Question:My husband is quite a bit older than me and needs surgery to repair a displaced, broken hip. The surgeon has explained the two options: repair or hip replacement. It does make sense to try and repair it first. If it doesn't work, then we can still go with the hip replacement. Is there a downside to this approach?
Answer:The treatment of some types of hip fractures remains a hotly debated topic among surgeons. Displaced femoral neck fractures can be especially complicated. Displaced refers to the fact that the broken bones have shifted away from each other. They no longer line up so good healing is not likely without surgery to repair or replace the bones.
Studies show that all in all, it makes more sense and costs less for the older adult to have a hip replacement. Reduction and internal fixation (the repair option) has a higher rate of complications. If the bone fails to heal, then a second surgery (hip replacement) is needed.
A total hip replacement (THR) after failed fixation does not give the same results as if the THR was done in the first place. Quality of life is less and cost is more when two surgeries are done instead of just one. There is also a chance that function will be further reduced by the second operation.
The repair option is advised if the patient is a good candidate for this management approach. This is usually the young, active adult who is in good health both mentally and physically. With good bone quality, there is an excellent chance for successful healing with no complications.
For the older adult who has decreased bone density, diminished mental capacity, or who had poor function before the fracture, THR is advised.Richard Iorio, MD. Primary Total Hip Replacement in Patients with Displaced Femoral Neck Fractures. In Current Opinion in Orthopaedics. January 2008. Vol. 19. No. 1. Pp. 28-32.
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