FAQ Category: Hip

Most hip fractures aren’t really “simple” even though that word is used to describe the fracture. A simple hip fracture often refers to the fact that the break is only through part of the bone or only in one place.

It’s often used to mean there aren’t pieces of bone broken off. It may describe a fracture in which the ends of the bone are still lined up and not displaced to one side or the other.

About two percent of the patients with a hip fracture die while in the hospital. Hip fractures often occur in older adults with many other problems. They may have kidney, heart, or lung problems. They often have diabetes and osteoporosis.

Bleeding, infection, pneumonia, and blood clots are the most dangerous complications after hip fracture. Often older adults have two or more medical problems at the same time. Death can occur from any one of these problems.

You’re wondering about the bias in such a study. It’s a valid and fair question. And one that researchers must ask themselves when setting up the study. There are ways to avoid this kind of problem.

For example, your study is being done after the operation is over. This is called a cohort or retrospective study. This type of study helps limit patient bias. The study takes place after you’ve finished your treatment. The results aren’t biased by what you expect to happen.

The doctor may choose to compare your results with the final X-rays of the hip joint. In these cases, the X-rays are read by a doctor who didn’t do the operation. The radiologist doesn’t know by looking at the X-ray which patients had a small incision and which ones had the mini-incision.

Finally, scientists think that independent researchers reduce bias. These are studies done by people who weren’t the first ones to try something. They aren’t trying to prove something works. They are just looking at the results of using the method developed by someone else.

The small incision is a fairly new method for hip joint replacement. It’s called a mini-incision. Many studies are being done to compare the mini-incision method with the standard way to replace the hip joint.

Right now doctors choose patients who aren’t overweight. Compared to the standard-incision group the mini-incision group is more likely to be male, taller, and thinner. In fact, the standard-incision group is six times more likely to be obese than the mini-incision patients. The mini-group also has fewer problems in general after surgery.

Researchers are working to find out what type of patients is best suited for each method. That information will help doctors guide their patients in choosing the right operation for each one.

There’s always a certain learning curve with any new skill. This is true for doctors, too. Some information is reported about this. Studies show that doctors using the mini-incision method have the same number of problems whether they are in training or not.

A recent study from Stanford Hospital in California reports no difference between doctors with special training and doctors without extra training. They suggest this means the safety of the operation doesn’t depend on the skill of the doctor. It’s more likely the things that aren’t under the doctor’s control make the difference.

If this is true then you are just as safe at home with your regular doctor as you would be traveling to a special center.

Early, mild osteoarthritis can be difficult to diagnose. Sometimes it isn’t until the patient has been treated on and off for several years that it becomes clear what is the true problem. By that time changes in the joint space start to show up.

Morning stiffness and stiffness after sitting are common with hip arthritis. If there’s no fever and only mild to moderate pain, a diagnosis of hip synovitis can often be ruled out. Hip bursitis doesn’t usually last five years. Limited hip internal rotation and hip flexion aren’t typical with hip bursitis. These motions are limited more often with arthritis.

There are two ways to approach this problem. The first is to treat the hip as if it were a case of arthritis. Improved motion, strength, and function are the goals. If you get better then follow whatever program the therapist suggests. If you don’t get better or the symptoms get worse, make a follow-up appointment with the doctor. You may need further tests, including X-rays.

You may want to make an appointment with her doctor to discuss this. A medical diagnosis is the key to understanding these changes. Many older adults are taking drugs or need new medications during their hospitalization. She could be having a reaction to one of these.

Delirium is a common problem in older adults with hip fracture. It’s different from Alzheimer’s. Delirium is the sudden onset of confusion. There may be a loss of consciousness and attention. The patient may ramble or say things that don’t seem to make any sense at all. It usually doesn’t last but can have long-term effects.

Dementia is a decline in memory and thinking abilities. Alzheimer’s is just one form of dementia. It’s unclear what brings dementia on. Infection, dehydration, or drugs can cause delirium. These are treatable problems.

There may be some things you can do to help your aunt. Talk to her slowly but clearly in adult terms. Tell her what time and day it is. Remind her who you are and why she’s in the hospital. Make sure she can see and hear if she uses eyeglasses or hearing aids. Put a large clock where she can see it. Besides talking with the doctor, ask the nursing staff what you can do to help. With a team effort, you may see your aunt restored to her old self.

You’ll want to be careful with this stretch. See a medical doctor or a physical therapist if you are having low back pain that goes into your buttock and/or down the leg during this activity.

If you’re just having some local low back discomfort, you can place a pillow, blanket, or towels under your abdomen. This can help put your lumbar spine in a more neutral position and take the pressure off the area. Sometimes it’s necessary to start with two pillows. Slowly remove one pillow at a time as your symptoms improve.

Decrease the thickness of the pillows or support when you are able to hold each stretch for 30 seconds without trouble or pain. Stretches should be done slowly with proper breathing. Never bounce or “push through the pain.”

Stretching your hip flexors can be done at home or at work. Stand with your feet about hip width apart. Make sure you are standing up tall with your toes pointing straight ahead. Put your hands on your hips and step forward with the right foot. Go into a lunge (half-kneeling) position.

Tuck your buttocks under and tilt your pelvis forward. You should feel a mild stretch in the front of your thigh where the hip flexor muscles are located. Hold this stretch 30 seconds and repeat on the other side.

Stretching should be done slowly and gently. Keep the rest of your body (jaw, face, shoulders) loose and relaxed. No bouncing! And don’t push to the point of pain or discomfort. You can do more harm than good with these methods. Remember to breathe slowly and naturally. Don’t hold your breath while stretching.

Remember advice on-line should not be a substitute for a licensed professional. It’s always best to see a licensed physical therapist for stretches specifically designed for your body and your needs.

No one knows for sure how stretching actually works. There’s some evidence to suggest that stress applied to a muscle in just the right way causes it to lengthen or stretch. Other researchers say stretching increases flexibility because the muscle itself is elastic. With a constant stretch, the muscle will relax and increase in length.

It’s also possible that using one set of muscles keeps the opposite group of muscles from contracting at the same time. This causes the opposing muscles to relax, loosen, and stretch.

We’re not sure about the effect of other factors on stretching. Maybe age, gender, and number of hours in one position each day make a difference in how far the muscles will stretch. More studies are needed to answer these (and other) questions.

There is a new tool that may be of help to you. It’s called the Risk Assessment and Prediction Tool or RAPT. It’s used by doctors and physical therapists before the patient has the surgery. It shows whether the patient is at low, medium, or high risk for
extended care after a hip or knee joint replacement.

Low risk means the patient can go directly home. Medium risk is more of the gray zone. The patient may need some extra time in the hospital and/or some extra sessions with the physical therapist. High risk means the patient is likely to need extra inpatient rehab
before going home.

Of course there are times when patients who go directly home still need some extra help. Managing meals, icy sidewalks in the winter, or taking care of other family members may
change the picture. Still, the use of RAPT has resulted in more patients going directly home after hip or knee joint replacement.

Ask the doctor or physical therapist to score your mother with this tool. The results may be very helpful.

An autopsy is usually the best way to find out the exact cause of death. Even with an autopsy, it can be very hard to link death with the recent operation. Older adults getting a joint replacement for severe arthritis often have many other health problems.

Diabetes, heart disease, and lung problems are just a few of the more common conditions. Sometimes the patient has two or three (or more) problems all at the same time. These can increase the risk of complications after total hip replacement.

Two other important factors are (1) type of surgery done and (2) mental status of the patient. The seriousness of any post-operative problems that come up must be examined. Wound infection and blood clot are two of the more life-threatening complications that
can lead to death.

A careful review of your father’s medical record may help you find what you’re looking for. State and federal laws guarantee access to your own medical records in most cases. The executor of your father’s estate can request your father’s records. Depending on the state you live in, you may need legal help to get these records and/or the autopsy report.

Generally it means the hospital does more than just a few total hip replacements (THRs) each year. Researchers often set 100 as the point at which a hospital is called high-volume.

A recent study of Medicare patients getting THRs in a high volume hospital reported a death rate of less than one percent. This was compared to a 1.3 percent rate in hospitals doing less than 10 joint replacements each year.

The research supports finding both a high-volume facility and an experienced doctor. Doctors who do more THRs also have lower rates of complications. Be aware that increased experience and volume can lower complications but not to zero. Problems still occur even with the most skilled surgeons. This may have to do with the age and overall health of the patient.

That may not be necessary. The first step is to bring this problem to your doctor’s attention. It’s possible a simple revision of the left hip implant is all that’s needed. Sometimes a plastic spacer can be inserted into the hip socket to make up the difference in leg length.

If the hip can’t be changed, then perhaps a shoe insert or shoe lift would help. A physical therapist can help you with this decision. It’s important to make sure that whatever measures are taken, your spine remains straight and your hips are level. This will help prevent other problems later on.

An osteotomy is used to change the angle of the hip. Sometimes the angle of the thigh bone (femur) as it goes from the knee to the hip socket causes problems. Too much angle causes a small gap between the outer edge of the hip socket and the head of the femur as it sits inside the hip socket.

This uneven angle can cause painful arthritis. Changing the position of the femur in the hip socket can reduce stress on the joint. It can even cause new joint tissue to form. During an osteotomy the doctor takes a pie-shaped piece of bone out of the femur. The gap in the bone is closed and the femur is more vertical with less angle.

Treatment of a failed osteotomy depends on many things. First, what caused it to fail? What’s the condition of the bone (weak or strong)? Is there enough bone to do the osteotomy over? Sometimes a simple muscle release is all that’s needed.

In more complex cases, the hip must be replaced. The doctor may only have to replace one-half of the joint. X-ray results will show the position and condition of the current osteotomy. The surgeon will decide what to do based on the X-ray results and the patient’s report.

An osteotomy is done to change the angle of the femur (thigh bone) as the top of the bone rests in the hip socket. When an osteotomy is converted to a hip replacement, the doctor evaluates what must be done.

Sometimes more corrective surgery is needed before the joint can be replaced with an implant. The surgeon will try and leave the plate and screws in place. Removing them causes more bleeding and adds time to the operation. Extra bleeding may keep the new cement for the new implant from hardening. Loosening of the implant can occur.

Be sure and ask your doctor about his or decision about removal of the plate and screws in your case.

Total hip replacement (THR) has always been reserved for older adults with pain and loss of function from arthritis. More and more young patients (less than 50 years old) are in need of help for severe arthritis.

Yet joint implants don’t last a lifetime, so doctors want to wait as long as possible before replacing the joint. Studies show young, active patients have a high rate of
revision surgeries after THR. Early loosening of the implant is common. Debris from the joint eats away at the bone causing this loosening.

A failed implant with revision surgery can leave the patient with one leg shorter than the other. Muscle weakness and scar tissue can also make daily activities difficult. Active adults find they can’t engage in sports or recreational activities as they once
did.

Doctors often suggest a hip osteotomy for the young patient with only one hip involved. This is a joint-saving operation that can buy the patient some extra time. It can reduce pain, increase motion, and improve function.

The Charnley® Hip was named after its inventor: Sir John Charnley of England. Sir Charnley began studying low-friction hip joint replacements in the late 1950s. The first joint replacement was used in humans around 1960. The implant remains the best-selling cemented hip system in the world.

The surgeon worked closely with the manufacturing company to improve the original designs for low friction hip arthroplasty. New (heavier) stems were devised. Different step sizes
were developed. Improvements were made in the cup (socket) design.

Newer designs of hip implants are on the market today, but none have surpassed the Charnley® for durability. There is no universal agreement as to which design is best. Each surgeon selects what seems best for the patient. In some cases the doctor uses what he or she was trained to use.

It depends on several things. Your age, the condition of your bones, and your activity level are all important. The reason you need the hip replacement is also a factor. The older you are, the more likely your implant will outlive you. Younger, more active patients tend to wear out the implant much faster than older, more stable patients.

Brittle bones from osteoporosis makes the decision more difficult. Hip implants after a failed hip fracture also don’t last as long.

Finally, hip dislocation is common in patients who don’t follow their doctor’s
directions. Certain motions and positions must be avoided in the first six weeks or the joint can dislocate.

There are several things to think about in a case like this. First, what advice or counsel has your father’s doctor given you? Is your father osteoporotic, a smoker, or have diabetes or cancer? All these things can delay bone healing.

Replacing a broken, infected hip with an implant can be a very good idea. Your father will likely be able to get back on his feet sooner. Early and rapid mobilization can reduce other health problems like blood clots, pneumonia, and muscle weakness.

A recent study at the Mayo Clinic in Rochester, Minnesota, compared two groups of patients. One group had a hip fracture that didn’t heal. The joint was replaced. The other group of patients who received a hip replacement didn’t have a hip fracture first.

Durability of the implant was less in patients who had a hip fracture first and then a joint replacement. The rate of hip dislocation was also high (almost 10 percent) in this group. It may be best to sit down with your father and the doctor and go over all the
risks and benefits before making this decision.

Your mother may be a candidate for the new mini-incision method of joint replacement. Instead of a long incision with trauma to the muscles, only a four or five inch incision is made. It’s not always necessary to cut the muscles with the mini-approach. There’s usually less blood loss as well.

There are several factors to consider here. How well can your mother follow directions? Even with the minimally invasive surgery, there will be a few guidelines to follow. After surgery, rehab is very important so she will need to be able to complete her exercises correctly every day.

How’s her overall health otherwise? Her age and the condition of her bones may be other factors to consider. Studies show mental status does affect outcome. A specific study on patients with Alzheimer’s having joint replacement hasn’t been done yet.

Talk to your mother’s doctor about this decision. There may be some other medical information that can be helpful in making this decision.