Definition and Overview

Partial hip replacement surgery is a procedure that replaces half of the hip joint, specifically the ball of the femur (also known as the femoral head) with an artificial or prosthetic joint. The procedure, which is also known as hip hemiarthroplasty, is different from total hip replacement surgery, which replaces both the femoral head and the socket.

Who Should Undergo and Expected Results

Partial hip replacement surgery is performed on patients who suffer from problems affecting the ball of the hip joint. These problems, which can either be caused by certain medical conditions or traumatic injuries, include:

  • Arthritis of the hip, which can result in bone spurs and other bone irregularities

  • Bone degeneration

  • Fracture

When left untreated, the above conditions can cause persistent pain and restricted movement of the joint.

A partial hip replacement is more commonly used to treat traumatic hip injury and is often prescribed to elderly patients whose bones are more brittle and prone to fractures even with mild slips and falls. Meanwhile, degenerative conditions typically require a total hip replacement since both the ball and the socket have to be replaced in such cases.

A partial hip replacement is recommended based on the type or severity of the hip fracture.

  • Type 1 - A fracture where the bones are stable but are pressed together

  • Type 2 - A complete fracture but the bones are not displaced and remain aligned

  • Type 3 - A fracture wherein the two broken bone fragments are displaced but remain in contact with one another

  • Type 4 - A fracture wherein the two bone fragments are completely displaced and are not in contact

Grades 1 to 3 fractures usually don’t interfere with the joint and are often treated using nailing devices called pins. Grade 4 fractures, however, often require surgery as they often disrupt the blood supply to the femoral head. In such cases, a partial hip replacement procedure is highly recommended.

Following the procedure, patients can expect complete relief from pain. They will also be able to carry out normal hip and leg movements as well as resume normal activities.

How is the Procedure Performed?

A partial hip replacement, which takes between 60 and 90 minutes, aims to remove the broken femoral head, trim the fractured end of the joint, and insert a one-piece prosthetic joint.

After making an incision in front of the hip or along the side, the surgeon moves the muscles and tendons away from the joint to access the hip socket and the femoral head.

The surgeon then uses special instruments to remove the head and neck of the femur before preparing the femoral stem for the placement of the artificial ball. The ball is then put in place and the hip joint reconnected. The surrounding tissues, such as the muscles and tendons, are returned to their normal positions and the incision is sutured closed.

This procedure is performed under regional or general anaesthesia with patients usually placed on IV pain medications after surgery. They are also given other medications to prevent infection immediately after the procedure. A cushion is placed between their legs to keep the hip in the right position and a urinary catheter is used so they can empty their bladder without having to move or get up. Compression stockings are also used to lower the risk of developing blood clots in their legs.

The total partial hip replacement recovery time depends on how well the patient follows the surgeon's post-operative care instructions. There are several partial hip replacement precautions to consider following the procedure, such as proper wound care, a healthy diet, and proper hip movements. Patients should undergo partial hip replacement rehab to strengthen their legs and restore proper hip movement to minimise their risk of future injuries.

Physical rehabilitation will also involve teaching the patient how to safely sit down, stand up, get dressed, bathe, walk up the stairs, and use the toilet. They may need walking aids such as crutches or a walker for the first few weeks following surgery.

Partial hip replacement surgery recovery may take three to six weeks, after which patients can resume their normal activities. However, partial hip replacement recovery in elderly may take as long as six months.

Possible Risks and Complications

In some cases, a total hip replacement is considered more beneficial than a partial hip replacement due to certain risks. For example, in a young patient whose socket is healthy, the use of a prosthetic femoral head may wear away the bone at the base of the socket. This may cause some problems with young, active patients. Thus, it is sometimes to their best interest that total hip replacement surgery is performed instead of hemiarthroplasty.

There are also other situations in which orthopaedic surgeons prescribe a total hip replacement rather than a partial hip replacement. This is true for when the patient has:

  • A bone cyst in the femur

  • A thin bone in the socket

  • Another fracture around the hip joint

Meanwhile, potential complications associated with partial hip replacement surgery include:

  • Dislocation

  • Infection

  • Loose implants

It is also normal for patients to experience postoperative pain during their partial hip replacement recovery. However, if the pain is progressively getting worse, they are advised to consult their doctor right away.

References:

  • “Partial hip replacement.” Advanced Orthopaedics. https://advancedortho.me/wp-content/uploads/2013/04/Partial-Hip-Replacement.pdf

  • “Partial hip replacement.” University of Wisconsin, School of Medicine and Public Health. http://www.uwhealth.org/health/topic/surgicaldetail/partial-hip-replacement/abr6036.html

  • Amit K, Yaron B, Alexander L, Rostislav N, David R. “Functional outcome after partial hip replacement for femoral neck fracture (subcapital fracture) with Austin Moore prosthesis.” Journal of Trauma and Treatment. https://www.omicsgroup.org/journals/functional-outcome-after-partial-hip-replacement-for-femoral-neck-fracture-subcapital-fracture-with-austin-moore-prosthesis-2167-1222.1000188.php?aid=26160

  • Nerurkar AA, Panse JB, Sancheti KH, Joshi R, Shyam A, Sancheti P. “Surgical and functional outcomes of conversion total hip replacement after a partial hip replacement.” Journal of Medical Thesis. 2016 January 10. Vol. 4 (1): Jan-Apr 2016. http://journalmedicalthesis.com/2016/01/surgical-and-functional-outcomes-of-conversion-total-hip-replacement-after-a-partial-hip-replacement/

  • Ashman B, Cruikshank D, Moran M. “Total hip replacement: Relieving pain and restoring function.” BCMJ 2016 November. Vol. 58 (9): 505-513. http://www.bcmj.org/articles/total-hip-replacement-relieving-pain-and-restoring-function

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