Hip hemiarthroplasty

Last revised by Henry Knipe on 28 Sep 2023

Hip hemiarthroplasty is an orthopedic procedure for the treatment of certain femoral neck fractures where the femoral head is removed and replaced. The prefix hemi (meaning half) refers to the fact that the prosthetic femoral head articulates with the native acetabulum.

Hemiarthroplasty is indicated for the surgical treatment of subcapital neck fractures that are displaced and at high risk of femoral head avascular necrosis, (Garden III and IV fractures) if treated with DHS internal fixation 1. As the procedure is quicker and far less morbid than internal fixation, hemiarthroplasty is also routinely used in older, less active and co-morbid patients who would not be good surgical candidates for total arthroplasty. In younger or more active patients, outcomes are better with total hip arthroplasty 1.

Hemiarthroplasty is generally performed via one of the following approaches 4:

  • direct lateral (Hardinge)

  • anterolateral (Watson-Jones)

  • transgluteal

  • posterior (Moore, Southern, and true posterior)

  • anterior (direct anterior, Smith-Peterson)

The femoral stem is inserted similarly to total hip arthroplasty and can be cemented or non-cemented. When cemented, a plastic medullary cavity plug may be used to stop the inferior migration of the cement. Many organizations worldwide recommend the cemented technique as standard 2,3. Cemented hemiarthroplasty have fewer prosthesis-related complications when compared to an uncemented hip prosthesis despite similar rates of mortality 4.

The prosthesis may be a bipolar hemiarthroplasty, which can be converted to a total hip arthroplasty in the future. The large prosthetic head can be removed and a smaller one attached to the femoral stem and an acetabular cup prosthesis is inserted. This is going out of fashion due to the added complication of osteolysis.

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