Hip hemiarthroplasty, also known as partial hip replacement, is a surgical procedure performed to replace the damaged or fractured femoral head while preserving the natural acetabulum. This procedure is typically indicated for patients who have sustained certain types of hip fractures or have conditions leading to femoral head necrosis. Understanding the specifics of hip hemiarthroplasty, including its indications, procedure and post-operative care is important.
Reasons for Hip Hemiarthroplasty
Hip hemiarthroplasty is suggested for several specific conditions, particularly those affecting the femoral head while leaving the acetabulum intact. These indications include:
Displaced Femoral Neck Fractures
A common indication for hip hemiarthroplasty is displaced femoral neck fractures, particularly in elderly patients. These fractures often result from falls and can significantly impair mobility and cause severe pain. Hip hemiarthroplasty provides a solution that allows for quicker recovery compared to other surgical options.
Osteonecrosis of the Femoral Head
Osteonecrosis, also known as avascular necrosis, occurs when blood supply to the femoral head is compromised, leading to bone death. This condition can cause significant pain and joint dysfunction. Hip hemiarthroplasty can replace the necrotic femoral head, alleviating symptoms and improving joint function.
Hip Joint Arthritis
While total hip arthroplasty is typically preferred for widespread hip arthritis, hip hemiarthroplasty can be appropriate for patients whose arthritis primarily affects the femoral head. This approach preserves the acetabulum and may be chosen for patients with limited joint involvement or specific clinical considerations.
Pathological Fractures
Pathological fractures, which occur in bones weakened by disease such as cancer or osteoporosis, can also be an indication for hip hemiarthroplasty. Replacing the femoral head in these cases helps stabilise the joint and relieve pain.
The Procedure of Hip Hemiarthroplasty
Hip hemiarthroplasty is a surgical intervention performed under general or regional anaesthesia. The procedure involves several key steps aimed at replacing the damaged femoral head while preserving the natural acetabulum. Here is an overview of the procedure:
Preoperative Preparation
Before the surgery, patients undergo a comprehensive evaluation, including a physical examination, imaging studies (such as X-rays or MRI), and laboratory tests. This assessment ensures that the patient is a suitable candidate for the procedure and helps plan the surgical approach.
Surgical Approach
The surgery typically begins with an incision made over the hip joint to expose the hip structures, using the direct anterior approach.
Removal of the Femoral Head
Once the hip joint is accessed, the damaged femoral head is carefully dislocated from the acetabulum and removed. This step requires precision to avoid damaging surrounding tissues and structures.
Preparation of the Femur
After removing the femoral head, the surgeon prepares the femur to receive the prosthetic implant. This involves reaming and shaping the upper femur to fit the stem of the prosthetic device. The femoral canal is carefully sized to ensure a secure fit for the implant.
Insertion of the Prosthetic Implant
The prosthetic femoral head, which is typically attached to a stem, is then inserted into the prepared femoral canal. The stem may be cemented or press-fit, depending on the patient’s bone quality and the surgeon’s preference. The prosthetic head is designed to articulate smoothly with the natural acetabulum.
Closure
Once the prosthesis is in place, the surgeon will close the incision with sutures or staples, and a dressing will be applied to protect the wound.
Postoperative Care
Recovery from hip hemiarthroplasty varies depending on the individual and the specific procedures performed.
- Initial Recovery: After the surgery, you will spend a few days in the hospital. Physical therapy will begin soon after surgery to aid in your recovery and help you regain mobility.
- Pain Management: You will experience some pain and swelling after the surgery. Medications and ice packs will be provided to help manage these symptoms.
- Physical Therapy: A physical therapy program is important for regaining strength and mobility in the hip joint. Your therapist will guide you through exercises that will gradually help you restore full function.
- Follow-Up Visits: Regular follow-up visits with your surgeon are recommended to monitor your healing and address any concerns that may arise.
Potential Risks and Complications
As with any surgical procedure, hip hemiarthroplasty carries potential risks and complications, including:
Infection: There is a small risk of infection at the incision sites or within the joint. This can typically be managed with antibiotics, but in rare cases, additional surgery may be required to clear the infection.
Blood Clots: Blood clots can form in the legs or lungs after surgery, though this is rare. Preventative measures, such as blood thinners and compression stockings, are often used to minimize this risk.
Dislocation: The prosthetic femoral head can become dislocated from the acetabulum, which may require a reduction procedure or additional surgery to correct.
Nerve or Vessel Damage: The proximity of nerves and blood vessels to the hip joint means there is a slight risk of injury during the procedure. This can lead to numbness, weakness, or vascular complications.
Loosening or Wear of the Prosthesis: Over time, the prosthetic components may loosen or wear out, potentially requiring revision surgery.
Stiffness and Reduced Range of Motion: Some patients may experience stiffness or a reduced range of motion in the hip joint after surgery, necessitating ongoing physical therapy.
Typical Recovery Timeline
The recovery timeline can vary but generally follows these stages:
First Week: Rest and limited movement are crucial during the first week to allow initial healing. Physical therapy typically begins during this time to promote gentle movement and prevent stiffness.
2-6 Weeks: Gradual increase in activity and continued physical therapy are essential during this period. Patients will work on improving range of motion and beginning to rebuild strength in the hip muscles.
6-12 Weeks: Continued physical therapy with a focus on regaining full mobility and strength. Patients will start incorporating more weight-bearing exercises and may begin returning to light activities.
3-6 Months: Most patients can return to normal activities, though full recovery may take up to a year. Ongoing physical therapy and regular follow-up appointments with the surgeon are important to ensure proper healing and address any concerns.
The Difference Between Hip Hemiarthroplasty and Total Hip Replacement
Hip hemiarthroplasty is generally recommended for patients who have sustained hip fractures that are not suitable for fixation and need replacement. It is particularly beneficial for patients who may not be good candidates for a more extensive surgery due to age, health conditions, or activity level. They are also more appropriate for patients who are at higher risk of implant dislocation.
Total hip replacement, on the other hand, is more suitable for patients with severe joint damage involving both the femoral head and the acetabulum. This procedure is ideal for those who suffer from debilitating pain and significant loss of function due to advanced arthritis, extensive fractures, or other severe hip joint conditions. The outcomes of total hip replacement are often highly successful, with many patients experiencing significant improvements in pain relief, mobility, and overall quality of life. While the recovery period may be longer and the surgery more invasive, the benefits for suitable candidates can be substantial, making it a preferred option for long-term joint health.
Both procedures have their specific indications and are chosen based on the patient’s overall health, the extent of hip damage, and the desired outcome. Consulting with an orthopaedic surgeon can help determine the most appropriate surgical option based on individual needs and conditions.
Conclusion
Hip hemiarthroplasty is a procedure for treating certain types of hip fractures and severe arthritis. While hip hemiarthroplasty is generally effective in alleviating pain and restoring hip function, it is important to understand the potential risks and complications, such as infection, blood clots, and prosthetic loosening.
If you are experiencing hip pain or have sustained a hip fracture, consult with an orthopaedic surgeon to determine if hip hemiarthroplasty is an appropriate option for you.
Dr Wang Lushun specialises in enhancing recovery after hip surgery. He specialises in Direct Anterior / Direct Superior Minimally Invasive Approaches to the hip using the latest modern implants.
