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Is weight bearing possible after a broken hip surgery?

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Orthopaedic Surgeon
Practicing since : 2011
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My wife suffered a severe broken hip 12 months ago and has a plate inserted. The plate has now moved and surgery is planned to remove the plate. The medical team thought there was insufficient bone strength for my wife to weight bear, so she has been on Forteo Injections for 6 weeks. They are now saying she has sufficient improved bone healing to commence weight bearing post surgery. We are very concerned if this is not the case that my wife may suffer a refracture and would like your opinion. I have attached a photo of the initial break, together with a photo just prior to commencing Forteo in September and a photo in October after being on Forteo for 4 weeks. Thank you
Tue, 17 Apr 2018 in Bones, Muscles and Joints
 
 
Answered by Dr. Aashish Raghu 33 minutes later
Brief Answer:
May need a hip replacement

Detailed Answer:
Hi there

Thanks for the query

I have read your query and gone through the attached reports.

It appears that the plate has moved in the neck of the femur making it more weak that it already is, for weight bearing purpose.

My impression will be that once the implant is removed on table, it can be assessed if the head of the femur bone is strong enough or not. If it isn't string enough for weight bearing, a decision to cut the head and neck of the femur and perform a Bipolar or Total hip replacement will be in keeping with the present standard of care.

I suggest you get a DEXA Scan done to look for the bone strength.

The quality of the bone needed for a cemented hip replacement is fair enough and can be sought after which she will be able to weight bear normally.

Do have a word with the doctors in this regard.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr.Aashish Raghu
Above answer was peer-reviewed by
 
Follow-up: Is weight bearing possible after a broken hip surgery? 1 hour later
Thanks for your reply doctor. My wife is 71 years of age, suffers from hypertension and has already had 4 surgeries. she would really struggle mentally with the thought of a hip replacement. Do you see any improvement in the bone growth in the second xray compared to the first? Once the plate was removed would the bone grow with increased exercise and physiotherapy. She also would have muscle atrophy, so would muscle exercise assist. Most of her pain is caused by the plate being in the wrong position, so she was hoping prolonged physiotherapy may assist to eventually weight bear. At the same time she is terrified about refracturing her hip.
 
 
Answered by Dr. Aashish Raghu 4 minutes later
Brief Answer:
Only one Xray posted twice

Detailed Answer:
You have posted only one Xray twice.

Kindly post the Xray before the surgery and the other sequential xrays so that I can comment further.
Above answer was peer-reviewed by
 
Follow-up: Is weight bearing possible after a broken hip surgery? 10 hours later
Hi Doctor I have attached the 2 most recent xrays and the initial xray. Thanks
 
 
Answered by Dr. Aashish Raghu 8 hours later
Brief Answer:
Implant needs to come out

Detailed Answer:
I have seen the latest Xray that you have attached in the reports.

The bone quality is quite poor and the implant has already begun to cut out from the bone.

The implant needs to be removed and at first Non-weight bearing walking needs to be done with a walker to mobilise her for 6 weeks followed by touch-down weight bearing and gull weight bearing as tolerated eventually.

The fracture does not look un-united so we can give her a chance to walk, but only with extreme care.
Above answer was peer-reviewed by
 
Follow-up: Is weight bearing possible after a broken hip surgery? 1 hour later
Thanks Doctor, could I finally ask you some questions about the surgery. Is it a simple process to remove the plate and what sort of pain levels can my wife expect post surgery? Any idea of the usual hospitalisation period and when she comes home will she be able to be as active as she presently is with a new wound ( will she be able to use her walking frame to go to the toilet etc). Her current wound is approximately 12 inches long, will the new incision need to be as long? Many thanks for all of your assistance.
 
 
Answered by Dr. Aashish Raghu 7 hours later
Brief Answer:
Answers to your questions

Detailed Answer:
The procedure to remove the late is fairly straightforward but there can be difficulties like screw or plate breakage and refracture due to bone growth around the plate and rounding off of the screw heads due to body fluid reaction.

Pain levels would as similar to the time of the first surgery.

Hospitalization time depends on if the surgery went well or there were any complications. If it goes well she can be mobilized early on a walker and get home within a couple of days and come back for suture removal.

When your mother comes back home she will need to bear a little pain and difficulty die to the new surgery but usually not more than a week to ten days.

She will be able to use her a walking frame.

The Incision would usually be a bit smaller than the 12 inch Incision.
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