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Hemiarthroplasty of hip

If you are considering having hemi-arthroplasty to treat a fractured neck of femur, or have an operation planned, it is important to know all you can about it. This includes:

 

  • why you need this operation

  • what it will be like

  • how it will affect you

  • what risks are involved

  • any alternatives.

 

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your choices of treatment for a fractured neck of femur with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

You have broken the upper end of your thighbone close to your hip joint. A break is also called a fracture. There is no difference in severity between a fractured bone and a broken bone. The upper end of the thighbone is called the neck of femur. Therefore your injury may be referred to as a fractured neck of femur.

Hemiarthroplasty

 

What is the neck of femur?

The hip joint is a ball and socket joint. The socket part is formed by a cup in the pelvis, called the acetabulum. The ball part of the joint is the head of the thighbone, called the head of femur. The top part of the thighbone, just below the head, is called the neck of the femur.

 

Your break is just below the ball, on the neck of the femur. The fracture is within the hip joint cavity. Your break is close to, but just outside your hip joint.

 

What has gone wrong?

Your thighbone has broken close to the hip, probably due to a fall. Most patients who suffer this fracture have thinning of the bones (osteoporosis). The bone was probably very weak due to osteoporosis. A fall can lead to the bone breaking. Alternatively the bone can break, resulting in the fall.

 

The fracture has disrupted the blood supply to the ball of the hip joint (head of femur). Even if your fracture healed, the head of the femur will just crumble away due to lack of blood. Therefore, the ball of the hip joint has to be replaced. You need an operation to take out the head of the femur and replace it with an artificial head.

Hemiarthroplasty 2

The aims

The aim is to replace the ball of your hip joint (head of femur) with an artificial metal ball. This replaces half the hip joint, not the socket of the pelvis. This is called a hemi-arthroplasty.

 

The benefits

The operation will stop your leg hurting. If you were able to walk prior to the fracture, you should be able to walk after your operation. You can put weight on your leg immediately.

 

Are there any alternatives?

If you are fit enough for surgery there are no real alternatives to having this operation.

 

A smaller operation just to screw the fracture together may be possible. The fracture may be further down the neck of the femur than normal, so there might be enough blood running to the head for healing.

 

Replacing the socket of the hip joint (acetabulum), as well as the head of the femur, may be needed if the joint is already very worn. This is called a total hip replacement or THR for short.

 

These options are only considered in the minority of patients.

 

If you are not fit enough for surgery, we can treat you without surgery. This will mean bed rest and traction. Traction means using a splint that pulls on the femur to keep it in place in the hope of the fracture healing over 2 months or so.

 

What if you do nothing?  

If you do not have an operation you may suffer one of the serious complications that results from staying in bed for a long time. These complications include pressure sores, pneumonia and deep vein thrombosis (blood clots in the legs). These complications can be fatal.

 

Without an operation your hip joint would not be normal and although the pain may go, your leg would be shorter and your walking would be poor.

 

Who should have it done?

If your hip is broken and you are fit enough for surgery, you ought to have an operation.

 

Who should not have it done?

If you suffer from major medical problems, these should be sorted out before you have the operation. These problems include irregular heart rhythms and breathing problems.

 

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.

© Dumas Ltd 2006

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