Replacement Surgery for Hip Fractures
Hip fractures are common fractures in the elderly population. Because of improvement in health care delivery systems and a better understanding of diseases and medical conditions, human beings have started to live longer. This means the elderly population is increasing day by day and so is the incidence of hip fractures. Hip fractures have become common in the younger age population as well because of High-velocity injuries like Road Traffic Accidents.
Why is hip replacement done for hip fractures?
Even if the head of the femur survives there is a chance of the fracture not uniting (Non-Union). It is because of these reasons the head of the femur is surgically removed and is replaced with a metallic or ceramic prosthesis.
There are two types of hip fractures: femoral neck fractures and inter-trochanteric fractures. Femoral neck fractures result in limited blood supply to the femoral head which can result in avascular necrosis. Despite timely treatment of femoral neck fractures with cannulated screw fixation, AVN can still develop.
Types of Hip replacement (arthroplasty) for hip fractures
There are two types of hip replacement surgery currently being done for hip
fractures Hemiarthroplasty: The hip joint is made up of the femoral head and the acetabulum. When the femoral neck is fractured, treatment may include removal of the femoral head and neck that is replaced with a prosthesis.
Total hip arthroplasty:
In this type of replacement surgery, the
acetabulum cup of the pelvic bone is reamed and the prosthesis (acetabulum
cup) is placed along with the replacement of the femoral head and neck.
When is total hip replacement done for Hip fractures?
With advanced age comes an increase in osteoporosis (poor bone quality) and osteoarthritis (degeneration of cartilage). Because of osteoporosis there is increased incidence of hip fractures with low intensity trauma such as falling on level ground. The incidence of hip osteoarthritis co-existing with hip fractures is a very common scenario dealt with by orthopedic surgeons. Performing a hemiarthroplasty in an osteoarthritic patient can result in persistent hip pain.
What are the advantages of having Total Hip Replacement for Hip fractures?
There are several advantages of total hip replacement surgery when done for hip
fractures in the elderly. Some of them are Decreased Hip pain. Total hip replacement surgery replaces both the femoral head and acetabulum. Co-existing Hip pain due to Hip arthritis is
effectively treated with total hip replacement.
Increased Hip Range of motion: Hip stiffness of Hip arthritis is almost eliminated
when a total hip replacement is performed. Patients who were previously unable
to walk, climb stairs, etc. will be able to do so following the surgery. Decreased cost and hospital stay: Although the total hip replacement surgery appears to be expensive than Hemi replacement surgery at first, it is less expensive in a long run. Hemi replacement surgeries leave the co-existing hip
arthritis unattended and the hip pain persists even after successful surgery. Persisting hip pain demands extensive physiotherapy, repeated hospital visits, and possible hospital admission for treatment and ultimately total hip replacement surgery is inevitable. Total Hip replacement surgery straightaway
during the time of hip fractures will help reduce the cost in the long run.
Decreased cost and hospital stay: hemiarthroplasty leaves the coexisting diagnosis of hip osteoarthritis untreated. Hip pain will likely persist after surgery resulting in continued treatment including physical therapy, injections, medications, and ultimately total hip arthroplasty. Performing a thorough exam and diagnostic evaluation is key to ascertain who is a candidate for hemiarthroplasty vs total hip arthroplasty to reduce cost and improve patient outcomes.
What are the disadvantages of having Total Hip Replacement for Hip fractures?
There are a few disadvantages of having total hip replacement surgery. Replacing both the femoral head as well as the acetabular cup will take a longer time during the surgery. Most of the patients undergoing total hip replacement surgery are older individuals and many of them have co-morbid conditions like Diabetes, Hypertension, Obesity, etc. Performing surgeries taking longer operative time increases risks in terms of surgical site infections, pulmonary embolism, deep vein thrombosis, need for ICU stay, dislocation, and even mortality. The lesser the age and comorbidities more successful the surgery will be.
What about the recovery time?
Recovery time is similar for both types of replacement surgeries. Many surgeons advise the patients to walk the next day if the pain and medical condition permits. Many patients will mobilize out of their bed with the aid of a walker and gradually to a walking cane and later without support. The physiotherapist and the surgeon will constantly monitor your progress and advise accordingly.
When is Total Hip replacement surgery for Hip fractures not recommended?
Total Hip replacement surgery is not recommended for patients who were not fully ambulatory, mentally lucid, or had an active lifestyle before to surgery. The patients who are less healthy, institutionalized, cognitively impaired, or require an assistive device for ambulation are usually not suitable candidates for Total Hip replacement surgery.
References:
Monzón DG, Iserson KV, Jauregui J, Musso C, Piccaluga F, Buttaro M. Total hip
arthroplasty for hip fractures: 5-year follow-up of functional outcomes in the
oldest independent old and very old patients. Geriatric orthopaedic surgery &
rehabilitation. 2014 Mar;5(1):3-8.
Azar F, Beaty J, Canale S, Campbell W. Campbell’s operative orthopaedics. 9th ed.
Stirton JB, Maier JC, Nandi S. Total hip arthroplasty for the management of hip
fracture: A review of the literature. Journal of orthopaedics. 2019 Mar
1;16(2):141-4