Hip pinning is a procedure performed to stabilize a broken hip, often called open reduction and internal fixation (ORIF). This surgery uses metal implants—such as screws, pins, rods, or plates—to hold the fractured sections of the upper thigh bone (femur) in their correct position. The hardware provides immediate stability, allowing the bone fragments to heal and fuse together over time. The duration of a hip pinning refers both to how long the metal hardware remains in the body and the long-term functional lifespan of the hip joint itself.
Hardware Retention and Removal Timelines
The duration of the metal hardware’s presence falls into two main categories: permanent retention or scheduled removal. For many adult patients, especially those who are older, the hardware is intended to remain in the hip permanently. Leaving the implants avoids the risks and recovery associated with a second surgery. This is often preferred when the patient’s activity level is lower or the fracture is complex.
The hardware is generally not removed routinely unless it causes a specific problem, such as pain or irritation. However, approximately 15% to 16% of patients eventually undergo surgery for hardware removal due to various issues. When removal is necessary, it is scheduled after the bone has fully healed, typically six months to a year following the initial procedure. The orthopedic surgeon must confirm complete bone union through X-rays before considering removal.
If the implants cause persistent discomfort, such as rubbing against soft tissues or being palpable beneath the skin, an elective removal procedure may be performed. If the fracture fails to heal (nonunion) or if the hardware breaks, a second surgery is required to remove the failed implants and address the underlying healing issue. The decision to remove the hardware balances alleviating symptoms against the potential for complications from an additional surgical procedure.
Factors Influencing Hardware Duration
Several patient-specific and injury-related factors determine the duration of the internal fixation hardware. A patient’s age is a primary consideration, as younger, more active individuals are more likely to have the hardware removed. Higher activity levels place greater mechanical stress on the implants, increasing the chance of symptomatic hardware or fatigue failure.
In children and adolescents, hardware removal is often planned as a necessary part of the treatment, especially when growth plates near the hip are involved. Removal prevents the implants from interfering with the natural growth and development of the bone. The specific type and location of the fracture also play a role, as certain patterns require more prominent hardware that is more likely to cause soft tissue irritation.
The most common reasons for unplanned hardware removal stem from complications following the initial surgery. These include mechanical issues, such as pins backing out or breaking, or biological problems like infection at the surgical site. If the fracture fails to heal or if the joint requires a total hip replacement, the existing hardware must be removed as a prerequisite for the joint replacement surgery.
Long-Term Health of the Repaired Hip Joint
The long-term success of hip pinning is measured by the functional health of the repaired joint over the patient’s lifetime, not by the life of the metal implants. Even when the fracture heals successfully, the hip joint remains susceptible to two major long-term complications stemming from the initial injury.
One potential complication is avascular necrosis (AVN), also known as osteonecrosis, which results from a disruption to the blood supply of the femoral head. A hip fracture, particularly one close to the ball of the joint, can damage the blood vessels supplying the bone, causing the tissue to die. AVN can progress over time, sometimes manifesting years after the injury, and may eventually lead to the collapse of the femoral head.
The other primary long-term concern is post-traumatic osteoarthritis, which is the breakdown of joint cartilage caused by the original trauma and subsequent surgical repair. Even a perfectly fixed fracture can slightly alter joint mechanics, leading to accelerated wear and tear of the cartilage. Both AVN and severe osteoarthritis can cause chronic pain and stiffness, limiting mobility and function decades later.
If long-term damage from AVN or osteoarthritis becomes debilitating, the intervention is often a total hip arthroplasty, or full hip replacement. This procedure involves removing the damaged femoral head and socket and replacing them with artificial components. For many patients, successful hip pinning allows them to maintain a high quality of life, though the possibility of needing a joint replacement later remains a factor in the overall “life” of the repaired hip.