Bearing choice in hip replacement balances two different failures: dislocation, which depends on soft tissues, approach, spinal mobility and cognition; and periprosthetic fracture, which depends on bone quality, falls and stem fixation. Patients with a femoral neck fracture often carry both risks at once.
A short assessment of bone density history, previous fragility fractures, fall frequency and cognitive state, recorded before theatre, makes the trade-off explicit. Starting or continuing osteoporosis treatment after a fragility fracture is established practice and lowers the risk of the next fracture whichever implant is used.
- Record falls history, previous fragility fractures and cognition before choosing a bearing for a hip fracture patient.
- Consider cemented stem fixation in osteoporotic bone, in line with hip fracture guidance.
- Start or refer for osteoporosis treatment after any fragility hip fracture.
- Discuss both dislocation and fracture risk with the patient when consenting.
Why it matters
The bearing that prevents one failure can increase the other in the same patient.
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