So You Broke Your Hip, Now What?
By Brett Robin, M.D.
The hip is a common place for injury, and therefore a common place for fractures, especially in elderly patients. Women tend to experience more hip fractures than men post menopause, due to the loss in the female hormone progesterone, which supports bone formation.
The hip is a ball and socket joint that connects the upper part of the leg and the pelvis together. It allows for a lot of movement. But due to aging in all patients, bone density and joint elasticity decrease, causing strain on the hip’s mobility. Restricted mobility in the lumbar spine can also contribute to strain on the hip joint. A fall can move the ball and socket out of place which could lead to a broken hip.
What are some hip fracture treatments?
For hip fractures, the only effective treatment is surgery. Depending on where the patient has broken their hip, makes the difference on whether the hip joint can be replaced or preserved by the operating surgeon. Surgeons prefer to preserve the native joint as much as possible. Yet, if the hip is fractured in the upper part of the ball and socket, the hip has to be replaced. Particularly, for highly active patients, surgeons will do a full replacement. For those who live a more sedentary lifestyle, surgeons will only do a partial replacement of just the ball side of the joint. . For those who broke their hip at the lower part of the ball and socket joint, they will get a plate and screws and or a rod to preserve the native joint.
If on a very rare occasion, patients are seeking a non-operative approach, they may be sent directly to rehab after a hip fracture. However, it often leaves the patient bedridden for most of their day, as to avoid putting a lot of weight on the joint. When a patient is upright and getting around, they will have to use either crutches or a walker, which is going to expend a lot of their energy, and will likely slow down their recovery. Not to mention, bedridden patients can be at high risk for pneumonia or even deep vein blood clots, or DVT. DVT can lead to a pulmonary embolism; in other words, a blood clot that gets stuck in an artery of the lung, which can lead to death. We highly recommend for patients who have broken their hip, seek surgery as soon as possible. Plus, the implants surgeons use are strong enough that a patient can put their weight on them immediately after surgery, which strongly supports their access to mobility more effectively and efficiently.
What are surgery and aftercare like for hip fractures?
Surgery is typically done in under an hour and is a familiar procedure to most orthopedic surgeons. The bigger concern is what happens after surgery. As a patient is older and frailer, hip surgery can lead to even bigger issues, potentially pneumonia or getting a blood clot if they stay sedentary or bedridden for too long. That is why it is so important for a patient’s recovery to follow the rehabilitation process that could take, sometimes, up to a year to complete.
When an orthopedic surgeon is treating patients, we do not just prepare them for surgery, but for the potential months after with rehab or the potential move to a nursing facility to watch over them as they are in recovery. We motivate patients to think of their treatment plan as a journey, with long-term goals, instead of a quick fix. We include the families and any facilities we are liaising with, such as the nursing home, or the physical therapists, to ensure that there are open lines of communication for everyone involved in the recovery process. We also ensure that the patient is fully aware that they will likely lose a lot of their independence as their mobility will be heavily limited during recovery. We support their mental and emotional well-being, as it can be hard to cope with this sudden change.
We also may refer or recommend the patient go see a psychologist or therapist to support their mental health; as a lot of patients may feel depressed or suffer from other mental health issues, as a result of their hip fracture and loss of independence.
What happens in the long term after a hip fracture?
Even after surgery and rehabilitation, the patient can have some long-term movement limitations, impacted by the fracture. Some will lose at least one level of mobility, especially elderly patients. It is possible that if an elderly patient was walking independently before the hip fracture, they could go down to walking with a cane or a walker. If they were walking with a walker or a cane, they could be wheelchair-bound.
Patients that are now walking with a walker, cane, or wheelchair-bound, could experience other chronic pain problems, such as back and shoulder pain. Also, because one hip has lost a level of mobility, the patient will usually offset it by putting their weight on other joints in the leg, shoulders, and back; which could cause pain in these areas.
The patient may have to work with a hip pain doctor to receive treatment on other parts of the body, either through steroid injections and/or by undergoing more physical therapy. Sometimes, we recommend they go to aqua therapy because their weight is significantly reduced, making it easier for patients to build strength and retain their mobility.
What are long-term recovery treatments for hip fractures?
After hip surgery and rehab, it is really important to maintain regular activity to support mobility, balance, and strength in the hip, and all throughout the body. I recommend to my patients yoga, walking, or cross-training to support the different muscles around the hip, such as muscles in the legs, groin, botox, and abdominals. Core strengthening is often overlooked in the rehab process; but, it is vital to achieving a good outcome. Also, it is equally important to maintain a healthy diet so that patients are not putting on more added weight, which could put more strain on the recovering hip and surrounding joints.
For women, especially those who are post-menopausal, bone health is even more important. Therefore, we recommend increasing their calcium and vitamin D intake. I also recommend to post-menopausal women talk to their general practitioner to get a Dexa scan, which is a medical imaging test to measure bone density. This can help prevent future fractures in the hips, along with the wrists and spine.