What might go wrong?
The main complications after a hip fracture sometimes develop as a result of being immobilized in bed. These may include pneumonia, bedsores, and mental confusion.
Complications that can result from the hip pinning surgery itself include:
- anesthesia complications
- nerve or blood vessel injury
- avascular necrosis of the femoral head
- nonunion of the bones
This is not intended to be a complete list of possible complications.
Most surgical procedures require that some type of anesthesia be done before surgery. A very small number of patients have problems with anesthesia. These problems can be reactions to the drugs used, problems related to other medical complications, and problems due to the anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist.
Thrombophlebitis (Blood Clots)
Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can occur after any operation, but it is more likely to occur following surgery on the hip, pelvis, or knee. DVT occurs when the blood in the large veins of the leg forms blood clots. This may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung. This is called a pulmonary embolism. (Pulmonary means lung, and embolism refers to a fragment of something traveling through the vascular system.) Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible. Two other commonly used preventative measures include:
- pressure stockings to keep the blood in the legs moving
- medications that thin the blood and prevent blood clots from forming
Any surgery carries the risk of infection. You will probably be given antibiotics before the procedure to reduce the risk. If you get an infection, you will need more antibiotics. If the areas around the metal pins or screws become infected, you may need surgery to drain the infection.
Nerve or Blood Vessel Injury
Several nerves and blood vessels travel in the area where the surgery is performed. It is possible to injure either the nerves or the blood vessels during surgery, but this is extremely unlikely during this type of surgery. Nerve problems may well be temporary if the nerves have been stretched by retractors holding them out of the way. It is rare to have permanent injury to either the nerves or the blood vessels, but it is possible.
Avascular Necrosis (AVN)
As described earlier, all of the blood supply comes into the ball that forms the hip joint through the neck of the femur bone. If this blood supply is damaged, there is no backup. Damage to the blood supply can lead to the bone that makes up the ball portion of the femur actually dying. Once this occurs, the bone is no longer able to maintain itself. When the neck of the femur fractures, the blood supply may be damaged, leading to problems with avascular necrosis. The risk of AVN is much higher when the fracture causes a large displacement in the bones. AVN can show up as late as two years after the surgery.
Related Document: Philip Physical Therapy's Guide to Avascular Necrosis of the Hip
Sometimes the bones do not bond together as planned. This is called a nonunion, or pseudarthrosis. This condition requires another operation to add more fixation or actually replace the head of the femur, a procedure called hemiarthroplasty.
Related Document: Philip Physical Therapys Guide to Hemiarthroplasty of the Hip
What happens after surgery?
After surgery, your hip will be covered with a padded dressing. If your surgeon used a general anesthesia, a nurse or respiratory therapist will guide you in a series of breathing exercises. You'll use an incentive spirometer to improve breathing and avoid possible problems with pneumonia.
A Physical Therapist will direct your recovery after surgery. You'll be encouraged to move from your hospital bed to a chair several times the first day after surgery. You'll be encouraged to begin getting up and walking with your crutches or walker but may need to keep from placing too much weight on your foot while you stand or walk. You'll be safe to go home when you can get up and move about safely with your walker or crutches, you are able to do your exercises, and your caregiver has made all the needed preparations for you to go home.
After surgery, you should keep the dressing on your hip until you return to the surgeon. Avoid getting the stitches wet. Your stitches will be removed 10 to 14 days after surgery. You should support your outer hip with a pillow when you sit or recline.
Portions of this document copyright MMG, LLC.