Partial Hip Replacement for Hip Fracture
The hip is one of the largest joints in the human body and is a ball-and-socket joint. The ball is the femoral head, which is the upper end of the femur (thighbone). The socket is formed by the acetabulum, which is part of the large pelvis bone. The bone surfaces of the ball and socket are covered with articular cartilage, a smooth, white connective tissue that enables the bones of a joint to easily glide over one another with very little friction allowing easy movement. The remaining surfaces of the hip joint are covered by the synovial membrane, which is a thin tissue lining that releases fluid that lubricates the cartilage, reducing the friction within the hip joint. Large ligaments (tough bands of tissues) connect the ball and the socket in order to stabilize the joint by preventing excessive movement.
When an individual has arthritis of the hip, the underlying bone develops spurs and irregularities which can cause severe pain and loss of motion. Depending on the severity of the damage in the hip joint, the physician my recommend a partial hip replacement (also referred to as hip hemiarthroplasty), which has the ability to relieve pain and restore normal function in patients whose hip joint has been significantly damaged by overuse or trauma. In this type of surgery, the femoral head of the damaged hip joint is replaced by man-made, prosthetic implants. Partial hip replacement surgery is done primarily to treat injuries rather than degenerative arthritis (which often lead to a total hip replacement surgery). Partial hip replacements are ideal for "broken hips" - occasions where a fracture that is difficult to mend develops in the femoral neck, but the socket is still strong. Partial hip replacements are only seldom recommended for elderly patients who are not very active.
Individuals who require a partial hip replacement surgery typically experience these symptoms:
- Persistent pain in the hip region that worsens with walking or bending
- Suspected fracture in the hip joint
- Limited or restricted range of motion or feeling that the hip is broken
Severe hip pain should not be ignored. Paying a visit to a physician is highly recommended if an individual experiences the symptoms mentioned above despite the use of pain medication.
The need for a partial hip replacement can be identified with a combination of physical examination as well as imaging studies. After gathering information about the individual's general health and the extent of his or her hip pain and how it affects their ability to perform day-to-day activities, the physician may examine the hip to assess the motion, stability, strength, and overall alignment of the hip joint. The physician may order X-rays to assess the extent of deformity or damage in the hip joint or an MRI scan to determine the condition of the tissues and bones of the hip and identify the fracture grade to determine if a partial hip replacement is necessary. The physician will educate you on the benefits from this surgery as well as what to expect post-operatively.
Hip fractures are divided into four different "grades":
Grade 1: Subtrochanteric
Grade 2: Intertrochanteric
Grade 3: Fractured Femoral Neck
Grade 4: Subcapital Fracture
Grade one, two, and three don't interfere with the joint, therefore can be mended with pins and nailing devices. Grade four is further divided into four types:
Type 1: Stable fracture with the bones being pressed together
Type 2: Complete fracture with the bone alignment undisturbed
Type 3: Complete fracture with displacement of the bone fragments, but there is some contact
Type 4: Compete fracture with total displacement of the fragments with no contact whatsoever
Types one, two, and three can be fixed with pins or nailing devices, but type four generally involves disruption of the blood supply to the femoral head and is highly unlikely to heal with the use of pins and nailing devices. Therefore, in this situation, a partial hip replacement or hemiarthroplasty is required. World Literature now supports a total hip replacement for younger, more active patients because of better outcome, decreased cost, and greater patient satisfaction.
A partial hip replacement entails replacement the ball of the femur with man-made prosthetic components. A partial hip replacement procedure takes anywhere between one hour to 90 minutes to complete and occurs in the following order:
- Entering the Joint - Depending on the approach and the physician, an incision is made near the front, side, or back of the hip and the muscles, tendons, and other tissues are moved away from the joint to expose the femoral head (ball) and acetabulum (socket). The hip is then positioned to expose or open up the joint.
- Removal of Femoral Head - During this step, the head and neck of the femoral head is removed.
- Femoral Channel Preparation - The channel inside the femur is then hollowed out in preparation for the femoral stem insertion.
- Femoral Placement - The femoral stem may be secured with the use of cement or is "press-fit" into the hollow center of the femur. A carefully fitted metal or ceramic ball is then secured to the top of the femoral stem.
- Rejoining the Hip Joint - The hip joint is then rejoined and the surrounding muscle and tissues are repaired back to position and the procedure is completed.
Recovery after a partial hip replacement or total hip replacement for hip fractures will depend heavily on how well the individual follows home care and precautions after the surgery. After a partial hip replacement surgery, there will be some pain, but the medical team will provide the proper medication to make the patient as comfortable as possible. Walking and hip movement will being soon after the surgery where a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Major part of the recovery process will occur at home where proper care must be taken in terms of wound care, diet, and activity as prescribed by the physician and physical therapist. Patients who have undergone partial hip replacement surgery generally resume normal activities three to six weeks post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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