Hip fracture

About a hip fracture

Your hip is a ball and socket joint. It sits where the top of your thigh bone (femur) meets your pelvis. A hip fracture is a break in this joint. 

There are three areas of the thigh bone (femur) where different types of fracture can happen. The image below shows the three areas and the name we give to these types of fracture.

Causes

Falls

Older people often fall. It happens to 1 in 3 people aged over 65 every year.

As you get older, your bones become less strong. Bone diseases like osteoporosis can make bones weaker. When this happens you can fracture a bone, even if you fall from standing height.

Pain relief

A hip fracture can be painful.

Painkillers

While you are in hospital waiting for surgery, we will offer you painkillers to keep you as comfortable as possible. Over-the-counter pain relief such as paracetamol is sometimes enough to control the pain.

Most people need stronger painkillers. However, these can also cause side effects such as constipation, and you may still be unable to move around comfortably in bed.

We may suggest a nerve block, which is an injection into the groin. It can reduce pain effectively, and it has fewer side effects.

Pain after your operation

Most people notice an improvement in the sharp pain, produced when you move, that is typical of a broken hip.

Your hip area will still feel bruised, but with painkillers you should be able to start moving by the day after your operation.

If you can get moving, this will help the pain to settle. It will also mean you spend a shorter time in hospital.

Hip surgery

If you break your hip, you will probably need an operation to help you move again comfortably. Only a small number of patients have a type of fracture that heals without surgery.

Sometimes a patient is just not well enough to undergo surgery. Some of these patients will improve with treatment and go on to have surgery soon afterwards. Approximately 1 in 100 will not be able to have surgery at all.

Types of surgery

The type of operation we recommend will depend on the type of hip fracture you have. We will discuss our recommendation with you, and you can ask us questions.

We will recommend one of the following types of surgery:

• full or part hip replacement 
• use of a plate 
• use of screws 
• use of a rod inside your thigh bone.

Each operation usually takes 30 to 90 minutes, though some can take longer.

After surgery

Most patients stay on Cambridge ward (our orthopaedic ward) for 7 to 14 days after their surgery. During your stay, a multidisciplinary team (MDT) will be involved in your post-surgery care. This team includes nurses and the following:

• orthogeriatricians (experts in geriatric medicine)
• orthopaedic experts (injuries to the bones/joints)
• physiotherapists 
• occupational therapists.

The discharge coordinator will also be involved in organising your rehabilitation and discharge from Kingston Hospital.

The length of your stay will depend on your individual recovery, and the level of care and support you will have when we discharge you home. Many people go home sooner, for example after a week or so.

You can expect the following during your stay in hospital.

Getting moving

• Your surgeon or the physiotherapist will tell you how much weight you can put on your leg.
• Your physiotherapist will help you to start walking using a walking frame. This usually happens 24 hours after surgery. They will teach you how to look after your new hip. An artificial hip never feels quite the same as a normal hip, and it is important to look after it.

Wound care

• You must keep your wound dry for 4 to 5 days.
• We will give you a waterproof dressing when you have a bath or shower. 
• We will let you know if you will need to have any stitches or clips removed.

Swelling

It is common for your leg to be swollen. It can take up to a year for the swelling to go down.

Frequently asked questions

When will I have surgery?

The sooner you have surgery, the sooner you will be able to start moving again. If you are well enough for surgery, we will aim to repair your hip on the day of your hospital admission. Sometimes the operation will take place the next day.

Who will look after me in hospital?

During your stay in hospital, a team of people will care for you. This team includes  surgeons, anaesthetists, nurses and physiotherapists. An orthogeriatrician will lead the team. An orthogeriatrician is someone who specialises in the care of frail and older people.

The orthogeriatrician will make sure you are as fit as possible before your operation. They will coordinate the work of the team who will help you recover afterwards.

When can I eat and drink normally again?

You will not be able to have any food or drink for a few hours before your surgery. However, you can have sips of water during this time, to keep your mouth feeling comfortable. (This is known as 'Sip Til Send'.)

When you have had your operation, we will advise you to eat well and drink as much fluid as you can. Food and drink will help you make a good recovery from your hip fracture and surgery.

Let us know if you find it hard to get into a comfortable sitting position at mealtimes. Your family and friends may be able to help you at mealtimes.

When will I start physiotherapy?

Our goal is for you to get up and put weight on your hip as soon as possible. This usually happens 24 hours after surgery.

You may experience pain and discomfort at first. You may also feel weaker than usual. This is normal and for most patients it improves as you recover. We can give you pain relief if you need it and this will make moving around easier.

Most people make a satisfactory recovery. It is important to follow the advice the physiotherapist gives you about exercises to strengthen your hip muscles. Your walking should continue to improve for at least 6 months.

What if I have memory problems?

If you already had memory problems when you broke your hip, you may find your memory gets worse for a while after your operation. 

Surgery and medication can cause some people to experience a condition known as delirium (mental confusion). This often starts suddenly and can be frightening. It usually improves when the condition causing it gets better.

What if I have problems with bladder control?

It is usual to have problems with bladder control after hip fracture surgery. These include:

• needing the toilet quickly
• difficulty passing urine (weeing)
• feeling you need to wee often
• leaking urine.

Let your medical team know if you experience any of these. Let them know, even if you experienced problems with bladder control before your operation.

How will I know if I am recovering well?

While you are in hospital, we will update you on your progress and plans for discharging you home. If you agree, we can also talk to your family and friends about the best way to help you when you are back home.

Talk to us about your home circumstances. This will help us plan your rehabilitation and avoid any delay when you are discharged.

When will I be discharged home?

Everyone who fractures their hip will recover at their own pace. Most of our patients stay in hospital for 7 to 14 days after surgery. 

Your discharge depends on how well you cope with the stresses of hip fracture, surgery and the challenges of rehabilitation.

It may also depend on how mobile you were before you broke your hip, your general  health and how much help you will get when you are back home.

While you are in hospital, we will encourage you to move around as much as possible. Staying in bed can lead to complications, such as blood clots, chest infection and pressure sores. Worsening muscle weakness can reduce your level of recovery.

Regular exercise should help you to recover and improve your long-term health.

Will I need a follow-up outpatient appointment? 

Modern hip fracture surgery is so successful that most patients do not need a follow-up appointment.

Regular exercise should help you to return to normal activities as soon as possible.

We may contact you after 4 weeks and again after 4 months to check on your progress. We will also want to check your progress if you are having bone-strengthening treatment (see 'Can I do anything to strengthen my bones?', below).

How can I reduce my risk of falling again?

Most hip fractures happen after a fall, so it is important to avoid falling in the future.

We will assess your risk of falling when we plan your rehabilitation and discharge home. This assessment usually includes the following:

• a review of your medication(s)
• physiotherapy to improve your strength and balance
• an occupational therapy assessment of your home environment, to make sure you can manage everyday activities.

Can I do anything to strengthen my bones?

As we get older, our bones become weaker and this can cause a hip fracture. Many people have osteoporosis, which makes bones fragile and more likely to break.

Our orthogeriatric team will assess your bone health and offer treatment where necessary. The team will refer you to our Fracture Liaison Service. 

You can find out about ways to strengthen your bones at the Royal Osteoporosis Society.

More information

Royal Osteoporosis Society: Information and support on osteoporosis

The Royal College of Physicians: Hip fracture: a guide for family carers