Partial Hip Replacement in HSR Layout

Partial Hip Replacement

Partial Hip Replacement/Hip hemiarthroplasty is an orthopaedic procedure, where only the femoral head is removed and replaced with a metal ball & stem keeping the natural acetabulum ( socket in the pelvis) intact and untouched.
The femoral stem is inserted into the hollow canal of the thigh bone (femur)and can be cemented or non-cemented. The acetabulum which is the socket is not interfered with as it is still in good condition. The metal ball (which corresponds to the removed femur head) is placed over the upper most part of femur stem like the ice cream scoop placed over cone. This ball can either be of ceramic also in some cases.

Indications :-
Neck of femur fracture in elderly individuals where fixation of the fracture is not possible or would fail.

Tumour of the upper part of femur bone – Fibrous Dysplasia, Aneurysmal bone cyst, Giant cell tumour (GCT)

Partial Hip vs Total Hip Replacement in Neck of Femur Fracture-

If the patient who has sustained neck or femur fracture belongs to an elderly age group (more than 60 years), follows a kind of active lifestyle, has good bone condition, and has less or no co-morbid conditions ( cardiac history, uncontrolled diabetes & hypertension, on treatment of cancer elsewhere in the body), then Total Hip Replacement is the choice of surgery. Or else Partial hip replacement comes into play.

Immediate mobilization with 100 per cent weight bearing from the very next day of neck or femur surgery operated by either partial or total Hip replacement ensures early recovery and return to routine activities of daily living.

When can Hip Replacement Surgery go wrong??

Although most total hip replacements are very successful, over time problems such as implant wear and loosening may occur which requires a revision procedure to replace the original components. Infection also sometimes plays a spoilsport.

Limb Length Discrepancy-

Proper pre-operative planning & good assessment skills are very much important in providing limb length of the operated side equal to that of the normal side.

Sciatic Nerve palsy & Foot drop-

As hip replacement surgery is done through a posterior approach, the sciatic nerve (the main nerve of your lower limb) is closely dealt with. Giving good respect to this nerve while dissection and throughout the procedure is very much essential so that it is very gently handled. Gross manipulation & mishandling of this nerve may lead to neuropraxia ( temporary palsy) and foot drop ( inability to lift the foot upward off the ground against gravity). Most of these cases recover well and become completely normal within 4-6 weeks of time until & unless this nerve is grossly damaged and severed.

Implant Loosening & Wear-

For a hip replacement to work properly over the years, an implant must remain firmly attached to the bone. During the initial surgery, the implant is either cemented to the bone or is firmly fixed to the bone with the help of natural fixation using Hydroxyapatite coated implants (HA-coated implants promote bone ingrowth and natural bony fixation). Over time, however, an implant may loosen from the underlying bone, causing the hip to become painful.

The cause of loosening is not always clear. High-impact activities, excessive body weight, and wear of the plastic spacer between the two metal components of the implant are a few factors that may contribute. Younger patients, when they undergo hip replacement, may “outlive” the life expectancy of their artificial hip due to their high activity level and may require revision hip replacement over time.

One of the hypotheses for this loosening is tiny particles which arise out of plastic liners over time may accumulate inside the joint and trigger the body’s immune system. Chemical mediators of this reaction can gradually lead to osteolysis ( destruction of bone around the implant) and loosening.

Infection –

Infection is a potential complication in any surgical procedure, including total hip replacement. If proper aseptic precautions are taken during skin preparation and surgery, chances of infection are very low. Unfortunately, even after taking strict precautions sometimes infection sets in due to the virtue of the patient’s immune factors. Infection may occur while you are in the hospital or after you go home. It may even occur years later. If an artificial joint becomes infected, it may become stiff and painful. The implant may begin to lose its attachment to the bone. Even if the implant remains properly fixed to the bone, pain, swelling, and drainage from the infection may make revision surgery necessary.

Instability-

Loosening of the implants and sometimes subsidence ( femur stem getting sunk into the canal of the thigh bone with time) leads to shortening of limb and lax hip joint without good stability.

Fractures-

Osteoporotic bones around the hip implant can sustain fractures due to falls. The plan of management here depends on the type & location of the fracture, the patient’s bone quality and the stability of the implant after fractures. Few cases can be managed with fixation of the fracture with a plate, whereas cases where the bone surrounding the implant is shattered and destroyed with implant loosening, need revision surgery with a larger revision knee component.

Stiffness-

Sometimes due to the development of extra scar tissue in and around the joint after surgery hip joint becomes very stiff and mobility gets hampered. Not following physiotherapy protocols in the initial weeks of surgery is one of the reasons for the development of scar tissue. Most of the cases of the stiff hip can be managed by physiotherapy, whereas few cases require revision surgery.

For the best orthopedic surgeon for hip replacement in HSR Layout, visit Dr. Akshay Shetty at Dr. Shetty’s Center of Orthopaedics. Dr. Shetty specializes in hip replacements and provides expert care for all your orthopedic needs.

Partial Hip Replacement in HSR Layout