Hemiarthroplasty literally means “half of a hip replacement”.  In this case, the fracture occurs across the neck of the femur and the best way to treat the problem is to remove the fractured femoral and replace it with a new one.  This type of surgery allows the patient to put full weight on the operated leg immediately afterwards and because there is no fracture that needs to heal, we are not expecting osteoporotic bone to complete the difficult process of fracture healing.  This type of surgical procedure has proven to be the best treatment for significantly displaced fractures in elderly patients.  When the two parts of the fracture are clearly separated from each other (what the surgeons refer to as “displaced”) it is almost certain that the blood vessels that supply the femoral had have been torn or a kinked.  In this situation, even if the bone are realigned, the hip fracture will often not heal and the patient will develop a condition known as avascular necrosis, wherein the head of the femur dies because of a lack of blood supply.  This causes persistent pain, a limp, and needs more surgery in the future.

For example, here are the pre-operative xrays of an elderly patient who fell and fractured the left hip.  In comparison to the right side, the head of the left femur is displaced inferiorly as the result of a fracture through the femoral neck.

hemiarthroplasty  femur fracture hemiarthroplasty  femoral-neck-fracture

In this case the patient was taken to the operating room and a variation of the surgical approach for a direct anterior minimally invasive total hip arthroplasty was used to removed the fracture head and replace it with a new prosthetic femoral head.  In this case the stem of the femur is made of titanium and the head of the femur is called a “bipolar” component which is made of both medical grade stainless steel and ultra-high weight polyethylene.

hip surgery position  sterile hip surgery  hip surgeon  hip surgery incision

Here are a series of images from a hemiarthroplasty operation.  First the patient is positioned on their side.  Next a sterile surgical drape is established around the hip.  The hip is accessed by an incision made over the anterior-lateral side of the joint.  The fourth picture demonstrates the incision that is closed with surgical staples on the side of the hip.  Once the operation has been completed, this is what the xray looks like in the post anesthesia care unit.  This patient can be seen by physical therapy on the day after the operation, assisted out of bed, allowed to put full weight on the leg, and immediately begin the process of rehabiliation.


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