Hip fractures happen when the upper part of your thigh bone (femur) breaks. This is most common in older people or those with osteoporosis. Surgery and physiotherapy can help you regain independence and mobility. In this article, we’ll explore what a hip fracture is, what hip fracture surgery entails, how it affects people with dementia and advice about the recovery process.

What is a hip fracture?

A hip fracture injury is typically the result of a fall or an accident. Hip fractures are more common in older people because our bones weaken and become more brittle when we age.

Most hip fractures cause distressing pain and require immediate surgery. Some people need a full hip replacement after a hip fracture. Alongside hip fracture surgery, physiotherapy can improve the outlook for people who have suffered a hip fracture.

Risk factors include:

  • Age: hip fractures are more common in people over the age of 65 due to weakened bones. Older people are also more likely to have mobility and balance problems, which can lead to falls.
  • Medications: some medications increase the risk of falls. For example, drugs that cause drowsiness or cause blood pressure to drop can result in a loss of balance. Talk to your healthcare provider about taking medications safely.
  • Osteoporosis: this disease causes bones to become weak and porous, increasing the risk of fracture. Women are four times more likely to have osteoporosis than men.
  • General health: people who don’t get enough vitamin D, calcium, and other nutrients have a higher fracture risk. Some health conditions, such as dementia and Parkinson’s disease, increase the risk of a fall.

Hip fractures can occur in several areas of the upper femur. The most common types of hip fractures are:

  • Femoral neck fracture: the neck is the area of bone just below the femoral head (ball).
  • Intertrochanteric fracture: the intertrochanteric area is the part of the femur that lies between the femoral neck and the long, straight part of the femur.

What are hip fracture symptoms?

Symptoms of a hip fracture can come on suddenly or they can appear gradually and worsen with time. Signs of a hip fracture include:

  • Pain: hip pain that is severe and sharp. It can also be mild or achy. Most people feel pain in the thigh, outer hip, pelvis, and groin area. Pain may radiate down your buttock to your leg (sciatica). You may also feel pain in your knee.
  • Limited mobility: most people with a hip fracture can’t stand or walk. Sometimes, it may be possible to walk, but it’s extremely painful to put weight on your leg.
  • Physical changes: there may be a bruise on your hip. One of your legs may appear shorter than the other. Your hip might look like it’s out of position or twisted.

You may also discover bruising or swelling around your hip.

Your healthcare provider can examine the area surrounding your hip and will likely ask about any recent falls or accidents. To check for nerve damage, they might touch your leg or foot and ask if you feel anything. To diagnose a hip fracture, you may undergo imaging studies, such as:

  • X-ray: uses radiation to produce images of your bones.
  • MRI: uses a high-powered magnet to create pictures of bones and soft tissues.
  • CT scan: uses a computer and several X-rays to allow your healthcare provider to see detailed images of the damaged area.

Are there more hip fractures in care homes?

A 2020 report by The Live-in Care Hub found that people living in residential care or nursing homes have a 3.2% chance of having a hip fracture in any one year. 

For comparison, the report also found that people who are receiving live-in care have a 1.7% chance of having a hip fracture in any one year. 

According to the report, this means those living in residential care or nursing homes are 61% more likely to have a hip fracture than those receiving live-in care.

The most common reason for this difference is that falls are three times more likely to occur in care homes than in other environments (source: The Care Inspectorate).

Besides the physical impacts of having a fall (such as bruising, injuries, and fractures), it can also contribute to psychological impacts, such as fears and isolation.

What is hip fracture surgery?

Hip fracture treatment depends on your age, overall health, and the type of injury you have suffered. 

Most hip fractures require hip fracture surgery within a day or two after the injury. 

Surgical treatment is required to relieve the severe pain of the fracture and to allow you to regain mobility. Having surgery as soon as possible can lessen the risk of complications.

Treatment for a hip fracture depends upon the type and location of the fracture, as well as the age and condition of the patient.

Your healthcare provider will recommend the most appropriate treatment for you. Treatment may include:

  • Hip fracture surgery: most hip fractures need surgical repair. There are several hip fracture surgery techniques. These include metal screws, nails, or plates to secure your bones and keep them in place.
  • Hip replacement: depending on the type of injury, you may need a partial or total hip replacement. 
  • Physiotherapy: your physiotherapist will create a programme to help you regain movement, flexibility, and strength. If you had hip fracture surgery, special exercises can significantly improve your range of motion.
  • Medications: over-the-counter and prescription pain medications can help you manage pain and reduce inflammation. If you had hip fracture surgery, you may receive antibiotics to reduce the risk of infection.

There are things to consider when speaking about hip fracture surgery and hip replacements.

Hip fracture surgery vs hip replacement

While hip fracture surgery can improve mobility and pain, it can be associated with major postoperative medical complications. 

Patients undergoing hip fracture surgery are at a substantially higher risk of medical complications compared with patients undergoing an elective total hip replacement (source: Scientific Reports).

What happens after hip fracture surgery?

After hip fracture surgery for the elderly, you will receive a customised rehabilitation programme from your healthcare provider. The programme will help you to regain your independence and mobility.

An effective rehabilitation programme has been proven to reduce the length of a person’s time in hospital.

You might speak with a number of healthcare professionals, including:

  • Physiotherapists
  • Social workers (to provide advice on practical issues such as benefits)
  • Orthopaedic surgeons (specialising in conditions involving the bones and joints)
  • Geriatricians (doctors who specialise in healthcare for elderly people – this is likely in cases of hip fracture surgery for the elderly)
  • Liaison nurses (healthcare professionals who may be involved in planning your discharge and keeping you and your family informed about the care you’re receiving)

The time you spend in the hospital will depend on the severity of your condition, your treatment, and how soon you regain mobility. 

Before you’re discharged, an occupational therapist may assess your home to see whether you’ll need any mobility aids fitted, such as handrails. You may also be given a walking aid, such as a walking stick or crutch.

Hip fracture surgery and dementia

People with dementia have a higher chance of experiencing a hip fracture. Those with dementia who fracture their hip also have a higher likelihood of developing delirium during their time in the hospital. If delirium develops, it can lead to longer hospitalisations, poorer recovery in terms of mobility, and longer facility care.

The recovery and rehabilitation of someone with dementia after a hip fracture can be complicated due to memory loss. 

When an older adult with dementia experiences a hip fracture, several complications are possible, including:

  • Less likely to rehabilitate to their previous level of functioning.
  • More likely to require ongoing care.
  • Less likely to receive adequate pain medication.

Although dementia makes it more challenging and decreases the likelihood of full recovery, people with dementia can regain their previous level of functioning. 

In other words, if you were quite strong and mobile before breaking your hip, you are more likely to regain that strength and mobility, even if you have some memory loss or a diagnosis of dementia.

Hip fracture surgery recovery

A hip fracture can be life-changing. The outlook depends on several factors, including:

  • Age: older people might not heal from a fracture as quickly.
  • General health: people who move soon after hip surgery have a much better prognosis. If you’re otherwise healthy, you should begin hip fracture rehab as soon as you can after surgery. Moving speeds the healing process and reduces the risk of complications from bed rest.
  • Type of fracture: a femoral neck fracture can cut off the blood supply to the femoral head, causing the bone to break down and die. If the injury also damages other tissues (such as nerves or blood vessels), recovery usually takes longer.

How long does the pain last after broken hip surgery?

Your doctor will remove your stitches or staples within approximately three weeks after your hip fracture surgery. You may still have some mild pain, and the area may be swollen for three to four months after surgery. Your doctor will give you medicine for the pain. 

You will continue the rehabilitation programme you started in the hospital. The better you do with your rehab exercises, the quicker you will get your strength and movement back. Some people, especially older people, are never able to move quite as well as they used to.

How long before I can walk after hip surgery?

Your healthcare providers will help you to get up and walk as quickly as possible after your hip fracture surgery. If you’ve had minimally invasive surgery or are on an enhanced recovery programme, you may be able to walk on the same day as your operation. Initially, you might feel swollen and uncomfortable. 

A physiotherapist will teach you exercises to help strengthen your hip and explain what should and should not be done after the operation. They’ll teach you how to bend and sit to avoid damaging your hip.

You will continue the rehabilitation programme you started in the hospital. The better you do with your rehab exercises, the quicker you will get your strength and movement back. Some people, especially older people, are never able to move quite as well as they used to.

Hip fracture surgery recovery exercises

Hip fracture physiotherapy includes:

  • Physiotherapy: including massage, manipulation, and exercises that promote healing and wellbeing.
  • Weight-bearing exercise: where your feet and legs support your weight, such as walking.
  • Non-weight-bearing exercises: where your feet and legs do not support your weight, such as swimming or cycling.
  • Treadmill exercises: such as walking at different speeds and inclines.
  • Strength exercises: strength training and balance training to promote balance and mobility.

Live-in post-op care for hip fracture surgery

Getting back home after hip fracture surgery can help to aid your recovery. However, you might feel less mobile and independent. S; some people can encounter fears due to falling or pain. 

You might be asked to consider residential care. It’s important to keep in mind that falls are more common in care homes than in other environments (as previously mentioned). For a more personalised care plan, you should consider a post-op live-in care service. This means you can recover in the comfort of your own home while receiving the care and support you need. 

It is proven that recovery is better at home. It provides a sense of normality where you can just be yourself and friends and family can pop in when convenient. Recovering at home means you also benefit from superior rest without disruption, being safer with less risk of infection, improved mental wellbeing and greater flexibility to follow your own routine, compared to a hospital or a care home.

There are several ways a live-in carer can help you, including:

  • Fetching and administering medication
  • Help with dressings and preventing infection
  • Assistance with getting dressed and personal care
  • Help and support with rehabilitation exercises
  • Encouragement for walking
  • Shopping, cooking, and household chores
  • Keeping in touch with your medical team
  • Recovery planning and charting progress
  • Looking after your home, garden and pets
  • Offer a listening ear.

Mumby’s outstanding post-op care 

Mumby’s post-operative care for hip fracture surgery allows you to recover in the familiar and comfortable surroundings of your home while receiving tailored support.

We understand that it’s sometimes difficult to know when you may need our support as situations can change fast. You also may not get much notice of your loved one’s discharge from the hospital. If you need emergency post-operative care, please contact us so we can fast track your enquiry.

Useful links

Post-operative Care at Home

Why recovery at home after surgery is better

Live-in Care or Care Home – Why live-in care is the preferred choice

Live in Care Cost and Funding