Periprosthetic Hip Fracture

Physical Therapy Videos - Hip and Pelvis

Basic Anatomy

Your hip joint is made up of two bones. The top of your femur or "thighbone" and your pelvis or "hip socket." Your hip is a ball and socket joint that allows you to move the top of your leg when walking. You may know someone who has had a hip replacement after his or her hip socket wore out from arthritis. A hip replacement involves removing the top of the femur and replacing it and the hip socket with metal and plastic.

Figure 2: An x-ray in which an artificial joint has replaced the left hip.

Mechanism and Epidemiology

A periprosthetic hip fracture is a broken bone that happens around or very close to the metal and plastic parts of a hip replacement. This broken bone can happen during the procedure to replace the hip or from a fall or other trauma. The fracture typically occurs in the thighbone around the metal stem of the implant. Less commonly, the bone around the hip socket can also break.

Figure 3: Red arrows indicate fractures that have occurred across a variety of hip implants.

Initial Treatment

If you have a periprosthetic hip fracture, they are generally so painful you won’t be able to stand or walk. Any motion of your injured hip will result in pain. If you have one of these fractures, you will need to be taken to an emergency room. The medical staff will check the blood supply and nerve function of your injured leg and may obtain x-rays or a CT scan of your hip and thighbone. You may need to be admitted to the hospital or transferred to another hospital that takes care of this specific type of injury. Other tests and scans of your head and heart may be done to see if you were injured anywhere else.

General Treatment

This type of fracture typically requires surgery. The type of operation depends on many factors, such as the location of your broken bone and whether your implant is stable or loose. If your implant is stable, a plate, screws, and wires will be used to fix the bone. If your implant is loose, it will need to be replaced. Plates, screws, and wires may also be added.

Figure 4: X-rays of different types of hip implants and periprosthetic fractures. New hip replacements that are longer or bigger may be used, as well as plates, screws and cables.

Post-operative Care

After surgery, you will work with physical therapists in and out of the hospital to rebuild your strength and walking ability. The amount of weight that you can place on your injured leg depends on a number of factors and will be determined by your surgeon. Typically, you will get a blood thinner after surgery to prevent blood clots. Blood thinners and early movement are important to minimize your chance of getting a blood clot. Several different types of pain medication are typically given for post-operative pain, including acetaminophen, anti-inflammatories, and possibly a narcotic (opioid).

To try to prevent a dislocation of your hip joint, you may also not be allowed to move your leg in a certain way after surgery. Braces may be used for this reason.

After a short stay in the hospital, you may need to spend some time in a rehabilitation facility. You will return to see your surgeon in the first few weeks after surgery. It is very important to follow the instructions of your surgeon.

Long Term

After surgery, you will generally require an assistive device such as a walker or cane to help you walk. You may need the assistive device for a short period of time or a long period of time. Usually, you will need physical therapy to get back to as much normal walking as possible. A physical therapist will also work with you on motion, strengthening, stretching, and endurance training. To make your recovery process as fast as possible, it is important for you to continue to do the exercises you learn in therapy at home.

Complications after a periprosthetic hip fracture may Include blood clots, infections, difficulty walking, a limp, hip dislocation, and unequal limb lengths. You may need further surgery, antibiotics, hospital stays, and/or braces to treat these complications.