Partial Hip Replacement: Difference between revisions

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== Description   ==
== Introduction   ==
[[File:Hemiarthroplasty hip.jpg|alt=|thumb|R hip hemiarthroplasty ]]
Partial Hip Replacement/Hip hemiarthroplasty is an orthopaedic procedure for the treatment of certain [[Femoral Neck Fractures|femoral neck fractures]] where the [[Femur|femoral]] head is removed and replaced. "Hemi" refers to the fact that the prosthetic femoral head articulates with the original acetabulum.<ref name=":0" />


Partial Hip Replacement is a surgical procedure used to replace half of the hip joint. The operation involves replacing the ball of the femur that has worn from arthritis, degeneration, or a serious fracture involving the ball of the hip joint. Normal motion becomes restricted and painful with advanced wear of the hip joint.<ref name="Description">Partial hip replacement, https://advancedortho.me/wp-content/uploads/2013/04/Partial-Hip-Replacement.pdf (accessed 6 April 2017)</ref><br>
Hemiarthroplasty is desirable for the:  


== Indication  ==
# Surgical treatment of [[Femoral Neck Hip Fracture|subcapital neck fractures]] that are displaced and at high risk of femoral head [[Avascular Necrosis|avascular necrosis]] ([[Femoral Neck Fractures, Garden Classification|Garden III and IV fractures]]).
# [[Multimorbidity|Co-morbid]], less active, older patients (not good surgical candidates for [[Total Hip Replacement|THR]]) as long procedure with high morbidity in this group (younger or more active patients, THR has a better outcome).<ref name=":0">Radiopedia [https://radiopaedia.org/articles/hip-hemiarthroplasty Hemiarthroplasty] Available from: https://radiopaedia.org/articles/hip-hemiarthroplasty<nowiki/>(accessed 15.2.2021)</ref><ref name="Description">Partial hip replacement, https://advancedortho.me/wp-content/uploads/2013/04/Partial-Hip-Replacement.pdf (accessed 6 April 2017)</ref>


*A fractured neck femur, where the fracture occurs just below the ball-and-socket hip joint causing the ball to get disconnected from the rest of the thigh bone or femur. Blood supply to the fractured portion of bone is often disrupted at the time of injury and is at high risk of not healing when the fracture is badly displaced.  
== Technique  ==
*Osteoarthritis: the degeneration of cartilages located at the end of the hip bones.  
[[File:Walking frame.jpg|right|frameless]]
*Rheumatoid arthritis: the inflammation of the synovial membrane in the hip joints causing abnormal production of synovial fluid.
The femoral stem is inserted similar to that of a total hip arthroplasty and can be cemented or non-cemented. The acetabulum is not interfered with as it is still in good condition.<ref>Bone smart Partial Hip Replacement Surgery
*Traumatic arthritis, from [[hip]] fracture or severe hip injury.  
Available from: https://bonesmart.org/hip/partial-hip-replacement-surgery/ (accessed 16.2.2021)
*Avascular necrosis where the head of the femoral bone dies due to lack of blood supply, and many other degenerative diseases are also factors that lead to broken the head of femur.<ref name="Indecation">Partial hip replacement,http://www.orthopaedic-consultant.com/partial-hip-replacement (accessed 6 April 2017)</ref><br>
</ref><ref name=":0" /> Most partial hip replacement surgeries can be performed in less than one hour in a hospital or surgical centre. The surgeon can choose to conduct open surgery, where a long incision is made diagonal to the joint, or a less-invasive computer-assisted procedure that requires only one or two small cuts. Computer-assisted surgery is usually preferred whenever the amount of bone that needs to be resurfaced or realigned is minimal<ref>Wise geek [https://www.wisegeek.com/what-is-a-partial-hip-replacement.htm PHR] Available from:https://www.wisegeek.com/what-is-a-partial-hip-replacement.htm (accessed 16.2.2021)</ref>.


Note:&nbsp;
== Complications ==
Complications following THR can be loosely divided into systemic and procedure specific complications. Incidence of complications have improved over time, due to [[Surgery and General Anaesthetic|surgical]] and anaesthetic techniques improvements, along with the better diagnosis and management of these complications.<ref>Park C, Merchant I. Complications of total hip replacement. InTotal Hip Replacement-An Overview 2018 Nov 5. IntechOpen. Available:https:https://www.intechopen.com/chapters/61241 (accessed 14.12.2022) </ref>


[Partial hip replacement is only recommended on occasion and generally when the patient is elderly and in poor health, because metal prosthesis bearing against bone is not the optimal solution. It can result in wear on the bone and possibly even to the point of wearing away the base of the socket. <br>For this reason, certain patients (young and very able and active older patients) may have a total hip replacement.]<ref name="Indication">Partial hip replacement, https://bonesmart.org/hip/partial-hip-replacement-surgery (accessed 6 April 2017)</ref><br>
* In a study it was found that the complication rate for hemiarthroplasty was notably higher when compared to THR. This may be explained by a poorer physiological condition of the hemiarthroplasty group upon admission. There were also a larger proportion of patients in this group with a [[Barthel Index|Barthel score]]5 <19. This score reflects mobility, and lower mobility  makes the group slower to rehabilitate and mobilise post-operatively, (making them more vulnerable to chest and urinary infection). This may have contributed to the high rate of chest and urosepsis in this group
* It is well documented that the rate of dislocation in THR performed following a fractured neck of the femur is significantly higher.<ref>Dawson D, Milligan D, Callachand F, Cusick L. Hip hemi-arthroplasty vs total hip replacement for displaced intra-capsular hip fractures: retrospective age and sex matched cohort study. The Ulster Medical Journal. 2018 Jan;87(1):17.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849947/ (accessed 16.12.2022)</ref>
* Hemiarthroplasty is frequently less painful and requires fewer hospital stays than a full hip replacement.<ref>brandonorthopaedics Hemiarthroplasty Vs Total Hip Replacement: Key Differences Available:https://www.brandonorthopedics.com/hemiarthroplasty-vs-total-hip-replacement-key-differences/ (accessed 16.12.2022)</ref>


== Clinical Presentation  ==
See [[Total Hip Replacement Complications|Hip Replacement Complications]]


add text here relating to the clinical presentation of the condition<br>
== Physiotherapy ==
For a comprehensive guide see [[Total Hip Replacement]],  protocol the same.


== Diagnostic Tests  ==


add text here relating to diagnostic tests for the condition<br>
== Pre-Op  ==
add text here relating to the pre-operative advice
== Post-Op  ==
add text here relating to post-operative rehabilitation<br>
== Key Evidence  ==
add text here relating to key evidence with regards to any of the above headings<br>
== Resources    ==
add appropriate resources here
== Case Studies  ==
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
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== References  ==
== References  ==
References will automatically be added here, see [[Adding References|adding references tutorial]].


<references />
<references />
[[Category:Orthopaedic_Surgical_Procedures]]
[[Category:Orthopaedic_Surgical_Procedures]]
[[Category:Older People/Geriatrics]]
[[Category:Older People/Geriatrics]]
[[Category:Older People/Geriatrics - Conditions]]
[[Category:Older People/Geriatrics - Interventions]]
[[Category:Osteoarthritis]]
[[Category:Arthroplasty]]

Latest revision as of 13:56, 11 January 2024

Original Editor - Asma Alshehri

Top Contributors - Lucinda hampton, Asma Alshehri, Kim Jackson, Lauren Lopez, George Prudden, WikiSysop and Ahmed Nassef  

Introduction[edit | edit source]

R hip hemiarthroplasty

Partial Hip Replacement/Hip hemiarthroplasty is an orthopaedic procedure for the treatment of certain femoral neck fractures where the femoral head is removed and replaced. "Hemi" refers to the fact that the prosthetic femoral head articulates with the original acetabulum.[1]

Hemiarthroplasty is desirable for the:

  1. Surgical treatment of subcapital neck fractures that are displaced and at high risk of femoral head avascular necrosis (Garden III and IV fractures).
  2. Co-morbid, less active, older patients (not good surgical candidates for THR) as long procedure with high morbidity in this group (younger or more active patients, THR has a better outcome).[1][2]

Technique[edit | edit source]

Walking frame.jpg

The femoral stem is inserted similar to that of a total hip arthroplasty and can be cemented or non-cemented. The acetabulum is not interfered with as it is still in good condition.[3][1] Most partial hip replacement surgeries can be performed in less than one hour in a hospital or surgical centre. The surgeon can choose to conduct open surgery, where a long incision is made diagonal to the joint, or a less-invasive computer-assisted procedure that requires only one or two small cuts. Computer-assisted surgery is usually preferred whenever the amount of bone that needs to be resurfaced or realigned is minimal[4].

Complications[edit | edit source]

Complications following THR can be loosely divided into systemic and procedure specific complications. Incidence of complications have improved over time, due to surgical and anaesthetic techniques improvements, along with the better diagnosis and management of these complications.[5]

  • In a study it was found that the complication rate for hemiarthroplasty was notably higher when compared to THR. This may be explained by a poorer physiological condition of the hemiarthroplasty group upon admission. There were also a larger proportion of patients in this group with a Barthel score5 <19. This score reflects mobility, and lower mobility makes the group slower to rehabilitate and mobilise post-operatively, (making them more vulnerable to chest and urinary infection). This may have contributed to the high rate of chest and urosepsis in this group
  • It is well documented that the rate of dislocation in THR performed following a fractured neck of the femur is significantly higher.[6]
  • Hemiarthroplasty is frequently less painful and requires fewer hospital stays than a full hip replacement.[7]

See Hip Replacement Complications

Physiotherapy[edit | edit source]

For a comprehensive guide see Total Hip Replacement, protocol the same.


References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Radiopedia Hemiarthroplasty Available from: https://radiopaedia.org/articles/hip-hemiarthroplasty(accessed 15.2.2021)
  2. ↑ Partial hip replacement, https://advancedortho.me/wp-content/uploads/2013/04/Partial-Hip-Replacement.pdf (accessed 6 April 2017)
  3. ↑ Bone smart Partial Hip Replacement Surgery Available from: https://bonesmart.org/hip/partial-hip-replacement-surgery/ (accessed 16.2.2021)
  4. ↑ Wise geek PHR Available from:https://www.wisegeek.com/what-is-a-partial-hip-replacement.htm (accessed 16.2.2021)
  5. ↑ Park C, Merchant I. Complications of total hip replacement. InTotal Hip Replacement-An Overview 2018 Nov 5. IntechOpen. Available:https:https://www.intechopen.com/chapters/61241 (accessed 14.12.2022)
  6. ↑ Dawson D, Milligan D, Callachand F, Cusick L. Hip hemi-arthroplasty vs total hip replacement for displaced intra-capsular hip fractures: retrospective age and sex matched cohort study. The Ulster Medical Journal. 2018 Jan;87(1):17.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849947/ (accessed 16.12.2022)
  7. ↑ brandonorthopaedics Hemiarthroplasty Vs Total Hip Replacement: Key Differences Available:https://www.brandonorthopedics.com/hemiarthroplasty-vs-total-hip-replacement-key-differences/ (accessed 16.12.2022)
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