Hip Fracture Surgery Risk: Not Just Due to Age

For those who require surgery to mend a fractured hip, the risk of potentially harmful complications—including death—is higher than the risk for people who have an elective hip replacement. Although the assumption has long been that the increased risk was simply related to age and resulting health conditions that come with being older, newer research suggests this is not the case. Here’s a look at why hip fracture surgery is riskier than hip replacement.

The Evidence

Recent studies examined complications of these surgeries:

A 2014 study looked into the mortality rates and complications for hip fracture surgeries in over 5000 patients aged 20 to 40. The results of the study showed that the 10-year survival rate for these patients undergoing hip fracture surgery was over 90 percent. But the complication-free rates in those same 10 years were lower at roughly 70 percent. Because of this, the researchers concluded that it is important to research how we can  prevent severe complications after a hip fracture surgery.

Another study, conducted by Dr. P.J. Deveraux, evaluated medical records from nearly 700,000 patients who were at least 45 years old and had undergone either a hip fracture surgery or a full hip replacement.

In the study, researchers revealed that nearly 3.5 percent of fracture surgery patients died in the hospital—that’s compared to under 0.2 percent of hip replacement patients. This large gap remained even when researchers isolated groups by age group or similar medical conditions. Fracture patients had more than double the risk of potentially serious complications, including heart attacks, strokes and infections. It’s clear from this study that age and medical condition alone cannot simply explain the higher risk of hip fracture surgery compared to hip replacement.

What Explains This Higher Risk?

So what does explain the higher risk? While the second study above wasn’t able to make firm conclusions, it did lead to some educated guesses:

• Inflammation: A fracture creates inflammation, which is the nervous system’s response to a stressor or an injury. Inflammation commonly leads to blood clots.
• Immobility: Prior to hip fracture surgery, patients are immobile. They also often aren’t eating. This combination can lead to the breakdown of muscles, which can in turn lead to complications after surgery.
• Procedure differences: The simple fact that hip fracture surgery is an emergency while hip replacement is elective may also play a big role in the difference in risk.

To help combat these risks, Devereaux suggests performing hip replacement surgery sooner might help reduce the risk of complications—in fact, a separate clinical trial is being carried out in this area.

Whenever possible, it’s also best for people undergoing these surgeries to have chronic medical conditions, like heart disease or blood pressure, as under control as possible. Finally, taking steps to prevent fractures—such as regular exercise, a good diet and the consumption of calcium and vitamin C—is also important. Fall prevention in those who are at risk of falls can also be valuable.

Your doctor can offer further recommendations when it comes to your risks of hip replacement or hip fracture surgery. Always consult your doctor before making conclusions about your health.

 

Dr. Carlson tends to be conservative with surgical treatment, and much of his training is in minimally-invasive procedures, such as arthroscopy. He believes everyone deserves a trial of a more conservative treatment before moving to more invasive treatments such as surgery. Dr. Carlson tries to spend time with patients to better understand their goals and work together to come up with a treatment plan based on those goals and their distinct medical history.

 

Sources:

“Hip-Fracture Surgery Risk Not Just Due to Age.” WebMD. https://www.webmd.com/osteoporosis/news/20150915/hip-fracture-surgery-risk#1

“Mortality and complications of hip fracture in young adults: a nationwide population-based cohort study.” BMC Musculoskeletal Disorders. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-362