Hip Fractures: Diagnosis, Treatment and Rehabilitation

Hip fractures can occur as a result of falls, especially in the elderly, but can also occur in young people due to high-energy trauma. With advancing age, additional health problems such as diabetes, high blood pressure and cardiovascular diseases may increase the risk of surgery after hip fractures. In elderly patients, the hip bone may fracture, usually as a result of a fall on the side of the hip. This may occur as a result of the transfer of the impact to the head of the thigh bone, or it may occur due to the forced external rotation of the thigh. When elderly people suffer a hip fracture, the main goal is to restore pre-fracture functionality as soon as possible. Hip fracture surgery is not a barrier to surgery in an elderly patient. If the patient was able to move and do his/her own work before the fall, he/she should definitely be operated on. When planning hip fracture surgery, factors such as the type of fracture, bone resorption in the patient, general health status, comorbidities and walking potential should be taken into consideration. In recent years, hip nailing surgeries are preferred for hip preservation and to minimize circulatory impairment and blood loss. This is a different approach to hip replacement surgery, which previously aimed to get patients up and walking early.

Hip Problems and Symptoms

Hip problems can seriously affect a person’s quality of life. These problems include labrum tears, soft tissue problems around the hip and hip bone decay (avascular necrosis of the femoral head). A labrum tear is usually asymptomatic, but can sometimes cause symptoms such as locking of the hip, a feeling of catching, pain, groin pain, stiffness in the joint, reduced range of motion and difficulty walking. Avascular necrosis of the hip (AVN) is a condition that leads to the death of bone tissue due to insufficient or interrupted blood supply to the femoral head. AVN can be associated with factors such as long-term use of high doses of cortisone, alcohol abuse, chemotherapy, trauma or fracture, bone marrow diseases and rheumatoid arthritis. AVN may initially be asymptomatic, but over time, pain, inability to walk, stiffness and limitation of movement in the hip may develop. Hip bone decay can occur as a result of calcification, usually with age. Calcification can occur for various reasons such as congenital hip development disorders, inflammatory rheumatic diseases, traumas or fractures.

Rehabilitation after total hip replacement

After total hip replacement surgery, most patients may have persistent muscle weakness. Therefore, physical therapy and rehabilitation are extremely important. Early and intensive rehabilitation is important to prevent postoperative complications. Patients should be taught to avoid dislocated positions in the postoperative period and to be careful during transfers. Patients who undergo uncemented total hip replacement surgery are usually given partial load with the help of a walker in about 1 week to 10 days. Patients’ ability to walk independently is improved over time.