A Comprehensive Guide to Hip Fractures and Hip Replacement Surgery

Hip fracture occurs when the femur (upper part of the thighbone) breaks due to an injury caused by a fall or vehicle accident. Hip fractures are more commonly seen in older people, who have increasingly fragile and brittle bones because of ageing. It is estimated that around 6.6 lakh people suffer from hip fractures every year in India; this number is expected to reach 1 million by 2050. Most commonly, hip fractures include femoral neck fractures that occur below the femoral head and intertrochanteric fractures, in the area between the straight part of the femur and the femoral neck.

A hip fracture causes severe pain and the doctor may recommend medication for inflammation and pain, joint injections, and physical therapy to treat it. However often, people require a total hip replacement surgery (hip arthroplasty) immediately following a fracture. Hip fracture surgery involves replacing portions of the hip joints with synthetic implants to reduce pain, restore mobility and enable the individuals to resume their everyday activities. This comprehensive guide explores the causes, symptoms, diagnosis, treatment options, and recovery process for hip fractures and hip replacement surgery.

What Are Hip Fractures?

Hip fractures refer to a break in the upper part of the femur (thigh bone). They are categorized into three main types:

• Intracapsular Fractures: Occur within the joint capsule.
• Intertrochanteric Fractures: Occur outside the joint capsule.
• Subtrochanteric Fractures: Occur below the trochanteric region of the femur.

Causes and Risk Factors

• Osteoporosis: Weakens bones, making them prone to fractures.
• Falls: A leading cause of hip fractures in older adults.
• Trauma: Car accidents or sports injuries.
• Age and Gender: Women and individuals over 65 are at higher risk.
• Lifestyle Factors: Smoking, excessive alcohol consumption, and lack of physical activity.

Symptoms of Hip Fractures

• Severe pain in the hip or groin.
• Inability to bear weight on the affected leg.
• Swelling, bruising, or stiffness around the hip.
• Shortened or outwardly turned leg on the injured side.

How do doctors examine hip fractures?

When checking for hip fractures, the doctor or orthopaedic surgeon will consider the history of the injury and rule out damage to other parts of the body. In addition, the doctor will also evaluate the movement, circulation, and sensation in the lower leg. The injured leg may appear shorter than the unaffected leg and may appear to be twisted externally or internally. The person may have a bruise on the outside of their thigh or hip. In addition to a physical exam, the doctor may also ask for a few imaging studies to be conducted.

Physical Examination

The doctor will perform a comprehensive physical examination to assess the possibility of a hip fracture. This includes examining the affected area and inquiring about any recent falls or accidents.

Imaging Studies

The doctor may ask for various imaging studies to diagnose a hip fracture and assess any soft tissue damage including:

• X-Ray: This produces an image of the bones by using radiation.
• CT Scan: Employs multiple X-rays and a computer to provide complete images of the affected area.
• Magnetic Resonance Imaging: This uses a powerful magnet for images of the bones and soft tissues.

Treatment Options For Hip Fractures

Treatment for hip fractures varies based on factors such as age, injury type, and overall health. In most cases, hip fracture surgery is necessary within 1-2 days. However, for nondisplaced fractures or individuals unfit for surgery, non-surgical management options are available.

Non-Surgical Treatment Approaches

• Use of Pain Medication And Assistive Devices: To manage pain during the healing process of a hip fracture, the doctor may initially prescribe over-the-counter painkillers like acetaminophen. If these are insufficient, stronger painkillers may be prescribed for a few weeks. It is advised to avoid putting weight on the fractured hip for approximately 6 weeks or longer to facilitate bone healing. The doctor may suggest using mobility aids such as a walker, wheelchair, crutches, or cane to assist with movement.
• Physical Therapy And Rehabilitation: In addition to addressing the injured hip, the doctor may advise range-of-motion exercises and stretches for muscles and joints to enhance strength and expedite recovery. Physical therapy is commonly recommended after the initial healing stage to improve muscle strength, enhance blood flow, aid in healing, and restore mobility to the hip joint.
• Lifestyle Modifications: Preventing falls and improving bone health.

Surgical Treatment Approaches

Hip fracture surgery is the primary treatment for hip fractures, tailored to factors like severity, location, patient age, bone alignment, and overall health. Two common procedures are

• Open Reduction And Hip Pinning (Internal Fixation & Orif): Involves making an incision to realign the bones, followed by using implants like wires, rods, pins, or screws to stabilise the fracture.
• Partial Hip Replacement (Hemiarthroplasty): This surgery replaces half of the hip joint, typically performed when the top part of the femoral head is fractured but the socket remains undamaged (acetabulum).
• Total Hip Replacement: Replacement of both the femoral head and the hip socket.

Read more about Understanding Arthritis Symptoms: Early Signs and How to Manage Them

Introduction To Hip Replacement Surgery

Hip replacement surgery, also known as total hip arthroplasty, involves replacing & removing damaged bone and cartilage and replacing them with prosthetic components (ceramic, metal, or plastic components). This procedure is recommended when hip pain significantly affects daily functioning or when other treatments have been ineffective.

It is commonly performed for conditions such as arthritis (osteoarthritis, rheumatoid arthritis), osteonecrosis, or fractures resulting from falls, accidents, persistent hip pain, or bone diseases.

Read more about Understanding the Various Causes of Arthritis: From Genetics to Lifestyle Factors

Hip Replacement Surgery Risks

Like all surgeries,hip replacement surgery carries certain risks. While some risks, such as anaesthesia-related complications, can have significant effects on the patient's overall health and well-being, others such as variation in leg length may not be life-threatening but can impact the quality of life.

Common risks associated with hip replacement surgery include:

• Infection: Infection is a potential risk following hip replacement surgery. It can occur near the new hip joint or at the site of the incision. In such cases, antibiotics may be administered, and in some instances, additional surgery may be necessary to replace or remove the artificial components to resolve the infection.
• Blood Clots: A potential complication of hip surgery is the development of blood clots in the leg veins. If these clots dislodge and travel to the heart, lungs, or brain, they can pose a significant risk.
• Dislocation: Following hip surgery, there is a risk of the new joint dislocating from the socket. In such cases, the joint may require a brace or surgical intervention for proper fixation.
• Allergic Reactions: Metal allergy may be a possible complication of hip replacement surgery. It may cause mild to severe symptoms including itching, skin rash and discolouration around the artificial hip and other symptoms like swelling, pain and joint stiffness.
• Leg Length Discrepancy: Hip replacement surgery can sometimes cause a discrepancy in the leg length because of muscle contracture around the hip. In such cases, stretching and strengthening exercises can help.

Types of Hip Replacement Surgeries

When the hip joint is significantly damaged and alternative treatments have proven ineffective, hip replacement surgery may be the optimal solution. Various types of hip replacement surgeries are available, including:

• Total Hip Replacement (Hip Arthroplasty): Total hip replacement surgery, also known as hip arthroplasty, is the most common type of hip replacement procedure. It involves the removal of the entire hip joint, including the femoral head and acetabulum, and replacing it with artificial or prosthetic components.
• Partial Hip Replacement (Hemiarthroplasty): Hemiarthroplasty replaces only the femoral head and not the acetabulum. It is primarily used for treating hip fractures in elderly individuals when the acetabulum is unaffected. This procedure is also employed for tumour removal.
• Hip Resurfacing: In this procedure, the femoral head is trimmed and covered with a metal cap instead of being fully removed. A metal shell is used to cover the damaged bone and cartilage in the socket.

Understanding Hemiarthroplasty vs Total Hip Replacement can help you make informed decisions about the best treatment option for hip conditions.

Hip Replacement Surgery Process

Hip replacement surgery is usually performed in the hospital with a stay of around 3-5 days. The surgery involves the removal of the damaged bone and cartilage and takes around 1-2 hours. The patient receives regional or general anaesthesia. The existing hip joint is then replaced with new ceramic, metal, or plastic implants to restore alignment and hip function. The steps of hip replacement surgery include:

Exposure And Removal of the Damaged Hip Joint

The patient is positioned for the surgery according to the surgical approach, which determines the location of the incision (back, front, or side). The surgeon then removes the damaged bone and cartilage from the hip joint.

Preparation of the Acetabulum (Hip Socket)

Afterward, the hip socket is prepared by eliminating any remaining cartilage and shaping it to accommodate the acetabular cup.

Insertion of the Acetabular Cup

The acetabular cup made of ceramic, metal, or plastic is then inserted into the prepared hip socket and is fixed into place.

Preparation of the Femur (Thigh Bone)

To prepare the femur or thigh bone, the diseased cartilage is removed, and the bone is reshaped to make room for the femoral stem.

Placement of the Femoral Stem And Ball Component

The metal femoral stem is then inserted into the femur. The ball component, usually made of metal or ceramic, is then attached to the top of the stem.

Closing the Incision and Wound Care

The tissue layers are then closed using dissolvable stitches and the incision is closed using staples, sutures, or surgical glue. A sterile dressing is applied to the surgical site to prevent infection and promote quick healing.

Recovery and Rehabilitation

• Post-Surgery Hospital Stay: Typically 1-3 days, depending on progress.
• Physical Therapy: Aims to restore mobility and strength.
• Pain Management: Medications and ice packs.
• Home Exercises: Essential for long-term recovery.

Preventing Hip Fractures

• Regular Exercise: Weight-bearing and strength-training exercises.
• Balanced Diet: Rich in calcium and vitamin D.
• Fall Prevention: Removing tripping hazards and using assistive devices.
• Bone Health Monitoring: Regular check-ups for osteoporosis.

Frequently Asked Questions

1. How long do hip implants last?

A hip implant can work well for a long time; however, it will not last forever. Typically, a modern hip implant lasts for around 15 years.

2. Can I return to sports and physical activities after hip replacement?

While individuals can resume sports and physical activities after hip replacement surgery, it is advisable to engage in low-impact activities to minimise wear and tear and reduce the chances of dislocation and fractures.

3. Are there any alternatives to hip replacement surgery?

Some alternatives to hip replacement surgery include painkillers, physiotherapy, exercise, walking aids, and steroid injections in the hip joint. Hip resurfacing is another popular alternative to hip replacement surgery that involves a smaller implant and less bone removal.

4. What types of prosthetic components are used in hip replacement surgery?

The hip replacement implant, or hip prosthesis, consists of a ceramic ball connected to a metal stem that is inserted into the femur for stability. It also includes a titanium cup with an inner plastic layer, which is affixed to the hip joint, facilitating the seamless rotation of the artificial joint.

5. Can hip replacement surgery be performed on both hips at the same time?

Yes, it is possible to undergo bilateral hip replacement surgery, which involves the simultaneous replacement of both hip joints during a single surgery.

6. How long does hip replacement surgery take?

The procedure typically lasts 1-2 hours.

7. What is the lifespan of a hip replacement?

Modern implants can last 20 years or more with proper care.

8. Can hip fractures heal without surgery?

Small or stable fractures may heal with conservative treatments, but most require surgery.

9. Which doctors are involved in treating hip fractures and surgery?

Orthopedic surgeons primarily handle hip fractures and replacement surgeries, often collaborating with physical therapists and anesthesiologists for comprehensive care.