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My hip fracture healed. What's next?

Sara Shupe, MSPT, Dip. MDT, is a physical therapy specialist and the Founder and President of J.O.Y Physical Therapy, which provides mobile and tele-health specialized physical therapy. She has shared her research related to low back pain at the North American Spine Society technology forum in Utah, NASS summer meeting in San Diego, The International Conference of MDT in Miami, and the American Physical Therapy Association in St. Paul, MN.

It's not very common to break your hip if you are in those "silver" ages of life (Which is, of course one generation before those wonderful golden ages). Current prevalence statistics vary considerably, but given the right set of circumstance, it happens. If you are blessed to be a Minnesotan like myself, there is a formula here that increases your chances:

Ice + speed = hip fracture.

The order of care for your hip.

Research in orthopedic medicine has had a difficult time proving the reliability and validity of certain tests
practitioners will do to determine if a middle aged hip fracture patient would respond best to surgery or non-operative management. A current article from Adrian Davis' group found that radiologic and CT tests done in the clinic haven’t been found to be predictably reliable (J Ortho Trauma 2013). In English, that means despite all the testing, we don't know who will do better down the road. These international studies suggest that the grand majority of these patients heal without surgery. Furthermore, once a hip has healed non-operatively, it was found that the likelihood of needing a surgery in the future from the "post-traumatic arthritis" or some-other-scary-phrase is less than 3% (Clarke-Jernesen, J et al J Bone Surg 2015). So why are Americans doing all these surgeries on these fractured hips? Why are healed acetabular or hip fracture being told that a "total hip is in my future?" 


The economics of orthopedic care.

The going rate of an average hip replacement in this country is $50,000. That is "without complications." Add an infection in there and your rate could double. If you have a $20000+ deductible like many Americans, you pay it. Kiss that European vacation goodbye!

In a few cases, the presence of acetabular or other hip fracture demonstrates significant pathology (i.e. instability) and thus requires surgical intervention (envision a bone moving around after a fall, pinching off the necessary arteries to this bones of your pelvis and/or hip). However, after the initial healing phase of the fracture, the majority of  middle-aged folks do not need surgery both at the time of fracture, or years down the road. 

Instead of surgery, it has been found that otherwise healthy people can demonstrate positive outcomes from a treatment called Mechanical Diagnosis and Therapy or MDT. It has been shown to be efficient and less expensive. With the mounting costs of treatments for musculoskeletal disorders in this country, MDT is a breath of fresh air for those searching for more efficient, less morbid, and less expensive methods of care.

By treating healed hip fracture patients with MDT we’ve managed to:

* Improved patients’ function long term, more efficiently
* Reduced the likelihood for expensive and unnecessary scans and surgeries etc.

Seek out a MDT provider in your region at www.mckenzieinstituteusa.org or call 651-800-MYPT if in MN or WI.


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