Hip and pelvic injuries are extremely serious and disabling. This large ball-and-socket joint is susceptible to fracture and soft-tissue injury. There is also a true risk of latent injury involved in hip trauma. A brief dislocation can occur. If the bones fall back into place, the patient may not be aware of any damage. Further, X-rays would indicate that the hip is back in proper anatomic alignment. Unfortunately, the damage from a brief dislocation can result in a condition known as avascular necrosis.
The hip joint is the area where the head of the femur (the top of the thigh bone) articulates into the pelvis. In a brief dislocation, the head of the femur is torn away from the pelvis. This sudden dislocation can sheer away the blood vessels at the head of the femur, which nourish the bones of the hip and the joint socket. After the femur falls back into place, the hip appears normal and the damage to the blood vessels is not evident. However, over a period of several months, the bones of the hip are malnourished and slowly die. Necrosis refers to death of the bone tissue. Football legend Bo Jackson is well known for this injury. After a brief dislocation that was quickly put back in place, he believed that he had recovered from his hip injury. Because of avascular necrosis, he experienced increasing problems several months later and soon had to undergo full hip-replacement surgery.
In cases involving avascular necrosis, hip replacement (arthroplasty) is the only proper repair. Unfortunately, the prosthetic hip is not a permanent installation. The prosthetic joint wears over time, can become unstable, or can become the site of infection. Patients with hip replacements can expect to undergo additional future surgeries to replace the prosthetic hip joint every ten to fifteen years following the initial installation. While many mistakenly assume this is a simple procedure, a hip revision (surgical replacement of a prosthetic hip joint) is actually a far more complicated, invasive, and dangerous surgery than the initial hip replacement. In fact, many doctors who handle hip replacements refuse to handle hip revision and they refer these patients to specialized surgeons with experience in this arena.
Pelvic fractures can be extremely complex and disabling. The pelvis is the core of the skeletal structure and is the fulcrum and balance point for the body. Damage to the pelvis can therefore permanently affect one’s ability to walk, balance, or perform basic functions. Because the nerves of the spine terminate at the pelvis, pelvic injuries can also result in loss of bladder and sexual function and other significant sensory deprivation arising from nerve damage.
Patients with severe hip injuries are often transferred from the hospital directly into nursing-care facilities for aggressive rehabilitative therapy. Careful attention should be paid to all medical details in these high-value cases. The patient often has to learn to walk again and is weaned back to weight bearing through a course of painful therapy. Close review of physical therapy notes and all medical records will reveal the difficult road to recovery. After the recovery, the effect on gait, leg length, strain on the back and other areas of the body, and ongoing pain and limited range of motion must be addressed in detail.
Future impact on earning potential should also be considered in all hip-injury cases. A vocational rehabilitation expert can work with physicians and a certified life care planner to nail down all costs of future medical care, all loss of earning capacity, and any apparent future limitations that may require early retirement for the victim.
The most common side effect of hip replacement / arthroplasty is the dislocation of the joint soon after the surgery. The artificial ball and socket are smaller than the one the patient had previously. Thus, the new ball can become displaced with certain movements. Infection, blood clots, and abnormal bone growth are also common side effects of this surgery. As time goes by, tiny particles from the prosthetic may also break off and become absorbed into the surrounding tissue. This process often triggers an inflammatory reaction that causes the implant to loosen.
Do not allow the insurance carrier to minimize the seriousness of a hip fracture. According to the National Center for Injury Prevention and Control, hip fractures cause the greatest number of deaths and lead to the most severe health problems of all injury-related fractures. The victim may become permanently disabled and wheelchair-bound and be confined to a long-term care facility.
Permanent impairment guidelines should also be carefully followed and applied in hip-injury cases. Physicians will consider percentage loss of use of the injured hip/leg and provide a permanent impairment rating for the patient. These impairment ratings can be quite significant. For example, American Medical Association guidelines note that excision of the head and neck of the femur translates to a 50 percent loss of the use of the affected limb. Total hip replacements have an average rating of between 60 and 66 percent loss of use of the leg. For best permanent impairment results, hip fractures should not be evaluated for permanency until two years after initial repair, and current X-rays should be reviewed to rule out aseptic or avascular necrosis or loosening of the hardware.
Because the prosthetic hip is not a permanent fix, many surgeons will perform lesser surgeries with the hope of holding off on complete arthroplasty. The following four additional procedures are commonly seen following traumatic hip injury:
- Hip Hemiarthroplasty — This is a less complicated alternative to a full hip replacement. The procedure involves removal and replacement of the head/ball of the femur while leaving the hip socket alone. This procedure accounts for one-third of all hip replacements currently performed. The surgery is less invasive and less expensive and carries a very high success rate. Less than 10 percent of patients will require further surgery.
- Hip Osteotomy — This procedure involves cutting away sections of the bone from the femur or the pelvis to alter the shape of the damaged hip joint. The surgeon is essentially seeking to shift the patient’s body weight to a joint position with healthier cartilage, thereby reducing the stress on the hip joint. This procedure typically addresses degeneration and is rarely performed in cases involving traumatic hip injury.
- Hip Arthrodesis — This is an invasive procedure that eliminates pain but also eliminates movement and function of the hip joint. The procedure involves fusion of the femur to the pelvis. All hip joint surfaces are surgically removed, and the hip joint is then fused in place with plates and screws. Following the surgery, the patient will still have a meaningful measure of physical function. However, immobility of the hip joint typically results in secondary conditions, such as pain in the back, knees, and the other hip.
- Core Decompression — This procedure is utilized to address avascular necrosis. The surgery involves drilling holes in bones of the hip joint to reduce pressure. It is not always successful. Avascular necrosis causes abnormal pressure to build in the bones of the hip joint, and drilling holes into the necrotic area reduces pressure, which stimulates bone growth and increases blood flow. Drilling holes in the shaft of the femur will create an area of weakness in the bone. Thus, the patient will be susceptible to future hip fracture during the first weeks after the surgery.
Hip injuries produce devastating consequences. Victims of these injuries often endure chronic pain and limited mobility. Statistics confirm that a hip fracture can shorten the victim’s life expectancy and result in future complications, such as avascular necrosis and avascular arthritis. These factors must be thoroughly confirmed and explained in the presentation of the hip-injury claim.