This article has been medically reviewed by Dr. Martin Duggan in 2021
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
A broken hip is usually a fracture in the upper femur or thigh bone. These injuries are very serious in elderly people. A hip fracture is intensely painful and often requires surgery. Surgery can be done to allow for healing and a return to walking or it can be done for palliative purposes, to reduce pain. The fracture and surgery often require significant rehabilitation. Each case is different, and an orthopedic surgeon will help patients and their families select the most appropriate surgical option and the most appropriate recovery steps.
As we mentioned above, a fracture of the femur bone near the hip joint is a grave injury. Broken hips are, unfortunately, common, amongst elderly patients who often suffer from frailty and osteoporosis or weakened bones. In older adults, a broken hip is life-threatening and a full recovery is not always possible. Research has suggested that as many as 40% of elderly people with hip fractures will die within one year of their injury.
Because hip fractures are so potentially deadly, it is important to take steps to avoid them. Improving diet, exercise, smoking cessation, and treatment for osteoporosis (brittle bone disease) is critical. Additionally, reasonable fall precautions are a must for anyone of advanced age. These precautions can include making walkers or other aids available or modifying bathrooms to minimize obstacles.
If these measures have failed and your loved one suffers a hip fracture, then close consultation with their surgeon will be key in determining the best path forward. Because each person and each fracture is so different, doctors will provide options for recovery that are tailored to your loved one’s specific circumstances. In what follows, we will briefly discuss some of the common paths that the recovery from a hip fracture can take.
Broken Hip Recovery
Broken hips commonly occur because of falls or severe impact from an accident.
Conditions like poor nutrition and osteoporosis that cause bones to weaken can lead to an increased risk of fracture even after a minor fall. Many other conditions can make bones more susceptible to breakage. Cancer, kidney disease, chronic illnesses like
A full or partial recovery after a broken hip, when possible, typically involves a combination of surgery and physical therapy. However, the recovery process depends on the way you broke your hip in the first place. That’s why only a physician, or team of physicians, is really qualified to suggest reasonable options. Remember, sometimes the most reasonable option available involves comfort measures rather than intense rehabilitation.
There are a number of different surgeries done for hip fractures.
For older adults, deciding whether surgery is the best option involves weighing the risks, benefits, and nonsurgical options. The most important question is often, “What happens if we don’t do surgery?” If the breakage happens in just the right way, there are rare instances where a full or partial recovery can be made without surgical correction.
Anesthesia and surgery become riskier as we age. Recovery after the surgery is also trickier for older adults as it may take more time or be more painful. This is all the more reason to be judicious and careful while weighing the options. There is a common saying in surgery: “Sometimes the only thing worse than doing surgery is not doing surgery.”
Either way, if surgery is an option that makes the most sense, then doctors will want to be as prepared as possible wheeling a person into the operating room. The anesthesiologist and surgeon will want to know what sorts of challenges they might face if things don’t go smoothly. As just one example, anesthesiologists like to know beforehand if there is a possibility they will have a difficult time placing a temporary breathing tube if one is needed.
Your surgeon may ask questions like:
- How severe is the pain?
- Can you put weight on the leg that is on the side of the broken hip?
- Do you have any other medical conditions?
- Have you ever had hip or leg surgery? Were there any complications?
- Do you have a family history of very bad reactions to anesthesia?
- Do you have a bleeding disorder?
- Have you fallen more than once recently or is there a chance you have another injury somewhere else?
Once the doctor has ascertained the severity of the hip injury, they will most likely go ahead with preparation for surgery. The surgery will typically be one of the following:
Internal or External Fixation
This surgery involves inserting screws into the bone that will hold the bone in place while the fracture heals. In an external fixation procedure, pins or screws are placed within the bone and then attached to a brace or “fixer” outside the body. Once the bones have moved closer together, the person will require another surgery to detach the screws from the fixer, and an internal fixation procedure will be done. Internal fixation is done by connecting bones back together with screws or pins, all beneath the skin.
There are many reasons that the portion of the bone that normally goes into the hip socket might require replacement. For example, hip replacement may be chosen if the fracture has hindered or damaged the pathways that bring blood flow to the joint.
Partial hip replacement
In this procedure, the top of the bone is replaced with a metal prosthesis. The hip socket is not replaced. So there is the replacement of “the head” of the femur bone but not the hip entirely.
Total hip replacement
This surgery involves the replacement of the top part of the femur and the socket inside of which the head of the femur normally sits. This option is usually chosen when there is damage to the joint due to arthritis or another injury.
Modifiable and Unmodifiable Risks
Of course, doctors and patients must make decisions where the outcome cannot be predicted with total certainty beforehand. If patients and their doctors had crystal balls then every surgery would be perfect! Unfortunately, it is impossible to know for sure who will and who won’t experience a bumpy road to recovery. Bumps along the road to recovery include things that are impossible to see coming. Someone may unexpectedly bleed more than is usually expected during the procedure, or someone may develop a new heart arrhythmia from the stress of surgery, or someone may even develop a bad reaction to a medication that they tolerated just fine in their past. These are unmodifiable risk factors. We know that they will happen to a certain percentage of people even though we do our best to avoid them, we expect them to happen occasionally.
However, there are other risks that can be reduced by patients and doctors cooperating together!
Pneumonia after surgery is often preventable. Any time we spend a large amount of time in bed, our lungs tend to be lazy about how much they expand. By using an incentive spirometer, and purposefully coughing vigorously when we feel a tickle in our throats we can reduce the risk that the fluids in our lungs will stand flat rather than stay mobile. When standing fluid builds in our lungs, it tends to cause little pockets of our lungs to stick together like two wet pieces of paper; this is called atelectasis. Atelectasis can cause uncomfortable fevers and can also cause pneumonia to develop. The less time we spend in bed, and the more we walk, the less likely our lungs will become lazy and stick together.
Once more, a prolonged period in bed is not our friend. When blood stands still for too long, it has a tendency to form clumps or clots. These clots can block up blood vessels in our legs – these events are called deep venous thromboses or DVTs. If we are less lucky, a blood clot can break off and travel all the way to our heart or lungs where it can block the ability of our heart and lungs to do their job – this is called a pulmonary embolus or PE.
After hip surgery, the patient may or may not be allowed to stand or walk with help. That recommendation will be made by the surgeon based on what they see during the operation. Most often, recovering patients will be asked to walk very carefully and with help, so as to not put any weight on their injured leg. Whenever a person can’t be out of bed, they are often asked to wear special stockings that massage the calf to keep blood from standing still too long. Finally, many patients will be asked to take medicines or shots that make it harder for blood clots to form.
Bedsores or pressure sores occur on skin that has been under continued pressure from a surface or object. In everyday life, we instinctively adjust in our behind in our seats every so often to prevent these types of sores! But when our mobility is reduced after an injury like a broken hip, we are much less mobile. By moving as much as possible, hopefully by walking as often as possible, we can reduce the risk of bedsores.
Have you noticed a theme yet? Of course! Get moving as often and as vigorously as possible. There is another benefit to staying out of bed. Did you know that people who are more active after surgery require less pain medication and feel less pain? It’s true!
Managing Emotions During Recovery
Recovery can be arduous if you are an older adult due to the physical stress of healing and the risks of surgery. Often, if the recovery is not going as planned, a doctor may suggest looking to a long-term care facility.
It can be disheartening not to move for such a long time, leading to depression. Support and reliability from family or loved ones are crucial to the mental health of the person who has broken their hip. If mental health is not taken care of, it can hinder physical recovery, too.
Rehabilitation and Physical Therapy
Rehab and physical therapy are the most crucial part of recovery post-surgery and take the most time. It can help you regain most if not all of your original mobility and independence and significantly speed up the recovery process.
Rehabilitation can occur in an orthopedic ward, a rehabilitation ward, or a geriatric orthopedic rehabilitation unit, which is meant for older adults.
The rehabilitation program will be tailored to your level of fitness and health. Some of the activities in the program may include:
- Weight-bearing or non-weight-bearing exercises
A physical therapist can help you begin to place weight on the side with the injured hip through activities like walking. They may also help you do exercises that do not involve weight-bearing, like swimming.
- Strength and balance training
- Treadmill exercise
Some equipment will need to be installed at home before the patient is discharged from the hospital after surgery. Most people spend at least one week in hospital after surgery, allowing time to set up home equipment.
It can be helpful to take advice from an occupational therapist about what you will need. Mobility aids like handrails or mobility scooters and walking aids like walkers and crutches are usually recommended. Any device like a scooter or a crutch should be used only if a doctor has allowed it.
Once you are discharged, you will also be informed of follow-up appointments and other things you should keep in mind to ensure a hassle-free recovery. Common recommendations are:
- Seeing a GP for follow up
- Taking a rehabilitation appointment at the hospital or another facility
- Staying in contact with healthcare professionals that are involved in the care of the patient
Broken Hip Recovery Time
The outlook for recovery time depends on certain factors. It can take three months or more to recover completely from a broken hip and return to the same routine as before the injury. A doctor will determine or predict the outcome based on:
- Age: Older adults tend to suffer from conditions like osteoporosis, and may in general, have weaker bones. Sometimes they may not be healthy enough for surgery, leading to long-term bed rest, which can cause further complications. With age, it is more likely that recovery time will be longer.
- General health: Your health before the injury can be a significant indicator of how long healing will take. Often if the patient is in good health, they are encouraged to move and walk around quite soon after surgery, but this should only be done with a medical professional’s advice.
- The type of hip fracture: Severe fractures that cut off or hinder blood supply will take longer to heal. If the injury also caused damage to nerves, blood vessels, or other tissues, recovery takes longer.
Broken Hip Recovery – Elderly with Dementia
Someone with dementia is more likely to experience a hip fracture than someone who does not have dementia or a similar condition. Dementia patients are also more likely to develop delirium during the hospital stay after the surgery. There may also be complications with recovery if the patient suffers from memory loss.
However, while dementia can make recovery more challenging, your health before the injury is a more significant predictor of how well you will recover. Hence, with the proper physical and mental health support, recovery for dementia patients has a good outlook.
Hip fractures are painful yet common injuries among older adults. They can take a lot of resources and time to heal. The pain and extended bed rest can lead to delirium or depression, which cause long-term mental health impacts. While recovery from the physical ailment is important, choosing recovery options that do not severely impact the patient’s mental health is also essential.
Surgery, rehabilitation, and overall attentive care from loved ones can take time but recovery, if possible, is worth it!
- Hip fracture, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/hip-fracture/symptoms-causes/syc-20373468
- Hip Fracture, Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/17101-hip-fracture
- Recovery, Hip fracture, NHS, https://www.nhs.uk/conditions/hip-fracture/recovery/
- WebMD, What to Know About Surgery for Hip Fractures, https://www.webmd.com/osteoporosis/what-to-know-about-surgery-for-hip-fractures
- Broken Hip, Healthline, https://www.healthline.com/health/hip-fracture-surgeries