Hip fractures are usually treated in hospital with surgery. The alternative to surgery is called conservative treatment. This involves a long period of bed rest and is not often used as it can:
- make people more unwell in the long term
- involve a longer stay in hospital
- slow down recovery
However, conservative treatment may be necessary if surgery is not possible, for example because someone is too fragile to cope with surgery.
Types of surgery
There are a number of different surgical techniques, which are explained in more detail below.
The type of surgery you have will depend on:
- the type of fracture you have (where in the femur the fracture is)
- your age
- how physically mobile you were before the hip fracture
- your mental ability before the hip fracture, for example if you have dementia (an ongoing decline of the brain and its abilities)
- the condition of the bone and joint, for example if you have arthritis (a condition that causes pain and swelling of the joints and bones)
In general, people under 65 years of age with intracapsular hip fractures may have internal fixation, while older people or those who are less fit may have hemiarthroplasty. In the latter group, the broken hip fragment is removed and replaced.
A complete hip replacement may be considered if you:
- already have a condition affecting your joints, such as arthritis
- are very active
- have a reasonable life expectancy
For people with an extracapsular fracture, some form of very strong plate and screw or locked rod internal fixation device will be necessary. This usually allows you to walk on the leg while the fracture heals over the following three to four months.
Internal fixation means fixing the fracture (break in the bone) using devices to hold the bone in place while it heals. Such devices include:
If internal fixation is used for an intracapsular fracture, you will need to be followed up over several months with X-rays (when radiation is used to create an image of your bones). This is to check that you are healing.
You can have problems healing and sometimes further surgery is necessary. This is why hemiarthroplasty is preferred in older people as a one-off operation.
Hemiarthroplasty means replacing the femoral head with a prosthesis (false part). The femoral head is the rounded top part of the femur (upper thigh bone) that sits in the hip socket.
Complete hip replacement
A complete hip replacement (arthroplasty) is when both the natural socket in the hip and the femoral head are replaced with prostheses (false parts). This is a more major operation than hemiarthroplasty and is not necessary in most patients.
See the Health A-Z topic about Hip replacement for more information about this procedure.
Ideally, you will have surgery within 36 hours of your arrival at hospital, provided you are in a stable condition. You will first have a pre-operative assessment.
A pre-operative assessment will check your overall health to make sure you are ready for surgery. During your assessment:
- You will be asked about any medications you are currently taking, such as low-dose aspirin (to prevent a stroke or heart attack).
- Any necessary tests and investigations will be carried out, such as an echocardiography (when sound waves are used to take an image of your heart).
You will also have an anaesthetic assessment. Anaesthesia is medication to relieve pain that will be used during your operation. Several different types of anaesthesia may be used:
- Spinal or epidural anaesthesia is used to numb the nerves in the lower half of your body so you cannot feel anything from this area.
General anaesthetic makes you unconscious and prevents your brain from recognising any signals from your nerves, so you cannot feel anything.
You may be given antibiotics (medicines that treat infections caused by bacteria) before your operation. This has been found to reduce the risk of your wound becoming infected after surgery.
Surgery carries the risk of venous thromboembolism (a blood clot forming in a vein). Because of this, steps will be taken to reduce your risk. For example, you may be given injections, such as heparin (an anticoagulant, which reduces the ability of the blood to clot).
You will continue to be monitored for venous thromboembolism throughout your stay in hospital. You may still need to take medication after you are discharged.
Depending on which type of surgery you are having (see above), the operation lasts around two hours.
Surgery will be performed by a team of healthcare professionals, including an orthopaedic surgeon (a surgeon who specialises in operating on conditions that involve the skeleton). If you have any questions about your operation, your surgeon or another member of the team should be able to help you.
After the operation, you will begin your rehabilitation programme (see Hip fracture - recovery for more information). This may take place in a different ward to the one where you had surgery.