May 11th, 2011
11:30 AM ET

How long does a broken hip take to heal?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Asked by Faye from Farmville, North Carolina

How long does it take to completely recover from hip fracture? I fell on December 8, then had surgery December 10 and came home from the hospital December 11. I'm doing well - walking with a cane but still limping.

Expert answer

Dear Faye:

A broken hip is one of the most common orthopedic injuries in people over the age of 65. It usually occurs as a result of a fall. It is often associated with osteoporosis. Osteoporosis is often referred to as having brittle bones due to a loss of calcium.

Although there are several kinds of hip fractures, most are repaired with a hip replacement, also known as a total hip arthroplasty. Approximately 150,000 hip replacement operations are done each year in the U.S., and 500,000 are done worldwide. About half of these surgeries are done under emergency circumstances for a broken hip, and half are planned surgeries because of arthritis or other hip problems.

In this operation, the top of the femur (thigh) bone is cut off and a "man-made" top of femur replaces it. This prosthesis is circular or ball-like on top and generally made of metal. A semicircular plastic liner is placed in that part of the pelvis known as the acetabulum. This is where the upper leg comes in contact with the pelvis. The ball-like top of femur sits and moves in the semi-circular acetabulum, and this defines the hip joint.

In the surgery, a lot of muscles and ligaments are pulled and held away from the joint to allow the surgeon access. In this process, these soft tissues are damaged and need to heal after surgery. The patient who has a routine recovery can expect bruising of muscle and inflammation of the tendons at a minimum. These flesh injuries and tendonitis can be extremely painful and limit mobility. It can take several months to a year before complete recovery.

Those whose progress becomes stagnant at any time after surgery should have an evaluation by their orthopedic surgeon. The most common reason for a plateau in recovery is muscle weakness. Patients do benefit from regular physical therapy. Weight training and stretching can strengthen muscles and stretch ligaments. It is unfortunate that there is a tendency to skip physical therapy or take short cuts. This is a special problem among older patients.

Leg length discrepancy is also a common problem after surgery. Orthopedists do work hard to minimize leg length discrepancy, but it is difficult to do. A shoe lift may be needed to equalize the limb length, and some patients do end up needing a cane permanently.

Less common problems are heterotopic ossification and loosening of the artificial hip.

Heterotopic ossification involves a fibrous band that grows about the joint. It causes a stiffening of the hip and can begin occurring 10 days to two years after hip surgery.

Loose hip prostheses were a significant problem 20 years ago but less so today. Loosening of the artificial hip is more common among people who are overweight. When walking, a heavier person puts more stress on the prosthesis as it goes into the bone. Both heterotopic ossification and loosening of the prosthesis are diagnosed with physical examination and radiologic imaging.

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