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Hip Hemiarthroplasty
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Hip Hemiarthroplasty?
Hip hemiarthroplasty is a surgical procedure primarily focused on the replacement of the hip joint’s femoral head.
The surgery aims to restore mobility and alleviate pain in the hip joint. This procedure is distinct from total hip arthroplasty, in which both the femoral head and the acetabulum, the hip socket, are replaced. In hip hemiarthroplasty, only the ball of the hip joint (the femoral head) is replaced with a prosthetic implant.
When is Hip Hemiarthroplasty Needed?
- Femoral Neck Fractures: Hip hemiarthroplasty is most commonly indicated for femoral neck fractures, particularly in elderly patients. These fractures, typically resulting from falls, significantly affect mobility and life quality.
- Severe Trauma: In younger individuals, the procedure may be necessary following severe trauma that causes irreparable damage to the femoral head. It is a viable option when the damage is confined to the femoral head while the acetabulum remains intact.
- Avascular Necrosis: This condition involves the loss of blood supply to the femoral head, leading to bone death. Hip hemiarthroplasty is often advised for avascular necrosis affecting solely the femoral head, while the acetabulum remains intact.
- Patient-Specific Considerations: The decision to perform hip hemiarthroplasty is influenced by factors such as the patient’s age, overall health, physical activity levels, and the condition of the hip socket (acetabulum). It is a preferable option when the acetabulum is healthy and free of disease, allowing for a less invasive approach than total hip replacement.
Benefits of Hip Hemiarthroplasty
- Pain Relief and Improved Mobility
A key benefit of hip hemiarthroplasty is significant pain relief and improved mobility, especially in patients with severe hip fractures or conditions. Replacing the damaged femoral head typically reduces hip pain and enhances mobility, allowing patients to walk and perform daily activities with greater ease post-surgery. - Quicker Recovery
Compared to total hip arthroplasty, hip hemiarthroplasty can offer a quicker recovery time, as it is a less extensive surgery. This is particularly beneficial for elderly patients or those with conditions that might complicate a longer recovery process. - Preservation of Natural Bone
Since hip hemiarthroplasty involves replacing only the femoral head and not the acetabulum, it allows for the preservation of more natural bone and hip socket. - Reduced Risk of Dislocation
The risk of dislocation post-surgery is generally lower in hip hemiarthroplasty compared to total hip replacement. This is due to the preservation of more of the patient’s natural hip anatomy. - Suitability for High-Risk Patients
Hip hemiarthroplasty can be a suitable option for patients who are considered high-risk for more invasive surgeries, such as those with certain comorbidities or advanced age, providing a safer alternative with beneficial outcomes.
Procedure for Hip Hemiarthroplasty
- Preoperative Assessment and Planning
Before the surgery, a comprehensive evaluation of the patient’s health is conducted. This includes a medical history review, physical examination, and necessary imaging studies like X-rays or MRI. The orthopaedic surgeon will discuss the type of prosthesis to be used and the specifics of the surgical technique. - Anesthesia and Surgical Preparation
General or spinal anaesthesia is administered. The patient is positioned to allow the surgeon access to the hip joint. The area is cleaned and sterilised to prevent infection. - Surgical Technique
A surgical incision is made over the hip to expose the joint. The damaged femoral head is carefully removed. The surgeon then prepares the femoral canal, which involves reshaping it to fit the prosthetic stem. The chosen prosthesis is then inserted into the femoral canal, and its position is verified for proper alignment and function. - Closure and Postoperative Care
Once the prosthesis is in place, the incision is closed with sutures or staples. Postoperative care includes pain management, prevention of infection, and monitoring for any immediate complications.
Recovery After Hip Hemiarthroplasty
- Immediate Postoperative Period
The initial recovery phase occurs in the hospital, typically lasting a few days. During this period, patients receive pain management and begin basic rehabilitation exercises under supervision. - Short-term Recovery
This phase involves continued physical therapy and gradually increasing activity levels. Patients may use assistive devices like walkers or crutches initially. The focus is on regaining mobility, strength, and flexibility in the hip. - Long-term Recovery
Over weeks to months, patients progressively return to normal activities. The duration of this phase varies based on individual factors like age, overall health, and the nature of the hip condition. Regular follow-up with the surgeon is essential to monitor the integration of the prosthesis and overall recovery. - Physical Therapy and Exercise
Structured physical therapy is a critical component of the recovery process. Therapists guide patients through exercises designed to strengthen the hip and improve range of motion. Home exercise programs may also be recommended. - Pain Management
Pain and discomfort are managed through medications and non-pharmacological methods like ice, rest, and elevation. Effective pain management is key to facilitating active participation in rehabilitation. - Long-term Outcomes
Most patients experience improved mobility and quality of life following hip hemiarthroplasty. The longevity of the prosthesis and the need for future surgeries depend on various factors, including patient activity level and prosthesis type.
Complications and Risks of Hip Hemiarthroplasty
- Infection: One of the potential complications following hip hemiarthroplasty is infection, which can occur at the incision site or deeper within the joint. Infection requires prompt treatment, sometimes involving antibiotics or additional surgery.
- Blood Clots: The risk of blood clots, such as deep vein thrombosis (DVT), is increased after hip surgery. Preventive measures include blood-thinning medications, early mobilisation, and compression devices.
- Dislocation: Although less common in hemiarthroplasty than in total hip replacement, there is still a risk of dislocation of the new joint. Patients must adhere to specific movement precautions to minimise this risk.
- Prosthesis Problems: Issues such as loosening or wear of the prosthesis may occur over time. Regular follow-up appointments are important to monitor the condition of the prosthesis.
- Nerve or Vessel Damage: There is a small risk of damage to nerves or blood vessels around the hip during surgery. This can lead to numbness, tingling, or circulatory issues.
- Uneven Leg Length: Occasionally, the operated leg may appear slightly longer or shorter post-surgery. This is usually addressed during the procedure, but minor discrepancies can occur.
- Persistent Pain: Some patients may continue to experience pain after the surgery, which could be due to various factors including the surgical procedure itself or the underlying health of the hip joint.
- Need for Revision Surgery: In some cases, a second surgery may be required to address complications or due to the wearing out of the prosthesis over time.
Patient Feedback
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
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Frequently Asked Questions (FAQs)
What is the difference between hip hemiarthroplasty and total hip replacement?
In hip hemiarthroplasty, only the femoral head (the ball of the hip joint) is replaced, while in total hip replacement, both the femoral head and the acetabulum (hip socket) are replaced.
How long does it take to recover from hip hemiarthroplasty?
Recovery time can vary but typically involves several weeks to months. The initial few weeks focus on healing and basic mobility, while the subsequent months involve more extensive physical therapy and a gradual return to normal activities.
Can I return to normal activities after hip hemiarthroplasty?
Most patients can return to their normal daily activities after recovery. However, the extent of activity may depend on individual factors like age, overall health, and the nature of the original hip condition.
How long does the prosthesis last?
The lifespan of a hip hemiarthroplasty prosthesis varies, but it can last for several years. The longevity depends on factors like the patient’s activity level, weight, and the type of prosthesis used.