Part One: Surgical Considerations
Studies have shown that there is an increase in mortality rate following a hip fracture in the elderly. Our job as a rehab team is to get our patients as mobile and active as possible following a hip fracture to increase their quality of life and to avoid adding to that statistic.
A hip fracture can be repaired by several different options depending upon the patient’s comorbidities, condition of the bone, complexity of the fracture, and physician preference. These options include open reduction internal fixation, hemiarthroplasty, bipolar hemiarthroplasty or a total hip arthroplasty. Open reduction internal fixation (ORIF) is performed when the hip-joint is still intact. A hemiarthroplasty is the replacement of the femoral component only and has only one articular surface. It is most used for the non-ambulatory or a person with a poor prognosis. The bipolar hemiarthroplasty has two poles of articulation with movement of the prosthetic head against cup and cup against the acetabulum. It does not attach to the acetabulum. It is primarily used in fractures in the elderly and it has a decreased risk for dislocation. A total hip arthroplasty involves replacement of the femoral component, as well as the acetabulum.
The main focus following hip surgeries has been maintaining the positional “hip precautions” which is no flexion past 90 degrees, no adduction past neutral, no combined flexion/adduction/internal rotation, and avoiding torsional loading. These precautions are present for the arthroplasties, but not the uncomplicated ORIFs. In addition to the above mentioned precautions, there occasionally will be a trochanteric precaution which is avoiding active hip abduction. These precautions are generally for 6 – 8 weeks to allow for tissue healing to protect the hip-joint and to decrease the risk of dislocation. This time frame might be extended by the treating physician depending on his preference or complexity/complications of the surgical procedure.