Partial Hip Replacement

Original Editor - Asma Alshehri

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

Introduction

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.

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).

Technique

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.

Most partial hip replacement surgeries can be performed in less than one hour in a hospital or surgical center. 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.

Second Xray Image: An A-P X-ray of a pelvis showing a total hip joint replacement. Contrast to xray 1 image.

Complications

• Infection
• Haematoma
• Non-union or malunion
• Implant failure
• Periprosthetic fracture
• Loosening
• Dislocation
• Osteolysis (in bipolar hemiarthroplasty)

Physiotherapy

The below is a brief outline. For a comprehensive guide see Total Hip Replacement as protocol are very similar.

Post Surgery

Moving around

As soon as possible teach client how to move without dislocating the hip ie "hip precautions" that must be followed. Most often, this means that client:

• Avoids twisting at the hips (keep shoulders, hips, knees, and feet facing forward).
• Do not let affected leg cross the center of your body toward the other leg eg in following situations
  • Do not cross your legs or feet.
  • Be very careful getting in or out of bed or a car. Make sure leg does not cross that imaginary line down the middle of the body.
  • Keep a pillow between your knees when you are lying down. When client on back, the pillow rests under the affected leg and on top of the other leg. This helps with turning onto side without twisting at the hips.

On the day of surgery or the day after

Educate and teach client

• Procedure for in out bed (help initially)
• Use of walker or crutches.
• Safe: sit down and stand up, dressing, use the toilet, shower and stairs.

After surgery client will probably be walking with crutches or a walker. You may be able to climb a few stairs and get in and out of bed and chairs.

Discharge

• Client will need someone to help you at home for the next few weeks. If client needs more extensive rehab, they may go to a specialized rehab centre for more treatment.
• Client will go home with a bandage and stitches, staples, tissue glue, or tape strips (removed when doctor allows). Stitches or staples, doctor removes 10 days to 3 weeks after surgery (Glue or tape strips will fall off on their own over time). Client may still have some mild pain and the area may be swollen for 3 to 4 months after surgery.
• Client continues the rehabilitation program (rehab) started in the hospital. The better rehab exercises performed, the sooner client will get strength and movement back. Most people are able to go back to work 4 weeks to 4 months after surgery.