FAQ Category: Hip

The treatment of some types of hip fractures remains a hotly debated topic among surgeons. Displaced femoral neck fractures can be especially complicated. Displaced refers to the fact that the broken bones have shifted away from each other. They no longer line up so good healing is not likely without surgery to repair or replace the bones.

Studies show that all in all, it makes more sense and costs less for the older adult to have a hip replacement. Reduction and internal fixation (the repair option) has a higher rate of complications. If the bone fails to heal, then a second surgery (hip replacement) is needed.

A total hip replacement (THR) after failed fixation does not give the same results as if the THR was done in the first place. Quality of life is less and cost is more when two surgeries are done instead of just one. There is also a chance that function will be further reduced by the second operation.

The repair option is advised if the patient is a good candidate for this management approach. This is usually the young, active adult who is in good health both mentally and physically. With good bone quality, there is an excellent chance for successful healing with no complications.

For the older adult who has decreased bone density, diminished mental capacity, or who had poor function before the fracture, THR is advised.

There isn’t a clear cut answer that can be applied to all older adults with this type of fracture. Many factors must be considered. Once the surgeon reviews the X-rays and examines your grandmother, he or she will be able to give you all of the pros and cons for each one.

In a young, active adult with good bone stock, this type of break can be repaired. The surgeon lines the bones up and holds them together with a metal plate, wires, screws, or pins. When the fracture heals, the fixation pieces may or may not be removed.

If the patient has brittle bones or is wheelchair bound, a total hip replacement (THR) may be the best option. General health and the presence of other conditions such as diabetes or heart disease must be considered.

The surgeon’s own level of experience and training will also factor into the decision. The goals are to relieve pain, restore function, and preserve independence. The surgeon, patient, and family should take these goals into consideration when reviewing each management option.

Early attempt to use hip resurfacing were done with titanium alloy, cobalt chrome, alumina or ceramic components. Over time, new developments have led to the use of metal components made from cobalt chromium.

As you’ve discovered, there were some concerns about heat build-up between the bone and the metal. If the temperature of this interface gets too high, bone necrosis (death) can occur. But surgeons have overcome this problem with modified techniques to dissipate the heat.

There were also some questions about maintaining an adequate blood supply from the shaft of the femur (thigh bone) up into the femoral head. But studies using nuclear imaging show that an even mount of blood flow is preserved.

Metal-on-metal hip resurfacing (MOMHR) has not been approved for use in woman of childbearing age. There is concern that debris from the metal can cross the placenta and affect the growing fetus. Cobalt and chromium ions have been found in umbilical cord blood to prove this can happen.

So far, there’s been no negative effect seen in children who have been exposed to ion particles. But we don’t know if long-term studies would show the same benign effect. More study is needed before MOMHR will be approved for this group of women.

Choosing between the standard length and small incision has become an option for many patients today. Sometimes the surgeon dictates the choice based on his or her training, expertise, and experience.

There are other factors that might make a difference as to which method can be used. For example, obesity may prevent the surgeon from using the short, less invasive incision.

Studies suggest that the smaller incision may be just for cosmetic purposes. Patients are no better and do not have improved function at the end of six weeks regardless of how the incision is made.

It may be important to ask your surgeon if the small incision technique will result in a higher risk of early complications. You’ll want to know if there’s a chance that the minimally invasive method will affect the long-term results. Anything that might reduce the performance and function of the implant should be avoided.

An interesting discovery has been made about the post-operative results of the mini-incision technique for hip replacement. At first, surgeons thought the smaller incision was the reason patients had a faster recovery.

But more and more studies have been done now comparing the various types of incisions (large and small). It looks like early weight-bearing and quick recovery are possible with all types of incisions. This is true for the anterior, posterior, single, and double incision of all sizes.

A second look at this result points to the importance of the rehab program. It looks like a more comprehensive rehab program may be what’s making a difference.

For one thing, patients are given more education before the operation. They are told what to expect and shown how to do the exercises and walking regimen before even having the surgery. This helps speed up recovery because the information isn’t new to them.

Better intra-operative technique has also proven beneficial. Pain medication is started while in the operating room, rather than after the patient wakes up.

New drugs have been developed to reduce side effects such as nausea from the anesthesia. And regional anesthesia makes it possible to numb the area without exposing patients to systemic effects of anesthesia.

Patients who get good education and follow-up care before and after surgery go home sooner, recover faster, and use less pain medication. Every surgeon or surgical center has their own way of coaching patients through the experience.

Ask your surgeon what his or her plan is for rehab for you. Try to follow the suggestions as closely as possible to avoid adding any extra problems or complications.

Range of motion defines how well you can move your hip as far as the hip joint was meant. A healthy hip joint can bend quit a bit and allow freedom for movement.

There are a few reasons why someone’s range of motion may be limited. It could be caused by pain (the more I move my joint, the more it hurts), swelling, clicking of the joint, or even stiffness around the joint.

If you are experiencing considerable limitations to the way your hip moves, you should see a doctor to see what can be done.

That’s a good question and it doesn’t always have a standard answer. As you point out, different doctors do things different ways, however, most procedures have standard protocols that should be followed in order to achieve the best possible outcome. So, if Dr. Smith and Dr. Jones both perform the same hip replacement, using the same technique and the same hardware, in patients who are similar in age, health, weight, and lifestyle, their rehabilitation protocols should be very similar.

However, things can change drastically with any difference between the patients, techniques, and hardware used. If Dr. Smith uses a partial replacement approach over Dr. Jones’ full replacement, their recommendations will be different, as they would be if Dr. Smith did to different procedures on the same day.

Researchers are constantly trying to find the best way to do things and the best approaches to take so treatment plans are changing and evolving. What may have been not recommended a few years ago, may be standard procedure now.

When there is a study regarding the best way of inserting a hip replacement or the best replacement to use, the technique or implants are usually ones that have been in use already, but the researchers want to know which one seems best.

Researchers may adjust treatment plans, exercises may be offered earlier or later, or different exercises prescribed, but the goal is not to prove that one is not as good, but that the other is better.

If there is found to be a big difference between to the two, to the point that the health or well-being of the study subjects, the trial is stopped, so as not to cause harm.

Range-of-motion exercises are exercises given to a patient following an injury, surgery, or procedure on a joint that may affect how well the joint can move.

The way you can move your shoulder, for example, provides you with and example of a range of motion. If you can move your arm in all the ways it is intended, you have a good range of motion. However, someone who has pain may not be able to move the arm as well. This is a restricted range of motion.

Physiotherapists provide ROM exercises to help enlarge that target range or to keep the current range from getting smaller.

Osteonecrosis of the hip is a condition where part of the bone does not get the blood it needs for nourishment and the bone cells die. When this happens in the hip, it is the top or the head of the femur, or thigh bone, that is affected.

It is generally a disease that affects young people, but doctors don’t understand yet what causes it. They do believe that it can be caused by previous hip dislocations or injuries, alcohol consumption, high doses of corticosteroids, or a genetic history of similar diseases.

Osteonecrosis of the hip, a condition where the bone cells in the head of the femur or thigh bone have begun to die, can cause a lot of pain and difficulty in moving around. Many patients who have this disease do end up having a hip replacement but some many do try managing it with medications first.

There have been studies with a medication called alendronate, a medication used to treat osteoporosis, thinning bones. The results have been promising although more studies do need to be done to really say if it is more effective than any other treatment.

A total hip replacement, called a total hip arthroplasty (THA) literally replaces the hip joint. The implant is attached to the bones and is set into place.

A partial replacement, called total hip resurfacing, replaces only part of the hip, which provides an advantage for many people.

With hip resurfacing, the surgeon reshapes the head (top) of the femur (thigh bone) and fits a lining over it, as opposed to the total replacement that will remove that part of the bone and replace it with an implant. With the resurfacing, the bones need to be strong and able to withstand the force of the procedure, so people who have weakened bones are not able to have this type of surgery.

The benefits to the resurfacing are that it appears to have a lower dislocation rate, the healing time is faster, and because the head of the femur is preserved, there is enough bone left for further surgery if it is needed.

After patients have hip surgery, there are some positions that they must avoid for a while and others that are most comfortable and will help the hip heal properly. As a result, a physiotherapy regimen is important so patients and families can learn what the patient should and should not do.

Immediately after surgery and for a set amount of time, patients should not bend their hip more than 90 degrees. Patients should not cross their legs while sitting, recline with their legs at more than 90 degrees, or pivot their hip outwards or inwards. When lying in bed, the hip can twist if a patient is lying on the side. This happens as the knee tries to rest on the mattress.

When lying in bed after hip surgery, if lying on the side, a pillow should be placed under the “higher” leg to rest on, so the hip stays straight and in line with the body.

Recovery after hip surgery can be long for some people as they learn to use their leg again without damaging the hip as it heals. However, with proper care, the rate of success is quite high.

When your mother is still in the hospital, she will likely be seen by a physiotherapist who will discuss the after-surgery care, including what your mother can and cannot do and for how long. It would be a good idea if you could meet with the physiotherapist as well so you also know what is important.

An issue following hip surgery is safety. It’s a good idea to try to minimize any chances of falls and eliminating as many dangers as possible. This means removing any scatter rugs, for example, and keeping the normal traffic pattern clear of something that could cause a slip or fall.

Be sure that you have the necessary equipment to help your mother. This may mean having an elevated toilet seat and a safe way for her to take a shower.

The type of replacement a doctor chooses to do depends on the damage, the patient’s health and condition, and the state of the femur, or thigh bone. It is possible that a doctor would prefer to do a partial replacement on both hips but one is not a good candidate for it – that could be one reason. This is the type of question that a patient should ask the surgeon beforehand.

Arthrokatadysis means there is a subsidence of the joint. Subsidence is the medical term for sinking-in. Quite literally, the joint starts to sink down into the bone.

The cause of this problem is largely unknown and may vary from patient to patient. Something causes the bone supporting the joint to soften. This could be a lack of enough blood to the area from a blood clot or other vascular problem.

There may be some kind of systemic disorder of the organs or glands affecting the bones. Despite the fact that the condition was first described in the 1920s, not much is known about it. The number of cases reported is small, which contributes to a lack of understanding.

Pain often migrates, or radiates, from one part of the body to another. A good example is when someone has a heart attack – often their pain is in the left arm or up into the jaw. In the case of your father, many people who have arthritis in the lumbar spine, the lower back, feel the pain radiate down into the hip or groin area.

The important part of getting proper treatment is for a physician to find out where exactly the pain is coming from, the hip itself or the spine. Only then can the pain be treated properly.

Many people who have hip or groin pain could have arthritis in the hip or in the lumbar spine, the lower part of the back. X-rays, while helpful in many cases, often can’t help in this situation. However, in order to treat your mother’s pain properly, the doctor needs to know where the pain is originating.

A procedure called a fluoroscopically guided intra-articular injection is one way to determine this. By injecting a medication directly into the joint, the doctor can find out if this helps decrease the pain. If the pain does decrease, then the problem is with the hip. If it doesn’t decrease, there is a good chance that it is the spine.

Arthroscopies are usually done for the knees and shoulders because of the way the joints are formed – they are easier to access with the small instruments used. However, the procedure is done on other joints, such as the hips, as surgeons learn the best ways to do them and for what reasons.

A small study done recently found that patients with certain types of hip problems did benefit from arthroscopies in helping determine their diagnosis and treatment.

There are many different types of hip fractures affecting either the femur (thigh bone) or the acetabulum (hip socket). In older adults, the most common hip fracture occurs in the upper portion of the femur.

A simple fracture through the main part of the bone is straightforward and usually heals well in healthy adults. But fractures affecting the neck of the femur can be quite complex. The femoral neck is a thin bridge of bone between the shaft of the bone and the round head that fits in the hip socket. This type of fracture can cause complications from a loss of blood to the femoral head.

Intertrochanteric fractures are located between the greater trochanter and lesser trochanter. The trochanters are projections of bone on the femur.

The greater trochanter is at the top of the shaft before the femoral neck begins. The lesser trochanter is on the opposite side of the femur and down below the neck. Prognosis for healing is usually good for healthy adults with this type of fracture.

Less often, subtrochanteric fractures occur. These breaks involve the shaft of the femur. They are located just below the lesser trochanter. The fracture pattern may extend down the upper to mid-portion of the femoral shaft.

Surgery is usually required for subtrochanteric fractures. The bone may be broken in several pieces. Plates, screws, and/or nails called internal fixation are used to hold the bone in place until healing takes place.

Some types of internal fixation cannot be stressed or overloaded. This may mean full weight-bearing isn’t allowed until X-rays show the fracture is stabilized. The surgeon wants to try and avoid pressure that will cause the fracture to move or the ends of the broken bones to sink into each other.

It might be a good idea to have the surgeon review with you and your mother the exact kind of fracture she has and specific precautions required. Collapse or nonunion of the fracture could delay healing even more.