My wife just had a total knee replacement and then she fell and fractured her hip socket (on the same side). The surgeons are debating whether to try and repair the hip socket or go for a hip replacement. What are all the considerations in a decision like this?
Increasing age combined with certain risk factors such as osteoporosis (decreased bone density) makes it more and more likely that an older adult will end up in the hospital with an acetabular fracture.
What's an acetabular fracture? The acetabulum is the socket side of the hip joint. It is made of cartilage over bone just like every other joint. The reason it breaks is because the person falls (and lands) in such a way that the head of the femur (thigh bone) is driven up into the hip socket (acetabulum) with enough force to break bone.
Until recently, this type of fracture was always treated conservatively (without surgery). And many times, this is still the most appropriate treatment. The presence of dementia, poor health, severe bone loss, and nonambulatory status before the fracture are reasons why surgery may not be possible. And in your wife's case, a second surgery so soon after the first may not be tolerated.
So long as the fracture isn't displaced (shifted), those patients who could walk before the injury are allowed to walk with the support of a walker. But only minimal weight through the hip is allowed until healing occurs. However, this approach is not the best way to rehab a total knee replacement (which needs to keep moving), so that is another consideration.
With or without surgery, patients with acetabular fractures are encouraged to get up and move as early as possible. The goals of treatment for all acetabular fractures are four-fold: 1) restore the weight-bearing surface of the socket, 2) keep good bone stock (strength and density), 3) maintain joint stability, and 4) prevent deformities.
In some cases, it's clear that the patient should have a hip replacement right from the start. For your wife between the hip and the knee, the decision becomes more complex and challenging because now there are twice as many things to consider. The decision is made on a case-by-case (individual) basis. The surgeon evaluates the best way to reduce blood loss, minimize operative times, and prevent complications.
Travis R. Torngren, et al. Acetabular Fractures in the Elderly. In Current Orthopaedic Practice. September/October 2011. Vol. 22. No. 5. Pp. 392-399.
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