What is a Hip Fracture?
Fractures of the hip joint most commonly involve a break in the upper portion of the thigh bone (femur), where it attaches to the ball of the hip joint. This region is known as the ‘proximal femur’ or ‘femoral neck’. Hip fractures commonly occur in patients with established reduction in the bone density (osteoporosis). In patients with osteoporosis, fractures may be sustained after only relatively minor trauma or simple falls.
Hip fractures can also occur in patients with normal bone strength after more severe injury (e.g. motor vehicle accidents) – in this situation hip dislocations, socket fractures, pelvic injury or other injuries unrelated to the hip may also be sustained. The term ‘hip fracture’ however commonly refers to an isolated fracture of the upper femur.
What is Osteoporosis?
Osteoporosis is gradual weakening of the bone with a reduction in bone density, leading to an increased risk of fractures. Osteoporosis is a ‘silent’ condition (causes no symptoms) and takes many years to develop. The risk of developing osteoporosis increases with age, particularly after menopause. Both women and men can develop osteoporosis. There are many treatments for osteoporosis – they are generally most effective if started prior to severe reductions in bone density. Ideally, all patients sustaining a fracture over the age of 50 should have an assessment of bone mineral density (BMD) by DEXA scan. Further information can be obtained from your General Practitioner.
How are Hip Fractures Treated?
In most situations where a significant hip fracture has been sustained, surgery is recommended. As many patients with hip fractures also have other health problems, other specialists (eg. Physician, Rehabilitation Consultant) are often asked to assist with various aspects of overall health management. After the surgery, most patients are instructed to full weight bear on the operated hip as desired, however regaining steady and confident walking may take some time. Often admission to a Rehabilitation Unit is useful to help regain confidence and mobility after hip fracture surgery.
What types of Operation are Recommended for Hip Fractures?
Broadly speaking, surgery for hip fractures is divided into two groups – internal fixation or joint replacement.
When is Internal Fixation Recommended?
Internal fixation involves placing the bone back into correct alignment and holding the position with a combination of metal devices such as plates, screws & rods. The metal devices hold the fracture fragments until the bone unites. Removal is not usually recommended.
When is Joint Replacement Recommended?
Some patterns of hip fracture have an unacceptably high risk of complications if treated with internal fixation. In these situations, joint replacement is recommended. Joint replacements used in hip fracture treatment may be ‘half’ hip replacements (where only the broken ball is replaced) or Total Hip Replacements (where both the broken ball and socket are replaced). Which joint replacement is recommended depends on a number of factors such as age, general health, activity level and pre-existing joint arthritis.
What are Periprosthetic Fractures?
Periprosthetic fractures are fractures that occur around pre-existing Total Hip and Total Knee Replacements. They affect a similar group of patients as described above. Many of these injuries require Internal Fixation or Revision Joint Replacement and therefore surgeons must be trained in this field in order to achieve the best outcomes for patients. Associate Professor Harvie has extensive experience in the management of all injuries associated with Total Hip and Total Knee Repalcements.
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
These can form in the calf muscles and can travel to the lung (Pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Ideally, your knee should bend beyond 115 degrees but on occasion, may not bend as well as expected. Sometimes manipulations are required. This means going to the operating room where the knee is bent for you while under anesthetic.
The plastic liner eventually wears out over time, usually over 10 to 15 years, and may need to be changed. Alternatively the remainder of your own knee may wear out requiring revision to a Total Knee Replacement.
Fractures or breaks can occur during surgery or afterwards if you fall. To repair these, you may require surgery.
The operation will always cut some skin nerves, so you will inevitably have some numbness around the wound. This does not affect the function of your joint. You can also get some aching around the scar. Vitamin E cream and massaging can help reduce this. Occasionally, you can get reactions to the sutures or a wound breakdown that may require antibiotics or rarely, further surgery.
The knee may look different than it was because it is put into the correct alignment to allow proper function.
Your leg will be restored to it’s original length as the deformity caused by wearing of the knee has been corrected.
There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Surgery may be required to correct this problem. This problem is minimised with Robotic Assistance.
Rarely these can be damaged at the time of surgery. If recognized they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent.
Discuss your concerns thoroughly with your Orthopaedic Surgeon prior to surgery.
Summary
Surgery is not a pleasant prospect for anyone, but for some people with arthritis, it could mean the difference between leading a normal life or putting up with a debilitating condition. Surgery can be regarded as part of your treatment plan it may help to restore function to your damaged joints as well as relieve pain. Surgery is only offered once non-operative treatment has failed. It is an important decision to make and ultimately it is an informed decision between you, your surgeon, family and GP. Although most people are extremely happy with their new knee, complications can occur and you must be aware of these prior to making a decision. If you are undecided, it is best to wait until you are sure this is the procedure for you.