Hip fractures are usually treated in hospital with surgery.
Types of surgery
Most people will need surgery to fix the fracture or replace all or part of the hip. There are a number of different operations, 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 joints and bones)
Internal fixation means fixing the fracture (break in the bone) using devices to hold the bone in place while it heals, including:
This type of operation tends to be used for people over 65 years of age who have a fracture inside the socket of the hip joint (intracapsular) and for fractures outside of the socket of the hip joint (extracapsular).
If internal fixation is used for an intracapsular fracture, you will need follow up appointments over several months with X-rays to check you are healing.
Problems healing can sometimes lead to further surgery so an operation called hemiarthroplasty is preferred in older people.
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.
A complete hip replacement (arthroplasty) is an operation to replace both the natural socket in the hip and the femoral head with prostheses (false parts). This is a more major operation than hemiarthroplasty and is not necessary in most patients.
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
Read more about hip replacement.
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 to check your overall health and make sure you are ready for surgery.
During your assessment you will be asked about any medications you are currently taking and any necessary tests and investigations will be carried out.
You will also have an anaesthetic assessment to decide what type of anaesthesia may be used. Different types include:
- spinal or epidural anaesthesia used to numb the nerves in the lower half of your body so you cannot feel anything in this area
general anaesthetic makes you unconscious and prevents your brain from recognising any signals from your nerves, so you cannot feel anything
A hip fracture can be very painful. Throughout your diagnosis and treatment, you should be given medication to relieve your pain. This is initially usually given intravenously (through a needle into a vein in your arm), with a local anaesthetic injection near the hip.
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 a blood clot forming in a vein. Because of this, steps will be taken to reduce your risk. This may include 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 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 will help you.
After the operation, you will begin your rehabilitation programme. This may take place in a different ward to the one where you had surgery.
Read more information about recovering from hip fracture surgery.
Alternative to 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.