FAQ Category: Hip

Osteoporosis is a decrease in bone density potentially leading to weak and brittle bones. Transient means it’s temporary. Transient osteoporosis of the hip is rare but not unknown. There are certain groups of people affected most often. These include middle-aged men (ages 30-60) and pregnant women (during the third trimester).

This doesn’t mean other people can’t develop this problem. Cases of transient osteoporosis of the hip have been reported in teenagers and women who aren’t pregnant. Such cases are very rare. No one knows for sure what brings this problem on. The physician orders lab tests to look for a possible underlying endocrine or metabolic cause. But these tests can be normal in the presence of transient osteoporosis. A calcium-deficient diet may be one possible risk factor.

The natural history of this condition is that it resolves or gets better over time. The painful symptoms last several weeks to several months. The changes in bone go away gradually, usually within a year’s time. Given the fact that transient osteoporosis of the hip goes away over time, it is considered a benign condition.

Conservative care is the standard for transient osteoporosis. Non weight-bearing with crutches is advised until the diagnosis is confirmed and stress fracture is ruled out. Once it’s clear that the condition is transient osteoporosis, then the patient can be progressed to walking with crutches while putting weight on the leg as tolerated by the individual patient. Swimming is encouraged and advised.

The first part of both terms (osteo) refers to bone. In the first word (osteonecrosis), necrosis means death — so, osteonecrosis is the death of bone. In the second word (osteoporosis), porosis refers to how porous the bone has become. Loss of bone density creates larger spaces between bone cells. As a result of these changes, the bone is more brittle.

The differential diagnosis is made using advanced imaging. X-rays may not show osteoporosis clearly. Doctors rely on MRIs to see patterns in the signals that indicate the presence of osteoporosis. For example, low-signal lines in the subchondral bone called crescent lines are seen with osteoporosis. Subchondral refers to the first layer of bone just under the joint cartilage.

When osteoporosis is present, MRIs can show fluid called bone edema. Bone edema can be present with stress fractures and bone tumors, so the presence of bone edema doesn’t necessarily confirm that the person has transient osteoporosis.

Further tests may be required such as DEXA bone scans. DEXA stands for dual-energy X-ray absorptiometry. A more up-to-date abbreviation for that term is DXA. DXA provides means of measuring bone mineral density that can be compared to the expected norm.

Osteonecrosis shows up on MRIs without the defects in bone seen with osteoporosis. Instead, there are clear changes in the subchondral bone of the femoral head. Subchondral refers to the first layer of bone just under the joint cartilage. The distinction between these two conditions (osteonecrosis and osteoporosis) is important because these are separate problems requiring individual treatment.

There are several types of total hip replacements, or arthroplasties, and yes, some require cement and others don’t. Doctors have been experimenting with antibiotic-impregnated cements in the hope that they would cut down on the infection rate of the hip replacements.

As with everything, we have to take cost into account when doing surgical procedures. So, not only is the cement being studied for effectiveness, it’s being studied for cost effectiveness. One recent study didn’t find that the cost of the cement justified its use as there were no substantial savings, considering the cement’s high price. In fact, there was a savings of only about 200 dollars, compared with a procedure that is, on average, equal to about 35,000 US dollars (2002).

Hip joint resurfacing was introduced several years ago to help younger patients who are more active and who would likely dislocate or wear out a total hip replacement. Surgeons found a way to replace the surface of the joint without removing the bone and replacing the entire joint. Bone is saved because the femoral head (round ball at the top of the thighbone) isn’t cut off. And it isn’t necessary to put a long stem down into the canal of the femur since the head isn’t replaced.

All of these features of joint resurfacing make it possible for patients to extend the life of their own joint before a full joint replacement is needed. There is also some thought that joint resurfacing may preserve a more normal load transfer during gait (walking and running). If that is true, gait recovery could be added to the list of advantages for joint resurfacing over total hip replacement.

These are just a few of the many reasons why joint resurfacing has advantages over a total hip replacement for younger, more active adults. Research is underway to find ways to further maximize these benefits. Scientists are studying all aspects of the implant design, surgical technique, and rehab protocols.

Each surgeon has his or her own way to perform the operation. The approach, type of implant, incisions made, and fine-points of surgical technique can vary. So, it’s the surgeon who ultimately must answer your question. You don’t want to do anything to compromise what would otherwise be a perfect result. You can expect at least a 12 week postoperative recovery time. Six months of concentrated rehab is not unreasonable for someone who wants to participate in competitive sports such as soccer.

Ask your surgeon for a timeline to guide you. Make sure you understand what (if any) motions or activities are not advised and how long these restrictions should last. Participation in high-impact activities may be always restricted in order to protect and preserve the joint for as long as possible. Find out what your particular restrictions may be when making your final decision about this procedure.

Studies do show that the average patient makes rapid gains in recovery after a hip replacement in the first three to six months following the procedure. Patients are encouraged to keep up their exercise program after that for at least another six months (if not longer).

It appears that it takes some people as long as two years to fully regain strength, motion, and function. It’s not entirely clear why there are such differences. Many factors may come into play. For example, the type of procedure performed has something to do with it. More invasive procedures that require the surgeon to cut through major hip muscles can delay restoration of normal movement patterns.

Implant placement is an important key. The implant must be put in place with the correct angle and rotation. If the center of rotation is off, the muscles can’t function normally. Hip stability, load on the hip, and biomechanics are all affected in different ways by these variables. Sometimes the patient ends up with a leg length difference. The implant may sink down into the bone too much making the operated leg shorter than the other leg. In other cases, the component parts make the leg longer than the other side. Either of these situations can impact recovery.

There’s also some question about how long the rehab program should extend. The standard time is two to three months. There’s some evidence that this just isn’t long enough. But it’s not clear yet what the ideal time frame may be.

Some experts who study human movement and posture have also suggested that a different rehab protocol may be needed. It’s clear that the hip abductor muscles are key here. These muscles move the leg away from the body. They also stabilize the hip when you stand on one leg. Both functions are equally important during standing and walking activities.

If you are not satisfied with your results, it may be time to check back with your orthopedic surgeon and your physical therapist. Together they can help find out what isn’t going well for you and why. It could be something simple to get you back on track.

You’re not alone in your concern about form over function. Even if the minimally-invasive approach doesn’t yield better functional outcomes, patients like how it looks. A shorter incision just looks better, and patients are asking for that. Patients also want an implant that will last as long as possible. And that factor is more important to them than the length of the scar or how long they are in the hospital.

There are many advantages to a minimally-invasive approach. And we’re not talking about just a shorter incision line. Minimally invasive refers to the fact that the group of muscles usually cut to remove the old hip joint aren’t touched. The gluteus maximus (buttock) muscle is split to get to the hip joint, but the length of the split is much shorter. The incision into the joint capsule is also smaller and repaired without any negative effects.

Studies are ongoing to assess the results of minimally-invasive surgeries. There are mixed reviews as to outcomes. In some studies, the operating time is shorter and there’s less blood loss. In others, the operation is complex and may take more time if the surgeon hasn’t done quite a few of them.

But the long-term results (a year or more later) don’t really show much of an advantage of the minimally invasive approach over the standard incision. Walking distance, walking speed, and muscle strength appear to even out between the two surgical approaches.

There are still plenty of factors to consider when comparing the two approaches. Patient education, preoperative counseling, analgesia, and rehabilitation programs may be the real keys to recovery. While the surgical approach might make a difference, there’s at least enough preliminary information to suggest that the postoperative treatment process may be equally (if not more) important.

Patients and surgeons are both interested in a speedy, painless recovery from surgery after a total hip replacement. To reach that goal, surgeons have introduced something called a minimally-invasive surgery (MIS).

Minimally invasive surgery refers to any operation where the surgeon changes how long or how deep the cut is made into the tissue. With some minimally invasive approaches, the surgeon can avoid cutting into most of the muscles around the hip that are normally removed from the bone during the standard hip replacement surgery.

The hope is that with less trauma to the soft tissues (especially the muscles around the hip), the patient will be able to recover that much faster. There are also some efforts to speed up the rehab or postoperative recovery process. A program called the fast-track has been designed to accomplish this.

Several studies have shown that patients who are on the fast-track after surgery get better faster. The fast-track means they get a patient-controlled pump to manage their pain. They start rehab sooner, and the therapist provides a more aggressive program. In studies so far, patients in the fast-track groups are discharged sooner, can walk better, and are more satisfied than patients following the standard rehab protocol. This is true no matter what type of incision or approach was used to do the surgery.

Not everyone can participate in a fast-track program. Patients are selected based on general health, motivation, and compliance level. Complications after surgery such as infection, dislocation, or fracture can put an end to someone’s fast-track status. But for those who are able to complete the program, the results have been very impressive.

More adults than ever before are having their first hip replacement. And more of those are being done at a younger age. If patients outlive the life of their implant, then revision surgery is needed. Or if there are complications from the first surgery, a revision replacement might be needed.

Infection, loosening of the implant, dislocation of the implant, and subsidence (sinking) of the implant into the bone are common reasons why implant failure occurs requiring a second (revision) operation.

Costs are also rising. Today’s implants can be put in without cement. New surface coatings to make this possible cost more. Hospital and rehab costs have also gone up in the last few years. Some of this can be attributed to inflation.

Patients with multiple comorbidities (other health concerns) tend to present as more complex, challenging cases. Longer operating time and more days in the hospital lead to higher costs. The costs for patients who can’t be discharge home and must go to an extended-care facility are five-times higher.

There are many possible reasons why each of your family members and friends had to have a hip joint revision surgery. It’s likely that they each had a different reason. In the future, developing and using evidence-based guidelines for standard of care, patient safety, reducing complications, and managing patient expectations at the time of the surgery.

Added together, these steps represent best-practice procedures for both hospitals and specialty centers. The final result might be total decreased costs as a result of reduced hospital length-of-stay, fewer complications, and fewer revision operations.

You raise some very good questions that deserve consideration. Researchers are applying themselves diligently to answering the risk-to-benefit ratio for many improvements in the health-care delivery system. Computer-assisted technology is one of them.

Like all advancements in science and technology, there’s always an early investment in research and development. The tremendous cost can seem way beyond the benefit derived by anyone. It brings up the idea that just because we can do something doesn’t mean we should.

An alternate way to look at this is to see the immediate benefit to a single patient. In the case of procedures like hip replacements or hip resurfacing, computer-assisted surgical navigation makes it possible to fit the implant with greater accuracy. Perfect positioning of the implant is linked with better outcomes.

Less wear and tear and lower loads with daily activities are two of the main byproducts. The patient can resume a high level of activity, including sports and recreational involvement. That can translate into greater patient satisfaction, increased well-being, and overall improved general health. Those are hard to put a price tag on.

On the other hand, the cost of an implant failure and revision surgery can be calculated. It runs into thousands of dollars. If we multiply that by the number of patients who end up with unavoidable complications and re-operations, then suddenly the value of the technology becomes abundantly clear.

Ultimately, time will tell if the visionaries of today were right to move ahead and embrace advancements that may not seem cost-effective right now. But these items could pay off in the future with big dividends.

Hip resurfacing arthroplasty is a type of hip replacement that replaces the arthritic surface of the joint but removes far less bone than the traditional total hip replacement. Because the hip resurfacing removes less bone, it may be preferable for younger patients that are expected to need a second, or revision, hip replacement surgery as they grow older and wear out the original artificial hip replacement.

You are asking, how well do they work? And what are the potential problems or complications? Using data from the 1000s of hips done outside of the United States along with studies done in the states, it’s clear that the overall revision rate is still higher for resurfacing than for standard total hip replacements. But the rate is still small enough to make it worth having the procedure for the many patients who aren’t ready yet for a complete total hip replacement.

The most common complications are femoral neck fracture, implant dislocation, and metal ion hypersensitivity. Because the component parts of the implant are metal, tiny pieces of metal ions flake off and get trapped inside the joint forming a tumor-like cyst or entering the blood stream. This could become a problem for anyone with metal hypersensitivity.

Studies show that women are more likely to have a failed resurfacing procedure. So are patients who’ve had a previous hip surgery or anyone who has osteonecrosis (loss of blood supply to the top of the femur or thighbone causing death of bone cells). And anyone with inflammatory arthritis or developmental dysplasia of the hip is at increased risk for implant failure.

Joint resurfacing is a wonderful stop-gap measure for patients with painful arthritic conditions. By preserving as much bone as possible, it buys them some time before converting to a total hip replacement. The beauty of this plan is that it allows younger patients to remain active and put off the inevitable hip replacement. This intermediate step is important since hip implants don’t last forever.

Dislocation is every patient’s fear after getting a new hip replacement. The surgeons call it instability. No matter what name you give it, the problem is troublesome for the patient and a complex challenge for the surgeon.

Conservative (nonoperative) care is usually tried first. Once the hip is back in the socket, a brace may be applied and the patient is sent to physical therapy. Not all surgeons use bracing in these situations. If they do, the brace used is called an abduction brace. It holds the hips apart and in a neutral position (not turned in or rotated out).

The physical therapist will help your mother learn how to move safely while strengthening the muscles around the hip. A special focus of treatment is to restore normal joint proprioception (sense of joint position) and kinesthesia (awareness of movement). Balance training is also very important.

Before discharging her to home, the therapist will interview the family to find out what kind of changes need to be made at home. For example, throw rugs will have to be removed, additional lighting (especially for at night) may be needed, grab bars installed in and around the bathroom, and so on.

If a conservative approach doesn’t work and the hip dislocates again and again, then surgery may be needed. The surgeon may have to tighten up loose tissue and restore a balance to soft-tissue tension on all sides of the hip joint. If the implant is improperly positioned, it must be removed and realigned. The surgeon may need to replace the femoral head with a larger one. The goal is to prevent a recurrent (second) hip dislocation.

The good news is that only 10 per cent of patients who dislocate the hip after receiving a total hip replacement will dislocate it a second time. Your surgeon and the rehab team will help you navigate through this difficult time. Don’t hesitate to bring up your concerns and questions. They have knowledge of your mother’s health and hip condition that they can draw on to provide you with answers.

A larger femoral head size has been shown to reduce hip dislocations and minimize instability. There are several reasons why they work. First, they provide a larger surface area in contact with the acetabular cup (socket).

Second, a larger head gives a better ratio of size from the head of the femur to the neck. That’s important in allowing a larger arc of motion and preventing impingement or pinching of the femoral neck against the rim of the cup.

The surgeon usually puts a polyethylene (plastic) liner inside the cup (between the cup and the femoral head). With this liner in place, the larger head can sit deeper inside the cup, making it more difficult for the head to jump out of the cup and dislocate. Studies have verified that a thinner liner can hold up while still accommodating the larger femoral head.

And improved materials have extended the wear on these heads. That’s important because larger heads do tend to wear more potentially reducing their long-term survival. Finally, larger heads can potentially eliminate the risk of early dislocation with implants of all kinds (e.g., ceramic, metal-on-metal, polyethylene). That makes them useful for a large variety of patients who need a hip replacement or revision surgery such as your grandfather requires.

Patients are surprised after a total hip replacement by how much it can hurt those first few days. They do okay while sitting or resting, but once they get up to move it can be another story. That’s why surgeons are working hard to find ways to control pain. And they would like to do so without using opioids (narcotics) because of the many side effects.

Patient-controlled analgesia (PCA) can be a wonderful tool for many patients. Being able to control the release of pain medications can help get them back on their feet and smooth recovery. But as you discovered, not everyone has a good result with PCA.

Nausea, vomiting, itching, trouble breathing, confusion, and even delirium are all potential side effects of opiate-based (narcotic) drugs. For some patients, these adverse effects can be worse than the pain they are trying to control!

Some surgeons have started a new approach. That’s the use of nerve blocks for the first 24 to 48 hours after surgery. There are different approaches being tried right now. Different types of nerve blocks are under investigation. By injecting a numbing agent around the nerve to the muscles in the hip, pain can be reduced.

Single-injection blocks can be delivered to the femoral nerve or higher up in the spine at the lumbar plexus. These provide pain relief for a short time after surgery. But for those first two days after surgery, continuous nerve blocks work much better. In particular, the lumbar plexus nerve block seems to have the best results. Patients use less (if any!) narcotic, which means fewer drug side effects to interfere with therapy.

Tell your surgeon about your concerns. Ask what other options might be available for you. If he or she doesn’t mention a nerve block, you may want to ask if this is a possibility. The continuous infusion of a numbing agent seems to work best. This option isn’t available everywhere, and not all surgeons have adopted this strategy. But it’s worth asking about.

Nerve blocks are somewhat new in the postoperative management of pain after total hip replacements. The idea is to block sensation to the nerve to the hip muscles. With less pain, you’ll feel more like moving, and that’s an important key to a quick and successful recovery.

But the injection of a numbing agent around the nerve can also affect motor function of the nerve to the muscles. The result may be an inability to contract the muscles used to hold the leg straight. The patient ends up with a problem (and solution) that’s similar to yours.

This doesn’t happen very often and hasn’t been reported in the literature yet. But surgeons are taking these kinds of effects into consideration when using nerve blocks. Different protocols are being tried such as a single injection of a numbing agent that lasts a short time versus a continuous delivery of the same numbing agent over a 12-, 24-, or 48-hour time frame.

With a successful nerve block, the physical therapy program can move total hip patients along faster. Studies comparing one daily physical therapy session versus two sessions have been suggested. It’s possible that with a more aggressive rehab program, patients can recover faster and leave the hospital sooner, thus cutting costs even more.

Impingement just means pinching. In the hip impingement typically occurs where the round head of the femur (thigh bone) comes in contact with the acetabulum or hip socket. Since there are always potential problems with surgery, conservative (nonoperative) care is usually suggested for this problem before considering a more invasive approach.

Early diagnosis and treatment has the best chance of a good outcome. The patient is usually interested in pain relief and improving painfree motion, which will in turn improve function. the surgeon has an eye on preventing the development of osteoarthritis.

A physical therapist can help by showing you ways to move without causing the painful pinching. Activity modification is often needed. This doesn’t mean you can’t do all the things you want to do. It usually means you have to change the way you go about certain activities. This is often successful with a little time, attention, and practice.

If it has been decided that surgery is the way to go, the surgeon has three choices: 1) full open incision and correction of the problem, 2) arthroscopic surgery, and 3) osteotomy. With the fully open surgical procedure, the head of the femur is dislocated from the socket to make the changes and corrections. With arthroscopic surgery, dislocation is not required. Osteotomy (reshaping the socket) is done for pincer-type impingement.

Whenever possible, the surgeon tries to save the hip. But when there is extensive damage to the cartilage, hip resurfacing or total joint replacement may be needed. There are many factors to consider when making this decision. The patient’s age, findings on imaging studies, type and severity of deformity, and presence of arthritic changes are important.

The best time for surgery isn’t known. Delays may result in even worse cartilage damage that can’t be repaired. But waiting can also give you a better chance for the development of better choices in the future, such as cartilage grafting or computer-assisted surgery. Less invasive approaches to hip surgery are being developed all the time. Young patients with minimal signs of osteoarthritis may want to take the chance and wait to see what comes in the future.

The full medical term for this problem is femoroacetabular impingement. Impingement just means pinching. Femoroacetabular refers to the place in the hip where the round head of the femur (thigh bone) comes in contact with the acetabulum or hip socket. Two types of impingement are known to cause pinching of the soft tissues in this area.

The first is called cam-type impingement. This occurs when the round head of the femur isn’t as round as it should be. It’s more of a pistol grip shape. It’s even referred to as a pistol grip deformity. The femoral head isn’t round enough on one side and it’s too round on the other side to move properly inside the socket.

The result is a shearing force on the labrum and articular cartilage, which is located next to the labrum. The labrum is a dense ring of fibrocartilage firmly attached around the acetabulum (socket). It provides depth and stability to the socket. The articular cartilage is the protective covering over the hip joint surface.

Sometimes cam-type impingement occurs as a result of some other hip problem (e.g., Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or SCFE). But most of the time, it occurs by itself and is the main problem. Men are affected by cam-type impingement more often than women.

The second type of impingement is called pincer-type (more common in women). In this type, the socket covers too much of the femoral head. As the hip moves, the labrum comes in contact with the femoral neck just below the femoral head. Repeated microtrauma at this site can cause the bone to overgrow, a condition called heterotopic bone growth.

Pincer-type impingement is usually caused by some other problem. It could be as a result of 1) hip dysplasia, 2) a complication after osteotomy surgery to correct hip dysplasia, or 3) an abnormal position of the acetabulum called retroversion. Hip dysplasia is a deformity of the hip (either of the femoral head or the acetabulum, or both) that can lead to hip dislocation.

The condition is brought to the orthopedic surgeon’s attention when the patient reports groin pain that occurs when the hip is bent or flexed. Although the condition is often present on both sides, the symptoms are usually only felt on one side. In some cases, the groin pain doesn’t start until the person has been sitting and starts to stand up. There is often a slight limp because of pain and limited motion.

The diagnosis is usually confirmed through clinical tests and X-rays. Sometimes advanced imaging such as MRIs or CT scans are also ordered. Once all the test results are available, a course of action is determined. This may be conservative (nonoperative) care with antiinflammatories and physical therapy. In some cases, surgery is required.

Hip pain from problems like osteoarthritis does often show up in the inner thigh or groin area, more so than the outside. This is because of the anatomy of the joint and where the ball of the femur, the thigh bone, fits into the socket of hip joint. It’s in the inner part of the hip that the motion takes place that allows you to move your leg inward and outward again.

The diagnosis of snapping hip syndrome usually only requires a careful patient history and examination. Many times, the patient and/or examiner are able to reproduce the symptoms. This helps identify the soft tissue structures that are involved.

The cost of more advanced imaging is always taken into consideration. Since the first step in treatment is the same regardless of the exact diagnosis, your surgeon may hold off on further imaging studies for a while.

Conservative care with rest, stretching exercises, and avoiding repetitive motions that aggravate the condition is advised. A physical therapist may also use deep heating treatments such as ultrasound or iontophoresis (antiinflammatory medications pushed through the skin to the tendon).

Magnetic resonance imaging or ultrasound for imaging (rather than for providing heat treatment) becomes helpful if and when the surgeon is considering a steroid injection into the iliopsoas bursa. The bursa is a small, oval-shaped soft tissue structure between the bone and the tendon. It helps reduce friction and provides smooth action of the tendon-muscle unit.

In the case of snapping hip syndrome, magnetic resonance arthrography (MRA) may be a better choice. A contrast dye is injected into the joint to help look for problems within (inside) the joint. This could be a loose fragment of cartilage or bone — or a frayed or torn piece of the labrum (rim of cartilage around the hip socket).

Dynamic ultrasound is another good diagnostic option. Images of the iliopsoas tendon show signs of tendon thickening, enlarged burse, pockets of fluid collection, or signs of inflammation. Each of these tests has its own sensitivity and specificity making them useful for certain patients. The surgeon is able to identify which test is best and when to use it to avoid unnecessary test procedures but gain important and necessary information when it’s needed.

Some athletes are bothered by a painful snapping at the hip when moving the leg from a flexed to an extended position. There can be a variety of reasons why this happens. Some occur outside the joint such as when a tendon rubs over a bony prominence. Others are caused by something going on inside the joint. It could be a tear in the labrum (rim of cartilage around the hip socket) or a loose fragment inside the joint.

The most common cause is the iliopsoas tendon rubbing over a bony bump called the iliopectineal eminence. Many times there is also a fraying or a tear of the labrum contributing to the problem.

Whatever the cause, treatment is needed to help the athlete get back into action. At first, conservative care with rest, stretching exercises, and antiinflammatory drugs is advised. A nonoperative approach should be tried for at least six months. Sometimes a steroid injection with a numbing agent into the iliopsoas bursa helps.

When none of these approaches reduces or relieves painful snapping symptoms, then surgery may be advised. The surgeon can partially or fully cut the iliopsoas tendon away from the bone. The tendon retracts and reattaches to the nearby soft tissue.

Recovery and rehab takes at least 10 to 12 weeks. At first, you won’t be able to bend the hip. This makes you unstable when trying to walk or use coordinated movements of the legs. This new symptom will last two to four weeks until the tendon reattaches and heals in its new location. You’ll be given some simple exercises to do at first.

You will probably work with a physical therapist who will supervise how much weight you put on the leg(s), how to use crutches or canes, and a progression of leg control exercises. Eventually stretching exercises will be included, then coordination exercises, and finally, sport-specific movements. When you can control your motion, have 90 per cent strength, and can handle impact activities, then you will be released to return to the soccer field.

There are many types of hip fractures, usually named for their location. A basic understanding of the hip anatomy will help visualize where the fractures occur.

The hip joint is one of the true ball-and-socket joints of the body. The hip socket is called the acetabulum.It forms a deep cup that surrounds the ball of the upper thighbone, or femoral head. The femoral head is attached to the rest of the femur by a short section of bone called the femoral neck.

A bony bump on the outside of the femur just below the femoral neck is called the greater trochanter. A smaller bony bump on the femur called the lesser trochanter is located on a diagonal from the greater trochanter. These two bumps on the femur are where some of the hip muscles attach.

A cervical hip fracture refers to the fact that the break is inside the joint itself. Either the top of the femur (called a subcapital fracture) or the acetabulum (hip socket) have a break. Another term for the location of these fractures is intracapsular or cervical.

When the break affects the hip, but is not right inside the hip, the fracture is referred to as an extracapsular hip fracture. The fracture may occur in the neck of the femur (femoral neck fracture), between the two trochanters (intertrochanteric fracture), or in the main shaft of the femur just below the lesser trochanter and may extend down the shaft of the femur. This last type of hip fracture is called a subtrochanteric fracture.