My father-in-law is just going into surgery for a broken hip. We won’t know until he comes out if they can repair it or if it has to be replaced. Isn’t it better to save the natural bone if possible? How do they decide these things?

Many surgeons agree that it’s best to try and save the patient’s hip when at all possible. What they don’t want to see happen is a failed fracture repair that has to be operated on again.

In order to reduce costs and save stress on the patient, they try to pick the best operation to fit the patient’s needs at the time. This isn’t always easy to do. If a plate and screws are used to repair the hip (an operation called internal fixation), the fracture might not heal. The blood supply to the hip can get cut off leading to death of the bone called osteonecrosis. If that happens, the bone has to be removed and a hip replacement put in.

The surgeon will take all factors of the patient’s health and living situation into consideration. Will he be going home alone or is there someone who can help take care of him? What is his mental state? Is he at risk for falls and injury because of Alzheimer’s or some other form of dementia?

How old is the patient? How active is he? What is the condition of his bone? Younger, more active patients with good bone quality do better with internal fixation. Older, more brittle-boned patients may do better with a total hip replacement (THR). Studies show that in the long run, THR is more cost effective than internal fixation or a partial hip replacement.