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Definition

Hip fracture surgery is done to repair a break in the upper part of the thigh bone. The thigh bone is called the femur. It is part of the hip joint.

Hip pain is a related topic.

Description

You may receive general anesthesia for this surgery. This means you will be unconscious and unable to feel pain. You may have spinal anesthesia. With this kind of anesthesia, medicine is put into your back to make you numb below your waist. You may also receive anesthesia through your veins to make you sleepy during the surgery.

The type of surgery you have depends on the kind of fracture you have and also your general health.

If your fracture is in the neck of the femur (the part just below the top of the bone) you may have a hip pinning procedure. During this surgery:

• You lie on a special table. This allows your surgeon to use an x-ray machine to see how well the parts of your hip bone line up.
• The surgeon makes a small incision (cut) on the side of your thigh.
• Special screws or nails are placed to hold the bones in their correct position.
• This surgery takes 2 to 4 hours.

If you have an intertrochanteric fracture (the area below the femur neck), your surgeon will use a special metal plate and special compression screws to repair it. Often, more than one piece of bone is broken in this type of fracture. During this surgery:

• You lie on a special table. This allows your surgeon to use an x-ray machine to see how well the parts of your hip bone line up.
• The surgeon makes a surgical cut on the side of your thigh.
• The metal plate or nail is attached with a few screws.
• This surgery takes 1 to 3 hours.

Your surgeon may perform a total or partial hip replacement (hemiarthroplasty) if there is concern that your hip will not heal well using one of the procedures above. Hemiarthroplasty replaces only the ball part of your hip joint. Total hip replacement replaces the ball and the socket part of the hip.

Why the Procedure Is Performed

If a hip fracture is not treated, you may need to stay in a chair or bed for a few months until the fracture is healed. This can lead to life-threatening medical problems, especially if you are older. Surgery is often recommended because of these risks.

Risks

Following are risks of surgery:

• Avascular necrosis. This is when the blood supply in part of the femur is cut off for a period of time. This can cause part of the bone to die even after the fracture has healed.
• Injury to nerves or blood vessels.
• Parts of the hip bone may not join together at all or may join in an incorrect position.
• Blood clots in the legs or lungs.
• Mental confusion (dementia). Older adults who fracture a hip may already have problems thinking clearly. Sometimes, surgery can make this problem worse.
• Pressure sores (pressure ulcers or bed sores) from being in bed or a chair for long periods.
• Infection. This may require you to take antibiotics or have more surgeries to eradicate the infection.

Before the Procedure

You will likely be admitted to the hospital because of a hip fracture. You probably will not be able to put any weight on your leg or get out of bed.

Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

On the day of the surgery:

• You will likely be asked not to drink or eat anything after midnight before your surgery. This includes chewing gum and breath mints. Rinse your mouth with water if it feels dry, but do not swallow.
• Take the medicines your provider told you to take with a small sip of water.
• If you are going to the hospital from home, be sure to arrive at the scheduled time.

After the Procedure

You will stay in the hospital for 3 to 5 days. Full recovery will take from 3 to 4 months to a year.

After surgery:

• You will have an IV (a catheter, or tube, that is inserted into a vein, usually in your arm). You will receive fluids through the IV until you are able to drink on your own.
• Special compression stockings on your legs help improve blood flow in your legs. These reduce your risk of getting blood clots, which are more common after hip surgery.
• Your doctor will prescribe pain medicines. Your doctor may also prescribe antibiotics to prevent infection.
• You may have a catheter inserted into your bladder to drain urine. It will be removed when you are ready to start urinating on your own. Most of the time, it is removed 2 or 3 days after surgery.
• You may be taught deep breathing and coughing exercises using a device called a spirometer. Doing these exercises will help prevent pneumonia.

You will be encouraged to start moving and walking as soon as the first day after surgery. Most of the problems that develop after hip fracture surgery can be prevented by getting out of bed and walking as soon as possible.

• You will be helped out of bed to a chair on the first day after surgery.
• You will start walking with crutches or a walker. You will be asked not to place too much weight on the leg that was operated on.
• When you are in bed, bend and straighten your ankles often to increase blood flow to help prevent blood clots.

You will be able to go home when:

• You can move around safely with a walker or crutches.
• You are correctly doing the exercises to strengthen your hip and leg.
• Your home is ready.

Follow any instructions you are given about how to care for yourself at home.

Some people need a short stay in a rehabilitation center after they leave the hospital and before they go home. At a rehabilitation center, you will learn how to safely do your daily activities on your own.

You might need to use crutches or a walker for a few weeks or months after surgery.

Outlook (Prognosis)

You will do better if you get out of bed and start moving as soon as you can after your surgery. Health problems that develop after this surgery are often caused by being inactive.

Your provider will help you decide when it is safe for you to go home after this surgery.

You should also talk to your provider about reasons you had the fall and ways to prevent future falls.

References

Keller AS, Kashiwagi DT. Perioperative medical management of hip surgery patients. In: Berry DJ, Lieberman JR, eds. Surgery of the Hip. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 24.

Morris JC, Baumgaertner MR, Cooney LM, Morris VA. Medical management of the patient with hip fracture. In: Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 53.

Southerland LT, Fath JJ. Geriatric trauma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 179.

Weinlein JC. Fractures and dislocations of the hip. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 55.

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