Surgery for a hip fracture in the elderly

The lower limbs of a person are connected to the body at the location of the acetabulum of the pelvic bones. This is made possible by the anatomical structure of the thigh. In its upper part, it has a thinning - a neck that turns into a rounded head, which is embedded in the cavity of the pelvis and forms a movable hip joint. The neck is the most vulnerable part of the femur. In the fall of the elderly, fractures most often occur in this place due to its thinner diameter and age-related fragility of the bones. Since they grow poorly in people after 60 years of age, surgery can help with injury. [1]

Indications for the procedure

Geriatricians say that every elderly person with a hip fracture should be operated on. Other indications for surgery may include:

• deformity of the hip joint (coxarthrosis stage 3 and 4);
• aseptic necrosis of the femoral head (necrosis of bone tissue);
• complete immobility of the joint;
• false joints of the neck (dangling);
• tumor processes.

Preparation

In case of a fracture of the femoral neck, the operation should not be delayed, because this can lead to dangerous complications. Usually it is carried out in the first 2 days after the incident.

Preparation for surgery consists mainly in determining the patient's condition, identifying factors that complicate its implementation. The choice of the most optimal method of treatment depends on this.

The cardiovascular, respiratory, endocrine, nervous systems are examined, the functionality of the liver and kidneys, the presence of inflammatory foci are determined.

All preparatory measures are aimed at stabilizing systems and organs: blood pressure, blood sugar levels, blood formula indicators are normalized, heart failure is treated, respiratory infections are prevented, and blood clots are prevented. 

Before the operation, using laboratory and instrumental methods, it is mandatory to evaluate the results of preoperative preparation, there should be an improvement in the controlled parameters. 

Technique of the hip fracture surgery

The operation for a fracture of the femoral neck at a younger age may consist of osteosynthesis - fastening the bone with screws or titanium plates. For the elderly, there is no alternative to arthroplasty. It is performed under partial or general anesthesia. [2]

The essence of the surgical operation is that the damaged bone and cartilage are removed, and an artificial prosthesis made of durable high-quality metal is installed in their place. It is strengthened depending on the strength of the bones with or without special bone cement. [3]

Contraindications to the procedure

All existing contraindications are divided into absolute and relative. The first ones include:

• severe chronic diseases associated with insufficiency of the heart, respiratory organs, kidneys, liver;
• diabetes mellitus and other endocrine pathologies that cannot be corrected;
• HIV infection;
• severe osteoporosis;
• partial paralysis of muscles on the side of the operation;
• mental illness;
• inflammatory process at the site of manipulation;
• technical impossibility of surgical intervention.

Of the relative factors that impede the operation, are obesity of the III degree, progressive osteoporosis, varicose veins.

Consequences after the procedure

From some published studies, it follows that the majority (about 93%) of the operations were successful, without negative consequences, which implies the absence of complications, restoration of the motor function of the joint within a month, and normalization of gait after half a year. The "satisfactory" rating was given to 4% of arthroplasty cases (consequences of mild severity), and only 3% ended in either severe complications or death. [4]

Complications after the procedure

Possible complications after surgery largely depend on the patient's age, health status, quality of the prosthesis, experience of the doctor, correct postoperative care, depth and accuracy of the examination before surgery. They can occur both immediately after the operation, and over the next few years. Among the complications are:

• dislocation of the implant head, i.e., its loss from the acetabulum (according to statistics, 15 cases per 1000 operations);
• prosthesis rejection (1.4%);
• thromboembolism (0.3%);
• fractures and fractures of the femur.

Care after the procedure

After the operation, the operated patient is sent to the intensive care unit, where antibiotics and blood thinning drugs are administered to him for a week. At this time, the legs should be at some distance from each other, so a pillow is placed between them. [5]

Almost immediately you need to start moving, sit on the bed and do simple physical exercises. After 4-7 days, the patients are already on crutches, and after 2 weeks the stitches are removed and discharged home, where there is still a long period of rehabilitation under the supervision of relatives or a nurse. [6]

Sometimes it takes up to a year to return to the usual way of life. Some rules must be followed to reduce the risk of complications:

• sit so that the knees are below the level of the hips;
• do not cross your legs;
• climbing or descending the stairs, hold on to the railing;
• do not lean forward;
• sitting spread legs;
• get up with a straight back;
• do not lift weights;
• If you experience fever or pain, contact your doctor immediately.

It is also important to create a safe moving environment in the home to eliminate the risk of falling.

For the elderly, professional care is most suitable, which specialized rehabilitation centers can provide. Here, not only rehabilitation specialists work with patients, but also psychologists who help restore faith in themselves.

Reviews

According to the opinions of people who survived prosthetic surgery, despite all the risks, its high cost, a difficult recovery period is the only way for older people to prolong their lives, to get back on their feet.