Dr. Elizabeth Bishop Gausden, MD, MPH

Hip fractures typically occur on the ball of the hip joint, called the femoral head. Types of hip ball fractures include:

• Femoral neck fractures, which occur on the upper end of the femur (thigh bone). The femoral neck is located just beneath the hip ball.
• Trochanteric hip fractures, which occur on a bony bump beneath the femoral neck.
• Although hip socket (acetabulum) fractures are possible, they are less common.

Hip fractures are painful and may make it difficult to stand or walk. If left untreated, patients may be confined to bed rest, which can itself lead to further complications, including muscle weakening, pneumonia, and bedsores. Treatment for hip fractures aims to relieve pain and allow patients to return to their normal routines.

Non-surgical treatment of hip fractures, called closed reductionxf, requires no incisions. A closed reduction is typically performed for patients under five, those who cannot undergo surgery due to illness, and for fractures that are stable and may heal within days. Most often, surgery is recommended. Hip fracture surgery often entails one of the following procedures:

• Hip replacement, which can be partial or total. In this procedure, a surgeon replaces the damaged hip with artificial components, or prostheses.
• Open reduction, which is often performed with internal fixation (ORIF). To perform ORIF, a doctor will make an incision to expose the fracture and then move the bones back into proper position. Screws, pins, or plates - types of internal fixators - will be used to keep the bones in place.

Following surgery, patients may stay in the hospital for a few days or weeks. Additionally, patients may need crutches or a walker after their procedure, and their doctor may recommend limiting movement to avoid another hip injury. Physical therapy can help patients to avoid complications and return to normal activity.

During hip replacement surgery, an incision is made along the side of the hip. The surgeon may access the joint directly through this incision, or by using small tools and a lighted tube called an arthroscope to see and treat the joint. The diseased tissue is removed, and the bones are smoothed out and fitted with metal ends. The metal pieces may be cemented in place, or they may have a porous structure that encourages bone to grow into them and hold them securely. A smooth plastic cushion is placed between the two bones to replace the cartilage and allow the joint to move freely.

Hip replacement surgery takes one to two hours, and afterwards patients may stay in the hospital for several days. When patients go home, they will have to use a cane, walker, or crutches at first. Patients will likely have physical therapy to improve their ability to move with their new hip. After the first few weeks, light exercise such as bike riding or swimming will help them heal, but certain actions, such as climbing stairs or bending over at the waist, may be difficult at first. It will take several weeks before they can drive or return to work. Full recovery may take six to 12 months.

Although joint replacement is one of the safest and most reliable medical procedures available, it is still a major surgical procedure. All surgical procedures carry risks, such as infection or blood clots. For this reason, doctors try to help their patients avoid surgery for as long as they can. Taking arthritis medications, losing weight, avoiding high impact sports such as running, taking supplements such as glucosamine or chondroitin, or having joint injections may allow a patient to enjoy life without the need for surgery.

After having joint replacement surgery, patients can expect some pain the first few days as they recover. Physical therapy is an important part of recovery, and it can decrease complications and increase future mobility. As soon as possible, returning to low impact sports such as swimming, walking or biking can stretch and heal the new joint. A prosthetic joint can last 15 - 20 years and cannot be further damaged by degenerative diseases such as arthritis, so once it is done patients should be pain-free for many years.