Hip pinning is a surgical procedure that uses metal screws to hold together a broken or unstable hip bone, most commonly after a fracture of the femoral neck (the narrow section connecting the ball of your hip joint to the thighbone). It’s a minimally invasive alternative to hip replacement, with shorter operating times and smaller incisions. The procedure is also used in children and teenagers to stabilize a condition where the ball of the hip joint slips out of position.
How Hip Pinning Works
The surgeon inserts two or three hollow (cannulated) screws through small incisions in the outer thigh, driving them across the fracture line and into the ball of the hip joint. The screws are placed parallel to each other and spread as wide as possible within the femoral neck to maximize stability. The goal is to compress the broken bone ends together so they can heal in their correct alignment.
During the procedure, you lie on your back under general or spinal anesthesia. The surgeon uses real-time X-ray imaging (fluoroscopy) to guide thin wires into the correct position first, then slides the hollow screws over those wires. Proper placement means the screws sit firmly in the bone without poking through the surface of the femoral head, which would damage the joint cartilage and nearby blood vessels. The entire surgery typically takes well under an hour.
Who Needs Hip Pinning
In adults, hip pinning is primarily used for femoral neck fractures that haven’t shifted out of alignment (nondisplaced fractures) in older patients, and for displaced fractures in younger patients who have good bone quality. Age and bone density play a major role in which procedure a surgeon recommends. Younger patients benefit from keeping their natural hip joint intact, while older patients with significantly displaced fractures or weak bone are more likely to receive a partial or total hip replacement instead.
In children and adolescents, hip pinning treats a condition called slipped capital femoral epiphysis (SCFE), where the growth plate at the top of the thighbone weakens and the ball of the hip slides backward. A single screw is placed through the growth plate to lock the ball in position and prevent further slipping. This technique, called in-situ pinning, has a long track record of good outcomes. The screw needs to land in the center of the ball and sit perpendicular to the growth plate without entering the joint space.
What Recovery Looks Like
Most patients begin partial weight bearing within the first day or two after surgery, using a walker or crutches to take some pressure off the healing hip. This partial weight-bearing phase typically lasts six to eight weeks. Full, unrestricted weight bearing is usually allowed somewhere between eight and twelve weeks, depending on how the fracture is healing on follow-up X-rays. Delaying full weight bearing has been associated with a lower risk of complications compared to loading the hip too early.
Hospital stays vary widely depending on the country and patient factors. In practice, many patients in the U.S. go home within one to three days for an uncomplicated pinning, though older patients with other health conditions may stay longer. Physical therapy starts early, focusing on gentle range-of-motion exercises and progressing to strengthening as the bone heals. Most people use a walker or cane for several weeks before transitioning to walking independently.
Risks and Complications
The two complications that concern surgeons most after hip pinning are avascular necrosis and nonunion. Avascular necrosis happens when the blood supply to the ball of the hip joint is disrupted, causing the bone to gradually die and collapse. Reported rates range from 5 to 40 percent of pinned hip fractures, a wide spread that reflects differences in fracture severity, patient age, and how quickly surgery was performed after the injury. Nonunion means the fracture simply fails to heal, leaving the bone unstable.
When screws are placed too close together rather than spread apart within the femoral neck, the failure rate increases. If either complication develops, the screws usually need to be removed and replaced with a partial or total hip replacement. Some patients also experience ongoing pain around the screw heads on the outer thigh, particularly if the hardware irritates surrounding soft tissue.
Hip Pinning vs. Hip Replacement
The main advantage of pinning is that it preserves your natural hip joint. There’s no artificial ball or socket, no risk of a prosthesis wearing out over time, and the surgery itself is faster with less blood loss. For younger patients, avoiding a replacement means avoiding the near-certainty of needing a second, more complex replacement surgery decades later.
The tradeoff is that pinning depends entirely on the bone healing properly. Hip replacement patients don’t face that uncertainty: because the damaged bone is removed and replaced with metal and plastic components, there’s no fracture that needs to knit together. Studies comparing the two approaches in older adults have found that replacement patients recover slightly more of their pre-injury function at one year (about 94 percent recovery versus 88 percent for pinning). Replacement patients also tend to have less pain during early mobilization, since they aren’t waiting for a fracture to heal.
For nondisplaced fractures in otherwise healthy patients, pinning remains the standard first-line treatment. For displaced fractures in patients over 60 or 65, most orthopedic guidelines favor replacement because the risk of pinning failure and the need for a second surgery outweigh the benefits of a smaller initial operation.
Are the Screws Permanent?
In most adult fracture cases, the screws are left in place permanently once the bone has healed. Routine removal isn’t recommended unless the hardware causes pain, backs out of the bone, or a complication like nonunion requires a different procedure. In teenagers treated for SCFE, the screw may be removed after the growth plate has fully closed, though many surgeons leave it in if it isn’t causing problems. If removal is needed, it’s a short outpatient procedure done through the same small incision used for the original surgery.