Hip arthroplasty

Hemiarthroplasty involves replacing the femoral head with a prosthesis.

Total hip arthroplasty which involves replacement of both the femoral head and the acetabulum with prostheses.

Advocates of total hip arthroplasty believe patients have better functioning and quality of life as compared with hemiarthroplasty.

Treatment of displaced femoral neck fractures, the standard approach is hip arthroplasty with prosthetic joint replacement rather than fracture fixation.

A metanalysis of randomized controlled trial showed that implants fix with bone cement are associated with less postoperative pain and better mobility than the first generation of uncemented implants.

Injection of bone cement during surgery is associated with a drop in patient’s blood pressure and in rare cases cardiovascular collapse and death.

In a trial of 610 patients 60 years of age or older within intracapsular hip fracture, cemented hemiarthroplasty resulted in a modestly but significantly better quality of life and lower risk of periprosthetic fracture than uncemented hemiarthroplasty.

Fracture fixation is associated with high rates of non-unions-5-28%, and avascular necrosis-5-18% because of the tenuous blood supply of the proximal femur.

During hip arthroplasty the femoral stem fixation can be accomplished with cement, or with bony growth into a porous coated implant.

Most hemiarthroplasties  in the United States are not done with cement, as using cement increases the procedure time, and risks bone cement implantation syndrome.


In patients with hip fracture treated  with hemiarthroplasty  uncemented fixation compared with cemented fixational is associated with a significantly higher risk of aseptic revision (Okie K).

Total hip arthroplasty have a greater surgical morbidity than hemiarthroplasty and may increase the risk of dislocation, which leads often to a secondary procedure to reduce or revise the prosthesis.

In a randomized trial of total hip arthroplasty or hemiarthroplasty among elderly patients with displaced femoral neck fractures the incidence of secondary procedures did not differ between the two groups, and total hip arthroplasty provided clinically unimportant improvement over hemiarthroplasty in functioning quality of life over 24 months (HEALTH investigators).

Historically the majority of the femoral neck fractures have been treated with reduction and internal fixation, most current guidelines advocate arthroplasty for displaced fractures of the femoral neck in elderly patients.

30 day mortality about 0.1% and the risk is increased by male gender, older age, and a history of cardiorespiratory disease.

High-intensity statin therapy was associated with markedly reduced rates of knee and hip replacement surgery for osteoarthritis or rheumatoid arthritis in a longitudinal cohort study comparing nearly 180,000 statin users with an equal number of propensity-matched nonusers, Jie Wei, PhD.

The Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty trial: older patients with displaced femoral neck fracture.

Analysis of the above study showed that total hip arthroplasty resulted in modestly better function than hemiarthroplasty, with no significant differences in quality of life or mortality.

The anterior approach is reported to have the fastest recovery for hip replacement but may have higher rates of fracture and nerve injury.


An anterior surgical approach compared with a posterior lateral surgical approach is associated with a small but statistically significant increased risk of major surgical complications.

The lateral approach has the fewest dislocations, but a greater limp rate. 

The posterior approach is the most extensile but historically has resulted in a higher dislocation rate.

In a study of 1913 patients at a high-volume center of patients undergoing hip replacement operations using posterior, lateral, or interior approach resulted in no difference in complications at 30 days.

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