Hip Hemiarthroplasty (Partial Hip Replacement): A Complete Guide

Introduction to Hip Hemiarthroplasty

Hip hemiarthroplasty, also known as partial hip replacement, is a surgical procedure where only the damaged femoral head (the "ball" part of the hip joint) is replaced with a prosthetic implant, while the natural socket (acetabulum) is preserved. This surgery is commonly performed in elderly patients who suffer from hip fractures, particularly femoral neck fractures, where blood supply to the femoral head is compromised.

Unlike a total hip replacement, which replaces both the ball and socket, hemiarthroplasty is a less invasive option when the acetabulum is healthy. The procedure helps restore mobility, reduce pain, and improve quality of life for patients who may not withstand a more extensive surgery. The artificial implant used is typically made of metal or ceramic, designed to mimic natural joint movement.

Recovery time varies, but with proper rehabilitation, many patients regain independence and return to daily activities. Understanding the procedure, its benefits, and what to expect can help patients and caregivers make informed decisions.

When is Hip Hemiarthroplasty Needed? (Indications)

Hip hemiarthroplasty is primarily recommended for patients with specific hip conditions where preserving the natural socket is viable. The most common reason is a displaced femoral neck fracture in elderly individuals, where the fracture disrupts blood flow to the femoral head, leading to bone death (avascular necrosis).

Other indications include:

• Non-union fractures – When a hip fracture fails to heal properly.
• Severe osteoarthritis (in select cases) – If only the femoral head is damaged.
• Tumor or bone disease affecting the femoral head.
• Patients with limited mobility who may not benefit from a full hip replacement.

However, hemiarthroplasty is not suitable for patients with arthritis in the acetabulum or those needing long-term high-impact activity. A thorough evaluation by an orthopedic surgeon determines the best approach based on age, bone quality, and overall health.

Preparing for the Surgery (Preoperative Steps)

Proper preparation before hip hemiarthroplasty ensures a smoother surgery and recovery. Here’s what patients can expect:

Medical Evaluation: A thorough assessment, including blood tests, X-rays, and sometimes an MRI, helps evaluate bone health and surgical risks. Chronic conditions like diabetes or heart disease must be stabilized.

Medication Review: Certain drugs (e.g., blood thinners) may need to be paused before surgery to reduce bleeding risks. Always consult your surgeon before stopping any medication.

Prehabilitation (Prehab): Strengthening exercises for the hip and legs can improve post-surgery recovery. Physical therapy may be recommended.

Home Preparation: Since mobility will be limited initially, arranging assistive devices (walker, cane) and modifying the home (removing rugs, installing grab bars) is crucial.

Fasting Before Surgery: Patients are typically asked to avoid food and drink for 8-12 hours before the procedure.

Following these steps minimizes complications and sets the stage for a successful surgery.

Step-by-Step Surgical Procedure

Hip hemiarthroplasty is performed under general or spinal anesthesia and usually takes 1-2 hours. Here’s a breakdown of the process:

1. Incision: The surgeon makes a 4-6 inch incision on the side or front of the hip.
2. Accessing the Joint: Muscles and tissues are carefully moved aside to expose the hip joint.
3. Removing the Damaged Femoral Head: The fractured or diseased femoral head is cut and removed.
4. Implant Placement: A metal or ceramic prosthetic stem is inserted into the femur, and a new artificial ball (head) is attached.
5. Closing the Incision: The surgeon repositions muscles and sutures the wound.

Minimally invasive techniques may use smaller incisions for faster recovery. Patients are usually moved to a recovery room for monitoring before starting rehabilitation.

Recovery & Rehabilitation Process

Recovery after hip hemiarthroplasty varies but generally follows these stages:

Hospital Stay (3-5 days): Pain management, wound care, and initial mobility exercises begin immediately. Patients often stand with assistance within 24 hours.

Early Mobility: Physical therapists guide patients in walking with a walker or crutches to prevent stiffness and blood clots.

Home Recovery (First 6 Weeks): Activities are limited; no bending past 90 degrees or crossing legs. Home exercises strengthen the hip.

Outpatient Therapy (6-12 Weeks): Gradual increase in mobility and strength training helps restore function.

Most patients resume light activities within 3 months, but full recovery may take 6-12 months. Consistency in rehab is key to success.

Potential Risks & Complications

While hip hemiarthroplasty is generally safe, potential risks include:

• Infection: Rare but may require antibiotics or additional surgery.
• Blood Clots: Prevented with blood thinners and early movement.
• Dislocation: More common in partial replacements; avoiding certain movements reduces risk.
• Implant Loosening/Wear: Over years, the prosthetic may loosen, requiring revision surgery.
• Leg Length Discrepancy: Minor differences may occur but are often manageable.

Choosing an experienced surgeon and following post-op instructions minimizes these risks.

Life After Partial Hip Replacement (Long-term Outlook)

Most patients experience significant pain relief and improved mobility after hemiarthroplasty. Key long-term considerations:

• Activity Modifications: High-impact sports (running, jumping) are discouraged, but low-impact activities (walking, swimming) are encouraged.
• Follow-up Visits: Regular check-ups monitor implant health and detect issues early.
• Healthy Lifestyle: Maintaining a healthy weight and avoiding smoking prolongs implant longevity.

With proper care, many patients enjoy an active lifestyle for 10-15 years or more before needing revision surgery.

FAQs About Hip Hemiarthroplasty