how they can manage home recovery for their hip condition.
Prevention is important for avoiding future hip fractures. Seniors should keep their homes well-lit and free from hazards that may cause a fall. In addition, how well a person recovers from a hip fracture is dependent on how healthy they are prior to injury. Regular exercise and a well-balanced diet are important to avoid additional problems associated with a hip fracture.
How frequently should I schedule follow up appointments with my doctor following surgery?
Post-operative visits help your surgeon know that your hip is healing well. Make sure to schedule your first visit within the recommended timeframe indicated by your surgeon. This recommended timeframe is as follows:
- One month following discharge from the hospital
- Three to six months following the date of surgery
- One year following the date of surgery
- Annually on the anniversary date of the surgery
It is important to comply with this schedule and to see your doctor regularly for routine office visits to ensure safe and effective recovery from your hip condition. Keep in mind that this schedule may be adjusted depending on your medical condition and individual needs and requirements following surgery. Generally speaking, patients have their first appointment two to six weeks following surgery. Additional follow up appointments are then scheduled based on the individual and their recovery progress.
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