Dr. Song Sang-ho, Wellton Hospital: "Hip Fracture Patients Must Walk Again — Fast"
"The prognosis of hip fracture treatment depends on how quickly the patient's walking function can be restored," says Dr. Song.
- hip fractures
- cemented stems
- elderly patients
- walking function
- personalized medicine
장인선 기자
"Hip fractures can devastate an elderly person's health in an instant."
As South Korea's aging population accelerates, the number of elderly fracture patients continues to rise. Dr. Song Sang-ho, Director of Wellton Hospital, distills the seriousness of hip fractures in this single sentence.
Prolonged bed rest can trigger life-threatening complications — pneumonia, thrombosis, pressure ulcers — rapidly deteriorating a patient's condition. Reports indicate that approximately 20% of hip fracture patients die within one year, and 50–60% suffer lasting mobility impairment even after recovery.
For this reason, hip fracture treatment is about far more than simply mending bone : the central challenge is how quickly the patient's walking function can be restored.
■ The Core of Hip Fracture Treatment: Getting Patients Walking Again
Dr. Song repeatedly emphasizes that the key to hip fracture treatment is
getting patients back on their feet as quickly as possible. The moment a patient can leave the bed and move — even minimally — physical function rebounds faster, and life-threatening complications can be avoided.
■ Cemented vs. Uncemented Femoral Stem: What's the Difference?
When the hip joint is fractured, surgeons perform arthroplasty — replacing the damaged joint with an artificial implant. The femoral stem (the implant component that anchors the artificial joint) is broadly classified into two types: cemented and uncemented.
Cemented stems use bone cement to fix the implant securely in place. Uncemented stems rely on direct bone integration without cement.
While most medical institutions use uncemented stems, Dr. Song actively employs cemented femoral stems. The additional step of injecting bone cement achieves a significantly more stable fixation.
■ Why Cemented Stems for the Very Elderly?
"Patients in their 60s–70s with good bone quality may do well with an uncemented stem," Dr. Song explains, "but the majority of hip fracture patients are in their 80s–90s with severe osteoporosis. In these cases, an uncemented stem may not provide sufficient fixation — increasing the risk of fracture both during and after surgery."
By contrast, cemented stems reinforce weakened bone and provide stable fixation immediately after surgery, enabling earlier ambulation and rehabilitation.
This is why the United States, the United Kingdom, and major European nations strongly recommend cemented arthroplasty for elderly hip fracture patients.
■ Clinical Evidence from Wellton Hospital
Dr. Song underscores the practical advantages: "Cemented stems
provide superior fixation even in severely osteoporotic bone, enabling patients to walk earlier and return to daily life faster. Although the procedure takes longer, it is ultimately a wiser choice that delivers safer outcomes and faster functional recovery."
Data support this approach. According to an analysis by the Health Insurance Review and Assessment Service (HIRA), Wellton Hospital's dislocation rate within 3 months of surgery was 0.172% — approximately 87% lower than the hospital-level average of 1.306%.
■ A Call for Practice Change in Korea
Dr. Song points to the reality that cemented implants remain underutilized in South Korea, and urges a shift:
"Korea must move toward routinely using cemented arthroplasty as the standard of care for elderly patients and those with fragile bones."
In an era that demands personalized medicine, hip fracture surgery must move beyond a one-size-fits-all approach.
A tailored treatment strategy — one that accounts for the patient's age, bone condition, and overall health — is now essential.
■ FAQ
Q1. What is a hip fracture and why is it dangerous for the elderly?
A. A hip fracture refers to a break in the upper part of the femur (thigh bone) near the hip joint. For older adults — especially those with osteoporosis — even a minor fall can cause this injury. It is particularly dangerous because prolonged immobility leads to severe complications: pneumonia, deep vein thrombosis, pressure ulcers, and rapid overall functional decline. About 20% of patients die within one year, and more than half experience lasting walking difficulties.
Q2. What is arthroplasty, and when is it performed for hip fractures?
A. Arthroplasty is a surgical procedure in which the damaged hip joint is replaced with an artificial implant. It is typically recommended when the hip fracture has displaced the femoral head or disrupted blood supply, making bone healing unlikely. The goal is to restore mobility as quickly as possible and prevent life-threatening complications from bed rest.
Q3. What is a cemented femoral stem?
A. A cemented femoral stem is an artificial joint implant that is secured to the femur using bone cement (polymethyl methacrylate, or PMMA). The cement fills the space between the implant and the bone, creating an immediate and stable bond. This allows patients — particularly those with osteoporosis and poor bone density — to bear weight and begin walking much sooner after surgery.
Q4. Why is the cemented stem particularly recommended for elderly patients?
A. Most hip fracture patients who undergo surgery are in their 80s or 90s and have severe osteoporosis. In such cases, an uncemented stem relies on bone ingrowth for fixation — a process that requires healthy bone density and takes time. With fragile bone, this fixation may be inadequate, raising the risk of implant loosening or peri-prosthetic fracture. The cemented stem bypasses this limitation by achieving immediate, strong fixation regardless of bone quality, enabling faster rehabilitation.
Q5. Is the cemented stem widely used internationally?
A. Yes. Major medical guidelines in the United States, United Kingdom, and across Europe strongly recommend cemented femoral stems for elderly hip fracture patients. Clinical evidence consistently shows that cemented fixation reduces dislocation rates, shortens time to ambulation, and improves overall outcomes in this population. In South Korea, however, uncemented stems remain more commonly used, and advocacy for wider adoption of cemented implants is ongoing.
Q6. Are there any downsides to cemented stems?
A. The main trade-off is that the surgery takes somewhat longer due to the cement preparation and application process. There is also a rare risk of 'bone cement implantation syndrome' — a cardiovascular response during cement insertion — which requires careful anesthetic management. However, for the appropriate patient population (elderly, osteoporotic), the benefits of stable fixation and early mobility far outweigh these considerations.
Q7. What does 'early ambulation' mean and why does it matter?
A. Early ambulation means encouraging patients to get out of bed and begin walking as soon as possible after surgery — often within 24 to 48 hours. This is critical because mobility prevents the cascade of complications associated with bed rest: muscle wasting, blood clots, pneumonia, and pressure ulcers. The sooner a patient can walk, the faster their overall physical function recovers and the greater their chance of returning to independent daily life.
