A hip fracture is a break or crack at the top of the thigh bone where it meets the hip joint. Fractures are normally due to a fall and are particularly common in older people who might be unsteady on their feet or have poor eyesight. Women are particularly prone to fractures as they may suffer from osteoporosis, a condition that causes bone weakness and increased fragility. Hip fractures are among the top 10 causes of disability among adults worldwide.
Symptoms of a fractured hip
If you have a heavy fall that results in pain and being unable to put weight on your leg, you may have fractured your hip. The affected leg may also appear bruised or swollen and may look shorter than the other leg. You should seek urgent medical treatment.
Doctors may refer you for an X-ray, CT scan or MRI scan to diagnose a suspected hip fracture. While some hip fractures can be repaired using plates, screws or rods, around half of them will require hip replacement surgery. Depending on the type of the fracture and extent of the damage, you may be offered a total or a partial hip replacement.
Total vs partial hip replacement
A total hip replacement involves replacing the upper femur (thighbone) and hip socket with an artificial implant. In a partial hip replacement (hemi-arthroplasty), just the head and neck of the femur is removed and replaced with a prosthetic implant.
This type of implant is normally recommended for adults who have other health conditions or who no longer live independently.
Revision hip replacement
Revision hip replacements are also sometimes required. These involve replacing a worn-out implant with a new implant. This type of hip replacement can result in more complications and lower overall success rates than a primary hip replacement.
So, which option is better after a hip fracture – a total or a partial hip replacement – and how do you decide?
Total vs partial hip replacement study
A recent study published in the New England Journal of Medicine in December 2019 compared the two approaches. A group of 1495 patients over the age of 50 were randomly assigned to the study. They were undergoing either a total or a partial hip replacement, following a displaced femoral neck fracture. The trial covered 80 locations in 10 countries around the world.
Researchers found that 7.9% of the 718 of the patients having a total hip replacement needed a secondary hip replacement within two years. Among patients who had a partial hip replacement (723 patients), the figure was 8.3%.
They also looked at the number of patients who experienced hip instability or dislocation. Among those who underwent a total hip replacement, 4.7% (34 patients) had hip instability/dislocation compared to 2.4% (17 patients) of those who had a partial hip replacement.
Researchers also compared levels of pain, stiffness and function and found that total hip replacements scored slightly more favourably than partial hip replacements. Serious adverse incidents occurred in 41.8% of patients who had a total hip replacement and 36.7% of patients who had a partial hip replacement.
The research team concluded there was no significant difference between the two procedures in each of the areas analysed. This is good news for patients as it means that whichever type of surgery is recommended for you, you are likely to have similar outcomes.
