Periprosthetic Hip Fracture Treatment
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Overview
Surgeons at Victorian Bone and Joint are fellowship trained in hip replacement surgery. Their team in Melbourne regularly assess patients for hip conditions and can recommend hip surgery when required. Revision hip replacement surgery for complex fractures is a special interest of Dr Stevens and Dr Slattery.
This type of surgery is complex and often requires significant planning to ensure the best outcome.
If you have a fracture around a hip replacement it may require revision surgery (surgery to replace parts of the artificial hip) and fixation surgery with plates, screws and cables.
Assessment
Surgeons will look at x-rays and scans of your fractured hip replacement to determine the right surgery for you. Scans are sometimes organised to understand the extent of the fracture.
Treatment
Surgical management
For a fracture around a hip replacement, surgery is normally required. Specialists at Bone and Joint will perform surgery to remove the old hip replacement, fix the bone and place in a new longer hip replacement into position. The results of this type of surgery depends on how badly the bone is broken and how fit the patient is.
If you and your surgeon decide that surgery is the best option for your fractured hip replacement, the team will organise for a review by a physician to make sure surgery will be as safe as possible. Blood test, a heart trace as well as other investigations maybe organised.
Ongoing pain, stiffness, infection, dislocation and dissatisfaction may result from this type of complex revision hip replacement surgery – despite a good technical outcome.
Post-operative management
Each person will recover from hip surgery in a different way. Some people will have little symptoms and good movement soon after surgery. Other patients may take longer for the hip to function at its best. This is due to many factors. Age, the type of hip replacement, the reason for the revision hip replacement, general health and other genetic conditions will all play a role.
Revision surgeries are considered more complex and harder to recover from than the first hip replacement.
Once you have had your revision hip replacement, you may be able to begin to move the hip, ankle and knee under the instruction of your surgeon. Hospital physiotherapists will aim to safely have you mobilising after your surgery. This is important for your hip and general health.
A dressing will be placed over the hip following surgery. As the tissue and bone heal, a small amount of blood may appear on the dressings. This is normal. Sometimes, replacing the bandage is required to reinforce any areas that continue to bleed. Sometimes a drain to collect excess fluid will be placed into your hip at the time of surgery – this is normally removed after 2 days. You may be placed on blood thinning medications such as aspirin to help reduce the risk of clots. Special vacuum dressings can help seal the wound as it heals.
Discharge home
After your surgery you will stay in hospital for several days. You will be discharged with pain relief tablets. If you need longer to safely walk, rehabilitation can be organised.
Pain relief
After surgery it is normal to have some pain or discomfort. The amount of surgery you have had will influence how much pain you can expect and how long you will need pain relief for. You will be given pain relief tablets to take home with you when you leave the hospital. Take these over the next week or so as you need.
Looking after the dressing
You will need to keep the dressing clean and dry for two weeks.
Movement after surgery
You can move your foot, ankle, knee and hip straight away after surgery. Your hip will slowly be able to bend in the days that follow your operation. You may experience some pain in the weeks following surgery. You will need crutches or a frame to walk after surgery. It is a good idea to keep moving even after your surgery, it helps your blood circulation and stops your body getting too weak. Avoid any strenuous activity for the first 2 weeks, but gentle movement and walking with your crutches is advised.
Wound review
After 2 weeks you will have an appointment with your surgeon to have your wound checked, any stitches will be removed. You will then given advice on exercises and physiotherapy.
Driving
You cannot drive until you have had your first review appointment with your surgeon. They will give you an indication then when you are likely to be able to drive again
Returning to work
This depends on the type of work you do. Most surgeries will need 6-12 weeks off work, some will require longer, especially if you have a manual job.
A revision hip replacement operation for fractured femur is major surgery. Despite good results there are risks associated with this procedure. Fracture, dislocation, infection and damage to nerve or blood vessels are some of the more significant risks. Your surgeon will discuss with you the risks of surgery.
When to contact us
If you have any of these problems, please call the rooms on 03 5752 5020
Fever
Heavy bleeding or ooze from the wound
Increased swelling and redness around the surgery site
Pain in the calf muscles or difficulty breathing
