Hemiarthroplasty: Innovative Partial Hip Replacement Surgery

Hemiarthroplasty is a specialized partial hip replacement surgery primarily designed to address hip fractures. In rare instances, it also serves as a treatment option for hips compromised by arthritis.

This procedure focuses on replacing only half of the hip joint — specifically the femoral head. The term "hemi" means "half," while "arthroplasty" refers to joint replacement. When the entire hip joint requires replacement, the surgery is known as total hip replacement (THR).

Explore the details below to understand the benefits and expectations of hemiarthroplasty.

Are You an Ideal Candidate?

Your hip functions as a ball-and-socket joint, where the "ball" is the femoral head — the rounded top of the thigh bone (femur) — and the "socket" is the acetabulum, which encases the ball, enabling smooth leg movement.

Hemiarthroplasty replaces the femoral head only. If the socket is also damaged, a total hip replacement is necessary.

If you've sustained a hip fracture, particularly when the femoral head is broken but the acetabulum remains intact, hemiarthroplasty might be the recommended treatment. Your healthcare provider will evaluate factors such as:

• The overall condition of your hip joint
• Your general health status
• Life expectancy
• Level of physical activity

Initially, non-surgical treatments like physical therapy, pain management, and activity modification might be attempted for arthritis-related issues. However, total hip replacement is often preferred for arthritis patients, with hemiarthroplasty reserved mainly for femoral neck fractures.

In exceptional cases, hemiarthroplasty may be chosen to reduce joint instability risks.

Comparing Hemiarthroplasty and Total Hip Replacement

Hemiarthroplasty typically involves shorter surgery duration and less blood loss compared to total hip replacement. It also tends to have a lower risk of hip dislocation post-surgery.

For older adults with minimal socket arthritis and lower activity levels, hemiarthroplasty can be an optimal choice. Conversely, younger, more active individuals often benefit more from total hip replacement, which generally offers superior pain relief, improved long-term function, and enhanced mobility.

Preparing for Your Surgery

Hemiarthroplasty is usually performed soon after a hip fracture occurs, leaving limited time for preparation. Expect to stay in the hospital for a few days following the procedure.

It’s advisable to have a support person during your hospital stay to assist with logistics and your transition back home or to a rehabilitation facility.

Understanding the Procedure

The surgery may be performed under general anesthesia (you’ll be asleep) or regional spinal anesthesia (you remain awake but numb from the waist down). Your surgeon will discuss the best option for you.

An incision is made near the hip, either on the side (posterior approach) or front (anterior approach) of the thigh. The surgeon then removes the damaged femoral head from the socket.

Ligaments, tendons, and muscles stabilize the joint. The femoral head is detached, and the femur’s interior is hollowed to insert a metal stem, sometimes secured with bone cement to minimize fracture risk.

A metal prosthetic femoral head is attached to this stem, occasionally featuring a bipolar design with a polyethylene lining to enhance joint movement. The incision is then closed and dressed.

Recovery and Rehabilitation

Post-surgery, pain management is crucial and should be followed as prescribed. Physical therapy begins in the hospital and continues after discharge, tailored to your age and fitness level.

Therapy may take place at home or in specialized facilities, and the use of assistive devices like canes or walkers might be necessary to prevent falls.

Patients might need to limit activities involving heavy lifting or extensive climbing, and high-impact sports could be discouraged. However, incorporating low-impact exercises remains important for overall health. Consult your doctor about suitable physical activities moving forward.

Potential Risks and Complications

As with any surgery, hemiarthroplasty carries certain risks, including:

Infection

Though rare (around 1%), infections can be severe, potentially spreading and necessitating further surgery. Infections can emerge shortly after surgery or years later. Preventative antibiotics may be advised before dental or other invasive procedures.

Blood Clots

Surgeries involving hips or legs increase the risk of deep vein thrombosis (DVT), where clots form in leg veins and may impair circulation. Blood thinners are commonly prescribed post-operation to mitigate this risk. Early movement is vital to prevent clots.

Dislocation

Dislocation occurs if the prosthetic ball slips from the socket, mostly in early recovery. Your healthcare team will guide you on how to avoid this complication.

Loosening of the Implant

Typically, a hemiarthroplasty implant lasts about 20 years. Over time, it may loosen from the bone, causing pain and often requiring revision surgery.

Prognosis and Long-Term Outlook

The 90-day mortality rate after hemiarthroplasty for hip fractures ranges from 20% to 35%, reflecting the vulnerable health status of affected patients.

Recovery demands adequate nutrition, emphasizing a high-protein diet to support healing.

While occasional pain or stiffness may occur, persistent discomfort is uncommon and should be addressed promptly.

With successful surgery and proper rehabilitation, patients can enjoy prolonged, active use of their new hip. Commitment to physical therapy and regular medical follow-ups is essential. Walking at least three times daily, with or without assistance, is strongly encouraged for optimal recovery.

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