This post was written by Jason Heisler, MD, orthopedic surgery, Orthopedics NorthEast.
At Parkview, we perform surgery to address over 500 hip fractures a year—that's a huge number. In my last post, I discussed risk factors, prevention and the biggest myth associated with this injury. Here, I offer an overview of the most common surgical interventions and what patients can expect during recovery.
Do all hip fractures require surgery?
The vast majority of hip fractures, particularly in younger people, need to be fixed. We discuss the options with patients and their family members prior to the procedure to ensure their comfort with the care plan.
How do you decide which procedure is best?
Essentially, there are two types of hip fractures. The first one is called a femoral neck fracture. If you think about the hip joint, it’s a ball and socket. The ball is called the head of the femur. Just below the ball, we find the neck of the femur. If you experience a break in that area, we call it a femoral neck fracture. In general, femoral neck fractures do not heal well, so, for those patients, we do either a partial or total hip replacement.
Below that area, there are some bumps on the bone. Those are called the trochanters. If you break the bone between the trochanters, we call that a intertrochanteric fracture. So, generally speaking, a femoral neck fracture is a little higher in the hip and intertrochanteric fractures are a little bit lower.
What we’re really looking at, in addition to the type of break, is the patient and their unique needs. What do they like? Are they active? Do they live in their own house? Do they grocery shop? Do they drive a car? Do they have help? Maybe they still have a job.
As a generalization, an active person with daily obligations, such as work, should have a total hip replacement. And a less active person, such as someone who lives in an assisted living facility, might be fine with a partial hip replacement or half hip replacement (hemiarthroplasty).
If the patient requires a total hip replacement, then we look at the best approach–anterior, lateral or posterior. Based on the literature, anterior hip replacement is best option to address an osteoporotic displaced femoral neck fracture in an active patient. But there are situations where a lateral or posterior approach is better.
Intertrochanteric fractures tend to heal better because there’s a better blood supply in that area. We will often fix these breaks with a rod and some screws placed through very small incisions–that's the gold standard. Sometimes, a patient requires a plate and screws or hip replacement, if the fracture is more complex.
What can patients expect during recovery?
Our goal for our patients is immediate mobilization or ambulation. The day of the surgery, we want them to sit in a chair or at the bedside to have dinner or their meal. We want them to get to the bathroom, walk in the hallway, etc. Why? The sooner you get moving, the better you'll be. You'll mitigate complications like urinary tract and blood clot issues or pneumonia.
It is a bit easier to get going on a total or partial hip replacement compared to those with an intertrochanteric hip fracture, so their progress might be a little slower.
Patients usually spend two to four days in the hospital after their hip fracture repair. The majority will need to go to rehab for full recovery.
What are the biggest factors that play into outcomes?
Outcomes have much to do with the patient and very little to do with me. If a patient and their family have a realistic view of the individual’s living situation and support, then they can make smart decisions for the healing process.
These patients must be around people who can help them get up and move at all hours of the day. They need to be surrounded by people who will push them not hold them back. I tell families that if their loved one can’t get out of the house on their own if it catches on fire, they should probably go to an inpatient rehab program, which is a lot of patients. The exception would be those with an anterior hip replacement, as that patient population is typically a little younger and healthier.
You also get out what you put in. There's no such thing as waiting for the hip to heal. From an anatomical perspective, it was fixed when we left the operating room. Then it becomes a matter of working on returning to where you were before the break.
The most successful patients have family, physician and rehab support. They have everybody pushing so that the patient can do a little more today than they did yesterday. We want you to walk further next week than you did this week. If you go 50 feet today, go a hundred feet tomorrow. Outcomes are best when we have everybody rowing in the same boat.
What does follow-up look like?
We follow the patients as long as they are in the hospital. Once they transition to home or a rehab facility, we follow from afar. We're available for any phone call and we generally see most of them around six weeks after surgery.
Why not sooner? Well, at two weeks, they're still hurting and having difficulty getting around, so we don’t want to put them through an office visit. We can make exceptions if the patient is healthy and up for it. These processes can change based on the individual’s needs as well.
After the six-week mark, we follow the patient until the fracture is healed or they have recovered enough to be more independent.
Are there any long-term risks associated with a hip fracture?
Contrary to what many believe, death is not a major risk factor following a hip fracture for most patients who are in reasonably good health prior to the break, though it can be dangerous for those who are already in poor condition.
Long-term, the biggest thing I talk to my patients about is subsequent falls, meaning, if you have one osteoporotic fracture (fall from standing), you have a 50% chance of having another one in your lifetime. So, if you suffer a fracture in your hip, pelvis, lumbar spine, wrist, top of the humerus, etc., you have a 50% chance of a second fracture, due to a weakened bone. There’s also a chance the bone might not heal entirely with repair, though this isn’t a risk for those who have a partial or full replacement.
To schedule orthopedic care in Allen County, call Ortho NorthEast at 260-484-8551 or request an appointment here, or visit this page to find orthopedic care outside of Allen County.
