Name of the Procedure:

Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)

Summary

Hemiarthroplasty is a surgical procedure that involves replacing one half of the hip joint with a prosthetic implant. This procedure typically addresses problems with the femoral head, replacing it with a metal or ceramic prosthesis while leaving the natural acetabulum (hip socket) intact.

Purpose

Hemiarthroplasty is primarily used to treat severe hip fractures or damage to the femoral head due to conditions such as osteonecrosis. The goal of the procedure is to relieve pain, restore hip function, and improve the patient's mobility.

Indications

• Severe hip fractures (e.g., femoral neck fractures)
• Osteonecrosis of the femoral head
• Advanced arthritis limited to the femoral head
• Failure of previous hip surgery

Patient criteria typically include persistent pain, loss of function, and significant impact on daily activities, particularly in older adults or those with compromised bone health.

Preparation

• Patients may be instructed to fast for a certain period before surgery.
• Medications may need to be adjusted, especially anticoagulants.
• Pre-operative assessments typically include blood tests, EKG, chest X-ray, and imaging studies of the hip (like X-rays or MRIs).
• The patient should arrange for post-operative transportation and support.

Procedure Description

1. The patient is positioned on the operating table, and general or regional anesthesia is administered.
2. An incision is made over the hip joint.
3. The femoral head is exposed by dislocating the hip.
4. The damaged femoral head is removed.
5. A femoral stem prosthesis is inserted into the hollow center of the femur.
6. If a bipolar prosthesis is used, it has a two-part head system to allow a better fit in the acetabulum.
7. The prosthesis is securely fixed in place.
8. The incision is closed and sterilized.

Duration

The procedure typically takes 1 to 2 hours to complete.

Setting

Hemiarthroplasty is usually performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Blood clots
• Dislocation of the new joint
• Prosthesis loosening or failure
• Nerve injury
• Leg length discrepancy

Management of such complications may include medication, physical therapy, or additional surgery.

Benefits

• Significant pain relief
• Improved hip function and mobility
• Enhanced quality of life
• Reduced risk of complications compared to total hip arthroplasty for certain patients

Benefits are typically realized within weeks to a few months post-surgery.

Recovery

• Initial hospital stay of 2-5 days.
• Pain management with medications.
• Early mobilization with physical therapy.
• Use of walking aids (e.g., crutches, walker) for a few weeks.
• Avoidance of hip-demanding activities for several weeks.
• Follow-up appointments to monitor recovery.

Alternatives

• Total hip arthroplasty, which replaces both the femoral head and acetabulum.
• Non-surgical management, such as physical therapy, pain medication, and activity modification.
• Pros: Total hip arthroplasty may provide more comprehensive relief for severe arthritis.
• Cons: Non-surgical options may not provide adequate pain relief or functional improvement.

Patient Experience

• During the procedure, patients typically receive anesthesia to ensure they do not feel pain.
• Post-operatively, patients may experience pain and discomfort, which is managed with medication.
• Physical therapy is a cornerstone of recovery to regain strength and mobility.
• Full recovery can take several months, but significant improvements are typically seen within weeks to a few months post-surgery.