Femoral neck fractures occur significantly more frequently in the elderly than in the young. As a rule, this occurs as a result of low-energy injury, for example, when falling from a height of human height.
Almost 92% of the affected patients are over 70 years old, and 70% of them are women. Within a year of injury, only 4 out of 10 people out of 6 return to their previous level of mobility. The vast majority of hip fractures are treated surgically so that the patient can start walking as soon as possible.
Indications for surgery
Surgical treatment of hip fractures is preferable because it reduces the mortality rate. Early surgery in the first 24 to 48 hours after injury reduces the risk of life-threatening complications and reduces hospital stay time.
Conservative therapy is prescribed to young patients, as well as to elderly people who cannot move, are severely weakened, or are in the late stage of an incurable disease.
Femoral neck fractures without displacement, puncture wounds in the elderly, and all femoral neck fractures in young patients are treated with osteosynthesis. At the same time, the fragments are connected and fixed with screws or other structures. Hip neck fractures with dislocation in people over 60 years of age are an indication for hip replacement.
Types of hip replacement surgery
During the operation, the surgeon can replace the entire joint with a prosthesis (total or bipolar arthroplasty) or only the femoral head (unipolar arthroplasty, hemiprosthesis)
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A complete replacement is performed for any joint deformities. A bipolar endoprosthesis is considered more durable. However, the installation operation can only be carried out by highly qualified specialists.
Elderly patients with a sedentary lifestyle are often offered to install a single-pole prosthesis. In this case, surgery takes less time. The operation is less traumatic and eliminates a lot of blood loss. After a single-pole arthroplasty, the patient recovers faster.
There are two ways to fix the prosthesis. If the femur has lost its density and has become brittle against the background of osteoporosis, which is common in the elderly, bone cement is used. The self-hardening synthetic material strengthens the bone tissue and holds the prosthesis securely. If the bone is healthy, cementing is not required.
Since patients in the older age group do not move much, TB prostheses usually serve them until the end of their lives. However, in some cases, repeated joint replacement surgery and revision arthroplasty are possible.
Preparation for endoprosthetics
After the decision about the operation is made, the patient is sent for a medical examination. It includes blood tests (clinical, biochemical, clotting tests, infection markers) and clinical urinalysis. The patient also undergoes fluorography, lung radiography, electrocardiography, ultrasound of the lower extremities and consultations with specialized specialists.
On the eve of prosthetics, the patient takes anticoagulants to prevent thromboembolism, a dangerous complication of surgical intervention.
Anesthesia
During endoprosthesis surgery, intravenous general anesthesia is used, which does not require a ventilator, spinal or epidural anesthesia.
Performing the operation
EMC surgeons perform hip replacement in 30 to 60 minutes. In accordance with European and North American protocols, the operation is performed through small incisions. This reduces blood loss, reduces postoperative pain, and shortens the recovery period.
Rehabilitation
Already on the day after the endoprosthesis, the patient is allowed to walk with a full load on the operated leg, using crutches or a walker. The patient stays in the EMC hospital for 5 to 7 days under the supervision of a surgeon, and also undergoes rehabilitation treatment in the rehabilitation department.
The individual program includes pain relief and joint development on special simulators. The task of the specialists is to get the patient back on his feet as soon as possible and return him to normal life after 4 to 6 weeks.
The cost of the operation
The cost of hip replacement depends on the degree of its damage, the amount of surgical intervention, the type, and also the price of the endoprosthesis. To get a turnkey treatment estimate, contact the assistants of the European Clinic of Sports Traumatology and Orthopedics EMC.
Questions and answers
What are the types of endoprostheses?
EMC offers dentures from Zimmer, Smith Nephew, DePuy, Aesculap and other well-known manufacturers.
Orthopedic surgeons use implants made of metal alloys, plastics, and ceramics for hip replacement. To replace the femoral head, unipolar endoprostheses are used, the joint is completely replaced by a bipolar artificial joint. According to the method of fixation, dentures can be cement-based or cement-free.
Are there any age restrictions for the operation?
EMC specialists accept patients of any age for hip replacement. Extensive experience, high-tech equipment, minimally invasive surgery techniques, and modern rehabilitation methods allow us to quickly put elderly people on their feet. The general practitioner prepares patients for surgery and monitors them in the postoperative period.
To make an appointment for a hip replacement consultation, please call around the clock at +7 499 490-91-42 in Moscow
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How is recovery going after surgery?
Patients walk with full support on their leg the day after the joint replacement. On day 5 and 7, they can climb stairs and are discharged from the hospital. The return to normal activity occurs 4 to 6 weeks after the arthroplasty.
What is the service life of the prosthesis?
In patients over 60 years of age who do not move very actively, they live for life. There are cases when prosthetics have served for more than 40 years. The younger and more active a person is, the more likely they are to require revision surgery.
- Maffulli N, Aicale R. Proximal Femoral Fractures in the Elderly: A Few Things to Know, and Some to Forget. Medicina (Kaunas). 2022 Sep 20;58(10):1314.
- Daniel Campain Hip Fractures // MSD Handbook. The professional version. 2022. URL:
https://clck.ru/3FupWk
- Schroeder JD, Turner SP, Buck E. Hip Fractures: Diagnosis and Management. Am Fam Physician. 2022 Dec;106(6):675-683.
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