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Hip Replacements: Hip Fractures and Failing Hip Revision Surgery

Staff Writer

Last updated: October 26, 2016 3:56 pm

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Hip fracture surgery is a common treatment for breaks that may occur in the upper part of the femur, or thigh bone, in the hip joint. There are three kinds of hip fractures: intertrochanteric hip fractures, fractures of the femoral neck and subtrochanteric fractures.

Hip fracture symptoms that can help you to determine if you have an injury include:

  • Pain in the hip, knee or lower back
  • Inability to stand or walk
  • Bruising or swelling around the hip
  • Irregularity in the angle at which the foot turns 1

If you have a break in the neck of your femur, it might be treated by a pinning procedure. These intertrochantric femur fractures make up about half of all hip fractures. They are usually caused by a low-energy impact, such as falling or slipping.

These are also more complex hip injuries, often involving multiple pieces of broken bone, and sometimes requiring the use of a plate and compression screws. If your surgeon does not think that such a procedure will be sufficient for the bones to heal properly, a partial hip replacement, or hemiarthroplasty, may be recommended. 2

Hip Fractures Require Treatment

A hip fracture is a serious injury and should be given immediate medical attention. More than a quarter of a million hospital admissions each year are for hip fractures suffered by patients 65 and older.

As the proportion of the U.S. elderly population increases, so will the number of hip fractures. That number is expected to reach 289,000 annually within the next 15 years. 3

Performed at similarly high volumes, hip replacements or total hip arthroplasties are orthopedic surgeries that are sometimes performed on people with hip fractures.

Even with strong rates of success, replacement surgeries to treat hip fractures are not without risk, including possible:

  • Infection after surgery
  • Blood clots, in the legs or even lungs
  • Structural misalignment or leg length discrepancy
  • Damaged nerves
  • Joint squeaking
  • Mental confusion or worsening of dementia
  • Implant dislocation or break
  • Loss of blood supply to the femur and subsequent tissue death (avascular necrosis)
  • Pneumonia 4

Hip Fracture Recovery

Hip fracture recovery usually takes approximately three to six months. Patients usually can go home a few days following surgery, but it’s critical to follow your doctor’s instructions for hip fracture recovery — the mortality rate following a hip fracture is approximately one in five. 5

If a fracture occurs in a patient who has already had a hip replacement, or if the patient is experiencing new difficulty walking, numbness or any of the abovementioned symptoms, there may be complications caused by the implant itself.

One possibility, hip dislocation, is usually something that the doctor can reposition externally. However, some dislocations require surgery to reposition the artificial hip into the hip joint, and some require revision surgery, in which the doctor has to replace the implanted hip.

Hip Revision Failure

If an X-ray reveals bone loss or an ultrasound or MRI — especially a special type called a metal artifact reduction sequence (MARS) MRI — reveal tissue inflammation resulting from problems with the hip implant, the hip replacement itself may need to be replaced. This is known as a revision. 6

Patients whose implants contain metal-on-metal bearings, in particular, have been reported to experience high failure rates. 7
In such cases, a revision surgery may be necessary to remove the faulty implant and position a new implant.

Metal-on-Metal Hip Replacement Failures

Unfortunately, the corrosion in faulty metal-on-metal implants has been shown to release ions that can damage the local tissue and bone 8 and even enter the bloodstream.

Symptoms related to the release of metal ions include: skin rashes, neurological damage such as loss of hearing or sight, kidney or thyroid dysfunction, depression or diminishment of cognitive skills, and even cardiomyopathy — which places the patient at increased risk for heart failure. 9

Depending on the type of materials used in your hip implant, and the status of your hip fracture recovery, your surgeon may recommend more frequent follow-up visits in order to assess your situation. This may include monitoring of the levels of cobalt and chromium in your blood. 10

Occasionally, implants are recalled, but not all recalled hip implants necessarily require removal from the patient. 11

  1. http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=85&ContentID=P08957 

  2. http://www.nlm.nih.gov/medlineplus/ency/article/007386.htm 

  3. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html 

  4. http://www.nlm.nih.gov/medlineplus/ency/article/007386.htm 

  5. http://www.webmd.com/osteoporosis/video/siris-dangers-hip-fractures 

  6. http://www.niams.nih.gov/Health_Info/Hip_Replacement/#9 

  7. http://www.ncbi.nlm.nih.gov/pubmed/23538122 

  8. http://www.ncbi.nlm.nih.gov/pubmed/23677352 

  9. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/MetalonMetalHipImplants/ucm241766.htm#5 

  10. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/MetalonMetalHipImplants/ucm241766.htm#2 

  11. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853662/