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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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.