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The hip joint is a ball and socket joint that connects the ball-shaped top of the leg bone (femur) to the hip socket. It is a strong, stable joint that allows a wider range of motion than other joints. The hip joint can endure a lot of stress but, of course, there are limits. Hip pain is common and has many causes, including:
- Ligament sprains, muscle strains, or nerve impingements
- Stress fractures—a result of repeated stress that occurs with activity
- Osteoarthritis—degeneration of the cushioning of the hip socket
- Rheumatoid arthritis—swelling and inflammation of the hip joint
- Fracture caused by an injury or possible bone tumor
Hip fractures are serious at any age and almost always require surgery to repair.
Causes of Hip Fractures
A hip fracture is a break in the thigh bone just below the hip joint. The hip joint consists of a ball at the top of the thigh bone and a rounded socket in the pelvis. Most hip fractures occur 1-2 inches below the ball portion of the hip.
Typically, a blow to the bone is not the cause of a hip fracture. Rather, it is caused by repeated stress or overuse. A stress fracture is a tiny crack in the bone from chronic overuse, and can occur when:
- Increasing the amount or intensity of an activity too quickly (most common)
- Switching to a different playing or running surface
- Wearing improper or old shoes
- Overuse or abuse
Stress fractures can worsen by continued physical stress. Smoking also can make stress fractures worse because it interferes with bone healing.
Symptoms of Hip Fracture
A hip fracture may cause:
- Localized pain in the groin and the front of the inner thigh
- Difficulty or inability to stand, walk, or move the hip
Risk Factors
A risk factor is something that increases your chances of getting a certain disease or condition. Factors that increase the risk of hip fractures in people with healthy bones include:
- Motor vehicle accidents and other types of major trauma
- Sporting activity that places excess stress on the hip—can lead to stress fractures
Other factors that increase the risk of hip fractures include:
- History of falling
- Previous hip fracture
- Family history of fractures later in life
- Small-boned, slender body—low body weight
Factors that can weaken bone and increase the risk of fractures include:
- Poor nutrition
- Deficient intake or absorption of calcium and vitamin D
- Physical inactivity
- Smoking
- Kidney disease
- Cortisone or other steroids
- Thyroid disorder
- Low testosterone in men
- Bone conditions such as osteomalacia (rare) and osteoporosis (common)
- Bone tumors—rare
Factors that increase the risk of falls that can lead to fractures include:
- Weakness
- Poor balance and coordination
- Excessive alcohol use
- Irregular heart beat or low blood pressure
- Chronic disease or fragile health
- Diabetes
- Arthritis
- Parkinson disease
- Stroke-related weakness and physical limitations
- Problems with vision
- Heart failure
- Mental impairments including Alzheimer disease
- Certain medications which cause lightheadedness, drowsiness, or weakness
Diagnosing Hip Fractures
You will be asked about your symptoms and medical history. The injured area will be examined for localized pain and swelling, and imaging tests will be done to evaluate your bones. These tests may include:
- X-rays—Stress fractures are tiny and usually not seen on an x-ray until at least 2 weeks after symptoms begin.
- MRI scan
- CT scan
- Bone scan
Treatment Options
According to the American Academy of Orthopaedic Surgeons, treatment for a hip fracture depends on the type and location of the fracture and the overall health of the patient. Occasionally, if a patient is too ill to undergo anesthesia or if they were already confined to a wheelchair or bed before the fracture, nonsurgical treatment may be recommended. Typically, though, surgery is the advised course of action and most surgeons prefer to operate as soon as possible to attain the best outcome.
In fact, one study found that undergoing surgery within 24 hours from the time of injury lowers the risk of hip fracture-related complications, or possible death.
Surgery
Surgery is needed for most hip fractures to make sure that the hip heals properly. Surgery also will allow you to move about as you recover. Using imaging tests, fractures are monitored as they heal.
The type of surgery depends on what part of the hip bone was broken, how severe the fracture was, and the overall health of the bone. Surgical options include:
- Inserting surgical plates and screws, or passing a rod down the leg with a screw into the top of the femoral head, to realign the bones and/or support the fractured area. The bone will be able to heal more securely.
- Hip replacement—damaged areas of bone are removed and metal devices are inserted in their place.
Your doctor may recommend assistive devices such as crutches, cane, or walker for your recovery and rehabilitation.
What To Expect From Hip Surgery
Prior to Surgery
Before surgery, your surgeon may request certain tests to determine your overall health and if there are any medical issues that could lead to an infection of the hip after surgery. These tests may include:
- Blood tests
- Chest x-rays
- Electrocardiograms
- Urine samples
Either general or spinal anesthesia will be administered and you will receive antibiotics before and during the operation to ward off any infection.
During Surgery
During the procedure, the surgeon will assess the fracture and decide whether to fix it with one or more individual screws or, in the case of a stress fracture, with a special compression hip screw to help stabilize the joint.
After Surgery
While you are recovering at the hospital, you may need to:
- Walk with help, using a walker, on the day after surgery.
- Be cautious. A fall can reinjure the hip joint. Do not try to walk without help.
- Take medication to prevent blood clots.
- Wear compression boots or stockings.
- Begin physical therapy to regain mobility and strength.
- Breathe deeply and cough 10-20 times every hour to decrease the risk of fluid build-up in the lungs, which can cause pneumonia.
When you return home, do the following to help ensure a smooth recovery:
- Work with the physical therapist. You will learn how to move your hip and maintain proper alignment. You should also talk to your doctor and physical therapist about ways to prevent total joint dislocations. Depending on your surgery, you may need to avoid crossing your legs, flexing your hips more than 90 degrees, and turning your feet very far inward or outward.
- Maintain a healthy weight. Obesity makes recovery more difficult.
- Be sure to follow your doctor’s instructions.
Within 6 weeks, you should be able to resume normal, light activities. It can take 6 months to a year to fully recover from hip surgery.
Physical Therapy
A physical therapist assesses your hip and creates an exercise program to aid in recovery and strengthening the muscles around your hip joint.
Preventing Dislocations
To prevent dislocations after a total joint replacement:
- Gradually increase the amount and intensity of an activity.
- Run on a softer surface, such as grass, dirt, or certain outdoor tracks.
- Do not overdo any activity.
- Wear proper footwear.
- Maintain a proper weight.
- Avoid smoking.
- Eat a healthy diet rich in calcium and vitamin D.
Sources:
American Orthopaedic Society for Sports Medicine (AOSM)
American Academy of Orthopaedic Surgeons (AAOS)
Pincus, Daniel, MD; Bheeshma Ravi, MD, PhD; David Wasserstein, MD, MSc; Anjie Huang, MSc; J. Michael Paterson, MSc; Avery B. Nathens, MD, MPH, PhD; Hans J. Kreder, MD, MPH; Richard J. Jenkinson, MD, MSc; Walter P. Wodchis, PhD. Journal of the American Medical Association: “Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery”. (November 28, 2017).
Dr. George Zimmerman is available for diagnosis of hip fractures and discussion of treatment options. To schedule an appointment, call the office at (540) 951-6000 or click the button to schedule an appointment online.
Book An Appointment Online with Dr. George Zimmerman