TOTAL HIP REPLACEMENT: HEMIARTHROPLASTY
OF HIP
Hemiarthroplasty, or partial reconstruction, of the hip is a less radical procedure than total hip replacement. It is performed when the acetabular cartilage is intact and the pathologic process is limited to the femoral side of the joint.
Partial hip replacement is frequently used in patients with metastatic
lesions of the proximal femur, especially if there is risk of impending
fracture. It is also appropriate for many patients with femoral neck fractures.
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| Plate 2-55 BIPOLAR PROSTHESIS FOR HEMIARTHROPLASTY OF HIP |
Although hemiarthroplasty is appropriate for most fractures of the
femoral neck, in children and young adults every attempt must be made to save
the femoral head and neck with internal fixation. This treatment may also be
desirable in older patients if the fracture is only slightly displaced or
impacted or if it can be stably reduced. Because the main goal of treatment in
older patients is early ambulation, hemiarthroplasty may be the treatment of
choice even for minimally displaced fractures, especially if the bone is
markedly osteoporotic. Displaced fractures of the femoral neck should be
treated primarily with hemiarthroplasty or total hip replacement
because of the high incidence of complications after treatment with ORIF.
Currently accepted practice is to perform an urgent ORIF of a femoral
neck fracture in young patients. In elderly patients with displaced femoral
neck fractures, hip replacement is the standard of care. Currently there is
debate as to whether a hemiarthroplasty or conventional total hip arthroplasty
achieves better results.
In our practice, patients who are community ambulators, live
independently, and do not have dementia undergo a
traditional total hip arthroplasty. This avoids the potential problem of
acetabular cartilage deterioration and subsequent groin pain and need for
revision surgery.
In patients who suffer from impaired cognitive capabilities or those who
are relatively housebound, hemiarthroplasty is performed. A hemiarthroplasty
has less potential for postoperative dislocation and thus is a better option
in this patient population.
