What is it?
In the elderly, as the bones are fragile and because the blood supply to the head of the femur is precarious, fixation of neck femur fractures is not attempted.
Instead, the femoral head can be removed and replaced with an artificial piece, or prosthesis. This is suggested because fixing the fracture carries a high chance that you will need a second operation several months later if the femoral head dies due to AVN.
When the hip is fractured, the socket portion (the acetabulum) is usually not injured. If the articular cartilage of the hip socket is in good condition, the metal ball of the hemiarthroplasty prosthesis can glide against the cartilage without damaging the surface. This procedure is easier to do than replacing both the ball and the socket, and it allows patients to begin moving right away after surgery. Early movement helps prevent dangerous complications that come from being immobilized in bed.
A fracture of the hip in an aging adult is not simply a broken bone, it is a life-threatening illness.
Replacing the damaged section of hip with a hemiarthroplasty can quickly get the patient out of bed and moving to reduce the risk of complications.
What can be expected of a Bipolar hip replacement?
A Bipolar hip replacement will provide complete or nearly complete pain relief in 90 to 95 percent of patients. It will allow patients to carry out many normal activities of daily living.
| PATIENT EXPECTATIONS | SURGEON EXPECTATIONS |
| 100% pain relief | 90-100% pain relief |
| 100% normal walking pattern | Trace of limp to 100% normal walking pattern |
| Able to bend fully forwards | Bend to 90° at the hip |
| Able to sit in deep or low lounges and chairs | Never sit in deep lounges or chairs |
| Able to turn the leg fully "any which way" | Avoid internal rotation of the hip permanently |
| The hip will never dislocate | Occasional hips will dislocate |
| The hip will never get infected | Occasional hips will get infected |
What are the risks of hip replacement?
Bipolar hip replacement is a major operation. The effect of most complications is that you must stay in the hospital longer.
The most common complications are not directly related to the hip and usually do not affect the result of the operations. These complications include urinary tract infection, blood clots in the legs / lungs and cardio-vascular complications.
1. Infection
Infection can occur following any type of surgery. In order to minimize the potential for infection to occur at the time of surgery, antibiotics are given before surgery and for 1 to 2 days following the operation. Infection following bipolar hip replacement is of special concern because of the prosthetic components. The prosthetic components have no blood supply and this makes them susceptible to infection. If the prosthetic components become infected, additional surgery is almost always required in order to treat the infection.
The most common way that a hip replacement becomes infected is by spread of bacterial infection from another location in the body. Bacterial infections may be spread from the mouth because of a dental infection; from a urinary tract infection; as a result of pneumonia; from a skin infection; or even an in-grown toenail. It is very important that any bacterial infection be treated promptly in order to minimize the chance of spread to the hip replacement. It is also recommended that antibiotics be taken before any dental procedure. You should inform your dentist that you have a hip replacement. Similarly, antibiotics should be given if you are going to have any type of invasive procedure such as an endoscopy or bronchoscopy.
Viral infections, such as a cold or flu, do not infect hip replacements
2. Persistent Pain
While more than 90% of patients have complete or nearly complete relief of pain following hip replacement, there are some patients with some persistent pain. In many cases, the pain resolves with time. It should be recognized that there are many causes of pain and, rarely, patients can have pain even if the hip replacement is well-fixed and well-functioning.
3. Blood Vessels and Nerves
There are several major blood vessels and nerves around the hip. Rarely, a major blood vessel or nerve is injured during a hip replacement surgery.
4. Blood Clots
Blood clots can form in the large veins of the legs and pelvis following major surgery, such as total knee replacement. It is possible for such a clot to break loose from the vein and travel to the heart. The clot can pass through the heart and into the lungs. This is called a pulmonary embolus. Rarely, a pulmonary embolus is fatal. In order to prevent this from happening, blood thinners are prescribed post-operatively.
5. Dislocation
Just like your real hip, and artificial hip can dislocate (where the ball comes out of the socket). There is a greater risk just after surgery, before the tissues have healed around the new joint, but there is always a risk !
The doctor will instruct you very carefully how to avoid activities and positions which may have a tendency to cause a hip dislocation.
6. Fractures
As the patient’s bones are brittle, there can occur a fracture during insertion of the prosthesis (artificial hip). This may need some additional wiring of the thigh bone. Also this may necessitate delayed weight bearing and ambulation. Rarely, this may need an additional surgery.
7. Other Medical Complications
In a few patients, due to the advanced age & co-existing medical problems, there may be some medical complications like Hematemesis ( GI Bleed, etc), breathlessness, abdominal distension, confusional status etc. This may necessitate a stay in the ICU for monitoring & so on.
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