Orthopaedic surgery and hip fractures in the elderly to aid recovery

Orthopaedic surgery and hip fractures in the elderly to aid recovery

Healthy lifestyles and modern medicine are allowing people to live longer than ever before. It has changed our outlook on what it means to be elderly and it’s now not unusual to have 70+ year olds in the local cycling group or regularly playing golf or tennis. This increased activity combined with less robust bone stock unfortunately increases the risk for injuries such as hip and wrist fractures and the early, safe and effective management of these injuries are the responsibility of your orthopaedic surgeon.

Hip fractures particularly can have devastating effects on one’s quality of living and can even be life threatening. We have learnt much over the years regarding the best treatment of hip fractures with respect to early management, type and time of definitive management and rehabilitation.

Our goals are to manage our patients’ pain immediately, optimize any associated pre-existing illnesses and plan for definitive, effective and safe care as soon as possible, which is usually within the next 24 hours. Rehabilitation starts the next morning and we hope to discharge our patients home from the second day after surgery.

Hip Fractures

Hip fractures fall into two main categories: Intracapsular or neck fractures, and extracapsular or outside the joint fractures. These two groups both require surgical treatment but the treatment is completely different. 

Femoral neck fracture
Extracapsular hip fracture

Fractures in Elderly

Displaced femoral neck fractures in the elderly are best managed with one of the forms of hip replacement surgery. This allows the patient to immediately mobilise as the femoral head and the painful fracture site has been resected and thereafter replaced with a stable and almost pain free hip replacement. The only pain after surgery is related to the surgical incision which is the same size as for an elective total hip replacement.

The reason we don’t fix these fractures is because the likelihood for healing is very low, the rehabilitation is slow and painful, and the time in hospital and on crutches is much longer. 

Replacements in active elderly

There are different types of hip replacements.  For active and healthy individuals, we would do a standard total hip replacement consisting of a replacement of the femur head as well as the cup or acetabulum. This is the same as a normal elective total hip replacement for arthritis.

For active and relatively healthy individuals who are at an increased risk of falling and therefore dislocation, we would use a special type of hip replacement called a Dual Mobility Construct that protects against dislocation in the event of repeated falls.

For the very old and less healthy patients who may also have dementia and therefore difficulty adhering to safe rehabilitation, and also a high risk of falling, we would do a hemiarthroplasty. This type of procedure only replaces the femoral head portion with a size-for-size prosthetic and provides the best resistance to dislocation in combination with certain surgical approaches. 

The X-rays all look very similar, but the implants are completely different.

Total hip replacement
Dual mobility hip replacement

For hip fractures outside of the hip joint, also called extracapsular fractures, the definitive management is different. Early pain control, medical stabilisation and optimisation are the same, and surgical treatment is also the best choice for definitive treatment, but the type of surgical treatment is different.

Extracapsular fractures have a high likelihood of healing if they are fixed. This leaves the hip joint unaffected and able to function as normal. The two most common ways of fixing these fractures is with an intramedullary nail or plate and screws.

It is very important to understand the different sub types of fractures in this group as subtle differences sometimes require very specific implants. If the wrong implant is used for certain sub types of fractures, the likelihood of complications are much higher. Although patients have to use crutches for much longer and be careful of not taking full weight on the fractured leg in the beginning, the long term benefit is a healed fracture with a normal hip.

X-ray of the hip after plate and screws surgery has been performed
Plate and screws
Intramedullary nail
Intramedullary nail

We take care to understand our patient’s physical health, their current activities and expectations, and their home environments and support systems. This information in conjunction with the type of hip fracture they sustained helps us to choose a course of action that has the highest likelihood to get them back home and back to their life as quickly and safely as possible.

For more information about the kinds of hip surgery we undertake, you can visit our website. If you want to discuss your hip care going forward, please contact us.