Hip fracture surgery is a medical procedure to fix a break in the upper part of the thigh bone (femur). This is common, especially among older adults, and often results from falls or accidents. The main goal of hip fracture surgery is to help the patient regain mobility and reduce pain. Without surgery, a broken hip can lead to serious complications, including long-term immobility and an increased risk of other health issues. By stabilising the fracture, surgery allows patients to start moving again, which is important for their overall recovery and quality of life.
This article will cover several aspects of hip fracture surgery, including its indications, benefits, types of procedures, the step-by-step surgical process, recovery, and potential risks. This will give a thorough overview of what to expect from hip fracture surgery and its importance in improving patient outcomes.
Indications of Hip Fracture Surgery
Hip fracture surgery is typically indicated for those who have sustained a break in the upper part of the femur (thigh bone). The most common reasons for requiring this surgery include:
Medical Conditions
Certain medical conditions can predispose people to hip fractures. These include:
Osteoporosis: Osteoporosis is a condition characterised by weakened bones, making them more susceptible to fractures. Even minor falls or impacts can result in a hip fracture as bone density decreases. This condition is common among older adults, particularly postmenopausal women, due to the loss of bone density over time.
Rheumatoid Arthritis: Chronic inflammation associated with rheumatoid arthritis can lead to bone erosion and increased fracture risk.
Traumatic Injuries
Traumatic injuries, such as those from car accidents, sports injuries, or falls, can cause hip fractures. These high-impact incidents can occur in people of any age but are more common among the elderly, especially those with pre-existing conditions or weakened bones.
Frequent Falls
People who have a history of frequent falls are at higher risk of hip fractures. This can be due to various reasons, including poor vision, neurological disorders, or medications that affect balance and coordination.
Age-Related Factors
As people age, several physiological changes increase the likelihood of fractures. As bone density declines, bones become more weak. The elderly often experience balance and gait issues, increasing the risk of falls. These combined factors raise the chances of hip fractures among the older population.
Benefits of Hip Fracture Surgery
Hip fracture surgery offers numerous benefits to patients, improving their recovery and overall quality of life. These benefits include:
Pain Relief and Body Comfort
A hip fracture is extremely painful, often causing constant, intense pain that can severely limit mobility and daily activities. Surgical treatment stabilises the fractured bone, which directly reduces pain levels. This pain relief is important for improving overall body comfort, allowing patients to rest and sleep more easily, which is essential for recovery.
Improved Quality of Life
By relieving pain and restoring mobility, hip fracture surgery improves the quality of life for patients. They can resume their usual activities, enjoy social interactions, and engage in physical exercise, positively impacting their mental and physical well-being. This progress in well-being supports a more positive outlook on life and encourages active participation in daily activities.
Ease of Movement
Hip fracture surgery enables ease of movement by stabilising the fractured hip, allowing for smoother and more coordinated motions. This improvement is important for daily functions such as walking, climbing stairs, and getting in and out of chairs. Patients can enjoy a more active and less restricted lifestyle with better mobility. This restoration of movement allows patients to carry out everyday tasks, reducing their reliance on others for assistance and improving their sense of autonomy.
Types of Procedure for Hip Fracture Surgery
Hip fracture surgery can be performed using various techniques. The main types of procedures include:
Internal Fixation
Internal fixation involves the use of metal screws, rods, or plates to hold the fractured bone together. This technique is typically used for fractures where the bone fragments are well-aligned and can be securely fixed. The metal hardware keeps the bone stable, allowing it to heal properly while maintaining alignment.
Hip Hemiarthroplasty
Hip hemiarthroplasty is a partial hip replacement procedure. It involves replacing the fractured head of the femur (the top part of the thigh bone) with a metal prosthesis. This procedure is commonly performed on older patients with limited mobility or fractures that cannot be fixed with screws or plates alone. Hemiarthroplasty provides a stable joint and allows for early mobilisation.
Total Hip Replacement
Total hip replacement, or total hip arthroplasty, involves replacing the femoral head and the acetabulum (hip socket) with prosthetic pieces. This procedure is recommended for patients with severe fractures, pre-existing arthritis, or substantial joint damage. Total hip replacement provides the most stable and durable solution, allowing for improved function and reduced pain. It is a more comprehensive surgery that usually requires a longer recovery period. This advanced form of hip replacement surgery is often the preferred choice for active patients or those with pre-existing joint degeneration to ensure long-term stability.
Step-by-Step Procedure
Hip fracture surgery involves several steps, from preparation to recovery. Below is an overview of the entire process:
Preparing for Hip Fracture Surgery
Preparation for hip fracture surgery begins with a thorough medical evaluation. This includes:
Medical History and Physical Examination: The orthopaedic surgeon will review the patient’s medical history and perform a physical examination to assess overall health.
Imaging Tests: X-rays, CT scans, or MRIs are conducted to determine the exact location and type of fracture.
Preoperative Assessments: Blood tests, ECG, and other preoperative assessments ensure the patient is fit for surgery. Any underlying conditions, such as heart or lung issues, are also addressed.
Hip Fracture Surgery Procedure
The surgery itself involves several steps:
Step 1: Anaesthesia
The patient is given either general anaesthesia, which puts them to sleep, or regional anaesthesia, which numbs the lower half of the body.
Step 2: Incision
A surgical incision is made over the hip to access the fractured bone, depending on the methods of surgery.
Step 3: Fracture Fixation / Joint Replacement
The orthopaedic surgeon uses one of three methods to treat the injury:
Internal Fixation
For internal fixation, the orthopaedic surgeon makes a small incision over the hip to assess the fracture. Metal screws, rods, or plates are then inserted to hold the bone fragments together, ensuring they are properly aligned for healing. After securing the bone, the incision is closed with sutures or staples, and a dressing is applied to protect the wound.
Hemiarthroplasty
The orthopaedic surgeon makes a larger incision to expose the hip joint fully. The damaged femoral head is removed and replaced with a metal prosthesis. This prosthetic femoral head is securely fitted into the thigh bone.
Total Hip Replacement
For total hip replacement, a large incision is made to expose the hip joint. The damaged femoral head and the acetabulum (hip socket) are removed. Prosthetic components replace these structures, including the femoral component fixed into the thigh bone and the acetabular component fixed into the pelvic bone, with all prosthetic pieces securely placed.
Step 4: Closure
Once the fracture is stabilised, the incision is closed with sutures or staples, and a dressing is applied to the wound.
Recovery After Hip Fracture Surgery
Recovery and rehabilitation are required for a successful outcome:
Immediate Postoperative Care
Immediately following surgery, patients are closely monitored in the hospital. This stage involves:
Hospital Stay: Patients typically stay in the hospital for several days to a week, depending on their recovery speed and overall health. During this time, medical staff closely monitor the patient’s condition and manage pain with medications.
Pain Management: Pain relief is provided through medications, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen to ensure patient comfort and facilitate early movement.
Early Mobilisation
Early mobilisation is an important part of the recovery process, helping to prevent complications and promote healing.
Physical Therapy: Physical therapy usually begins within a day or two after surgery. Early mobilisation is recommended to prevent complications such as blood clots, pressure sores, and pneumonia. Exercises such as strengthening, balance, and flexibility training are recommended to regain strength, mobility, and function.
Assisted Walking: Patients are encouraged to start walking with the help of mobility aids like walkers or crutches to support weight-bearing activities. These initial steps focus on correct posture, safe walking techniques, and gradual weight-bearing on the affected hip. Assisted walking helps build confidence as strength and balance improve.
Long-Term Recovery
Long-term recovery focuses on regaining full strength and mobility, allowing patients to return to daily activities.
Continued Physical Therapy: Ongoing physical therapy sessions help patients gradually increase their activity level and strength. The orthopaedic surgeon will tailor exercises to the patient’s progress and abilities, focusing on gaining strength and endurance. As recovery progresses, therapy may include more high-impact exercises such as stair climbing, standing on one leg, and more dynamic movements to mimic daily activities.
Home Exercise Program: Patients are often given a set of exercises to continue at home, ensuring consistent progress. These exercises help maintain the gains made during formal therapy sessions and promote ongoing improvement in mobility and strength.
Follow-Up Appointments: Regular follow-up visits with the orthopaedic surgeon ensure that the fracture is healing correctly and monitor for any complications. These appointments also allow for adjustments to the recovery plan as needed to address any issues or concerns that arise during the recovery process.
Risks of Procedure
Patients need to be aware of these risks to make informed decisions about their care. The main risks associated with hip fracture surgery include:
Infection
There is a risk of infection at the surgical incision site or deeper within the hip joint. Infections can be serious and require additional treatment, including antibiotics or surgery. Proper sterile procedures and postoperative care are required to minimise this risk.
Blood Clots
Patients undergoing hip surgery are at an increased risk of developing blood clots in the legs, known as deep vein thrombosis (DVT), or in the lungs, known as pulmonary embolism. Blood thinners and early mobilisation are used to reduce this risk. Regular monitoring by the orthopaedic surgeon is important to detect and treat clots early.
Nerve or Blood Vessel Damage
The surgical procedure can sometimes damage nearby nerves or blood vessels, leading to numbness, weakness, or circulatory issues in the affected leg. The orthopaedic surgeon takes great care to avoid these structures, but some risks remain, especially in complex fractures.
Dislocation
After hip replacement procedures, there is a risk that the new hip joint can become dislocated. Patients are usually given specific instructions on moving and what activities to avoid to reduce this risk. Proper adherence to the recovery plan is recommended for prevention.
Nonunion or Malunion
In some cases, the fractured bones may not heal properly, resulting in nonunion (failure to heal) or malunion (healing in an incorrect position). This can lead to continued pain and dysfunction, requiring further intervention. Both conditions might need additional surgical intervention to correct.
Conclusion
Hip fracture surgery is an important procedure for those who sustain a hip fracture. The surgery aims to stabilise the fracture, relieve pain, and restore mobility, greatly improving the patient’s quality of life. A thorough consultation with a hip specialist in Singapore and careful adherence to a recovery plan is important to maximise the chances of a successful outcome.
Dr Wang Lushun specialises in enhancing recovery after hip surgery. He specialises in Direct Anterior / Direct Superior Minimally Invasive Approaches to the hip using the latest modern implants.
