Types of Hip Fractures
There are 2 main types of hip fractures. The type of fracture you have determines what the treatment will be and how well you are likely to do.
We know that fractures just below the head of the femur do poorly when fixed and often require further operations and ultimately a hip replacement.
The reason for this is that there is poor blood supply to that area and therefore the fractures tend not to grow and the hip bone can die due to poor blood supply.
As most of these patients are reasonably frail, it is best not to expose them to multiple procedures and rather to "do the last operation first" and do a hip replacement as treatment.
Fractures lower down the femur tend to heal better as they have better blood supply and they are usually fixed using a nail and screw fixation system.
Treating Hip Fractures
Some hip fractures are best treated with a hip replacement and that decision is based on the type of fracture. Obviously, this category of hip replacement is not really for you to decide when or whereas it is invariably an emergency.
There are 3 main options of hip surgery in this scenario:
This is the replacement of the ball part of the femur and is usually only for people with very limited mobility. Its advantages are cost and time in theatre, but they can remain symptomatic and are not suitable for people who are reasonably mobile. I would not consider this option on anyone who still goes out of the house and walks around - even if they need support with a stick or walker.
2. Total Hip Arthroplasty or Total Hip Replacement:
This is the replacement of both the ball and socket of the hip joint. This can be done by either cementing the stem into the femur or making use of the structure of the bone to press-fit the stem in place. This is dependant on the quality of bone of the patient and the decision is usually made based on the X-rays.
3. Resurfacing procedures:
This is a procedure that allows a minimal amount of bone to be removed and placing a metal bearing surface as the new joint surface. The worldwide results of this operation are poor when compared to those of Total Hip Arthroplasty and therefore I do not do this operation at all.