WASHINGTON — Elective hip replacement and hip fracture repair may be roughly equivalent in terms of their degree of invasiveness, but there is often a world of difference between the outcomes these procedures help patients achieve, Joseph Zuckerman, M.D., observed at an international symposium sponsored by the National Osteoporosis Foundation.
Even among patients of the same age, those who undergo elective hip replacement surgery are far more likely to have favorable outcomes compared with those who undergo hip fracture repair.
And while both groups have a history of long-standing chronic disease, osteoporosis patients with fractures often present with complex medical, surgical, and psychological issues that involve challenges well beyond mending the fracture itself.
In fact, “in many ways the surgical treatment we provide is less challenging than the medical and psychosocial problems associated with the disease,” he said. Ultimately, it's these other issues that determine a patient's ability to achieve their pre-fracture level of function and independence, said the chairman of the department of orthopedic surgery at the New York University-Hospital for Joint Diseases in New York City.
“Hip and knee replacements are among the most successful operations in medicine in general,” he said. “You can assure patients with a 90–95% certainty that they will have a successful result.”
By comparison, the literature suggests that 50%–65% of hip fracture patients will regain their previous levels of ambulation, 10%–15% become home ambulators, and up to 20% will become nonambulatory.
In his own series of 366 hip fracture patients aged 65 and older, Dr. Zuckerman reported that following surgery, 41% regained their prefracture ambulation. However, the degree of improvement was often minor. In addition, 12% became home ambulators, and 8% became nonambulatory.
In general, the infection rate among hip fracture patients ranges from 2% to 15%, compared with a less than 1% infection rate among hip replacements performed electively.
Likewise, when dislocations occur in approximately 1%–10% of hip fracture patients vs. 1%–3% of hip replacement patients, they tend to be due to circumstances that cause the dislocation to reoccur and necessitate additional surgery.
The poor bone quality among hip fracture patients means they're more likely to have bone fragments that complicate the repair. Newer surgical techniques, however, have helped minimized such complications, compared with 20 years ago, he observed.
Fixation failures, usually due to inferior bone quality or poor surgical technique, occur in 12%–20% of hip fracture patients, and reoperations are often needed. By comparison, fewer than 1% of hip replacement patients experience fixation failure.
Similarly, healing complications can occur in 5%–35% of hip fracture patients, compared with fewer than 1% of hip replacement patients.
Overall, mortality rates in the elderly population following a hip fracture can be as high as 40%, compared with a mortality of less than 1% during the year following a hip replacement.
Dr. Zuckerman had no financial relationships to disclose.