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partial hip replacement

PARTIAL HIP REPLACEMENT

partial Hip Replacement for fracture OVERVIEW

Partial hip replacement, also called hip hemiarthroplasty, is a surgical procedure where only the femoral head (the ball) of the damaged hip joint is replaced. The acetabulum (the socket) is not replaced. Basically, a partial hip replacement (hemiarthroplasty) is performed to treat femoral neck fractures which are a type of hip fracture. During a partial hip replacement, only the head of the femur (thigh bone) is replaced and the new prosthetic head rotates in the body’s own natural hip socket. The ceramic or metal ball is attached to a metal stem. This is called a hip implant. The stem is set down into the core of the thighbone (femur).

By comparison, a Total Hip Replacement involves replacing the femoral head and resurfacing the socket. With this procedure, the prosthetic femoral head moves within the prosthetic socket. Total hip replacements most often are performed when there is cartilage damage on both the femoral head and within the socket, which occurs from degenerative osteoarthritis of the hip. There is, however, an increasing trend to treat some hip fractures with total hip replacements.

basic hip anatomy

The hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement. Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.
hip anatomy diagram
Usually, patients who are considered good candidates for partial hip replacement have no underlying hip arthritis and have healthy acetabular cartilage. This is often the case for someone who has fractured the femoral neck after a fall but did not have troublesome hip symptoms or hip arthritis prior to their injury.

types of hip fractures

Hip fractures most commonly occur from a fall or from a direct blow to the side of the hip. Some medical conditions such as osteoporosis, cancer, or stress injuries can weaken the bone and make the hip more susceptible to breaking. In severe cases, it is possible for the hip to break with the patient merely standing on the leg and twisting. Osteoporosis is the most common bone disease. Osteoporosis is characterized by progressive bone loss that leads to brittle, thin and weak bones. The term osteoporosis (AH-stee-oh-por-OH-sis) literally means “porous bone”. In the United States, more than 53 million people either already have or are at high risk of developing osteoporosis. Half of all women and a quarter of all men over the age of 50 years will suffer a bone fracture caused by osteoporosis during their lifetime. Osteoporosis will contribute to an estimated 2 million bone fractures this year, and the National Osteoporosis Foundation estimates that number will increase to over 3 million by the year 2025. Osteoporosis is a disease that can be prevented and treated.

Basically there are four different categories or “grades” of fracture. Grades 1, 2 and 3 – subtrochanteric, intertrochanteric and fractured neck – don’t interfere with the joint at all and will generally be repaired with pins or nailing devices. Grade 4 – subcapital fracture – is graded into four “types”, according to the amount of displacement at the fracture site. Type 1 is a stable fracture with impaction, meaning the bones are pressed together. Type 2 is complete but non-displaced, meaning the bones remain aligned as they were pre-fracture. Type 3 is displaced but the two bone fragments have some contact with one another. Type 4 is completely displaced and there is no contact between the fracture fragments. Types 1, 2 and 3 can be fixed with pins or a nailing device. Type 4 will involve disruption of the blood supply to the femoral head with early bone death. This fracture is highly unlikely to heal if it is pinned like the other categories. In this situation, partial hip replacement or hemiathroplasty is required. Again, hemiarthroplasty simply involves removing the broken femoral head, trimming the fractured end of the neck and inserting a one piece prosthesis of stem and ball. The socket or acetabulum is never interfered with as it is still in very good condition.
femoral neck fracture classification diagram

symptoms of hip fracture

The patient with a hip fracture will have pain over the outer upper thigh or in the groin. There will be significant discomfort with any attempt to flex or rotate the hip. If the bone has been weakened by disease (such as a stress injury or cancer), the patient may notice aching in the groin or thigh area for a period of time before the break. If the bone is completely broken, the leg may appear to be shorter than the non-injured leg. The patient will often hold the injured leg in a still position with the foot and knee turned outward (external rotation).

partial vs. total hip replacement for fracture

Because younger people can sometimes suffer a Type 4 subcapital fracture, a hemiarthroplasty is not normally used 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. For this reason, certain patients – young patients and also very able and active older patients – may have a total hip replacement performed as an emergency procedure, rather than a partial hip replacement.Even in the event of this type of hip fracture, a partial hip replacement is only recommended on occasion and generally only when the patient is elderly and in poor health.

Usually, patients who are considered good candidates for partial hip replacement have no underlying hip arthritis and have healthy acetabular cartilage. This is often the case for someone who has fractured the femoral neck after a fall but did not have troublesome hip symptoms or hip arthritis prior to their injury.

For a variety of reasons, your surgeon may decide it is more suitable to treat your fractured hip with a total hip replacement rather than a partial hip replacement, even if you have no evidence of osteoarthritis. Your surgeon may feel a total hip replacement would be in your best interest if you have other conditions, such as thin bone in the socket, a bone cyst in the femur or pelvis, or an additional fracture elsewhere around your hip joint. As with any orthopedic surgery and, certainly, with any hip replacement surgery, patients are best-advised to speak with an experienced, board-certified orthopedic surgeon about all available surgical and conservative options. He or she will give you a recommendation based upon your specific circumstances and their history and familiarity with certain implants and procedures.

Partial hip replacement animation by Understand.com

A partial hip replacement removes and replaces the ball of the hip joint. It does not replace the socket. This surgery is most often done to repair certain types of hip fractures.The ceramic or metal ball is attached to a metal stem. This is called a hip implant. The stem is set down into the core of the thighbone (femur).

hip replacement recovery

The success of your surgery will depend in large measure on how well you follow your orthopedic surgeon's instructions regarding home care during the first few weeks after surgery. You may have stitches or staples running along your wound or a suture beneath your skin. The stitches or staples will be removed approximately 2 weeks after surgery.Avoid getting the wound wet until it has thoroughly sealed and dried. You may continue to bandage the wound to prevent irritation from clothing or support stockings. Some loss of appetite is common for several weeks after surgery. A balanced diet, often with an iron supplement, is important to promote proper tissue healing and restore muscle strength. Be sure to drink plenty of fluids. The majority of people who undergo total hip replacement are able to participate in a majority of their daily activities by six weeks. By three months, most people have regained much the endurance and strength lost around the time of surgery, and can participate in daily activities without restriction. While daily activities have resumed, it is important to avoid high impact activities to give you the best long-term outcome with your hip.
Most surgeons and hospitals today emphasize getting you out of bed quickly. Most people are walking with the assistance of a walker on the day after surgery. Early ambulation has been shown to reduce the risk of a post-operative blood clot and is an important part of your recovery. Progression to using a cane or nothing at all typically occurs within the first month or two after surgery and depends on each individual’s progress. Despite the rapid progression to moving without assistance, it is typically not recommended that you return to sporting activities until the third month after surgery. Most surgeons allow patients to drive at four to six weeks after surgery, and sometimes sooner if the operative leg is the left leg. There is some literature that states that your reaction time will not be back to normal prior to six weeks. You should not drive while on narcotics, and should discuss returning to driving with your operating surgeon. Returning to work is highly dependent on your general health, activity level and demands of your job. If you have a sedentary job, such as computer work, you can expect to return to work in four to six weeks. If you have a more demanding job that requires lifting, walking, or travel, you may need up to three months for full recovery.

physical therapy and recovery following hip replacement

Initially, you will receive some physical therapy while in the hospital. Depending on your preoperative conditioning and support, you may or may not need additional therapy as an outpatient. Much of the therapy after hip replacement is walking with general stretching and thigh muscle strengthening, which you can do on your own without the assistance of a physical therapist. To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement.Prior to discharge from the hospital, your surgeon and physical therapist will provide you with any specific precautions you should follow.

To assure proper recovery and prevent dislocation of the prosthesis, you may be asked to take special precautions when sitting, bending, or sleeping — usually for the first 6 weeks after surgery. These precautions will vary from patient to patient, depending on the surgical approach your surgeon used to perform your hip replacement.Prior to discharge from the hospital, your surgeon and physical therapist will provide you with any specific precautions you should follow.

You may feel some numbness in the skin around your incision. You also may feel some stiffness, particularly with excessive bending. These differences often diminish with time, and most patients find these are minor compared with the pain and limited function they experienced prior to surgery.Your new hip may activate metal detectors required for security in airports and some buildings. Tell the security agent about your hip replacement if the alarm is activated. You may ask your orthopedic surgeon for a card confirming that you have an artificial hip.

follow-up and precautions following hip replacement

Patients may be encouraged to get out of bed on the day following surgery with the assistance of a physical therapist. The amount of weight that is allowed to be placed on the injured leg will be determined by the surgeon and is generally a function of the type of fracture and repair (fixation).The physical therapist will work with the patient to help regain strength and the ability to walk. This process may take up to three months.

It is important to follow up with your surgeon after your joint replacement. In most cases, joint replacements last for many years. You need to meet with your treating doctor after surgery to ensure that your replacement is continuing to function well. In some cases, the replaced parts can start to wear out or loosen.The frequency of required follow up visits is dependent on many factors including the age of the patient, the demand levels placed on the joint, and the type of replacement. Your physician will consider all these factors and tailor a follow-up schedule to meet your needs.In general seeing your surgeon every three to five years is recommended.

Source: American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/; American Association of Hip and Knee Surgeons, https://hipknee.aahks.org/total-hip-replacement/; BoneSmart, https://bonesmart.org/hip/partial-hip-replacement-surgery/
Cory Calendine, MD is an Orthopedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.
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