A hemiarthroplasty is a partial hip replacement in which the ball of the hip joint (femoral head) is replaced with a metal implant, while the natural socket is preserved. It is most commonly performed for displaced neck of femur fractures in older patients.
An incision is made over the side or back of the hip. The broken femoral head is removed and replaced with a smooth metal ball on a stem, which is inserted into the thighbone. The natural socket is left in place. The components may be cemented or uncemented. The operation usually takes approximately one hour.
Hemiarthroplasty is the standard treatment for displaced intracapsular hip fractures (fractures across the neck of the femur) in older, less active patients. It allows early mobilisation and return to walking. For more active or younger patients, a total hip replacement may be preferred.
Non-operative management of displaced hip fractures is rarely appropriate as it usually leads to prolonged immobility, severe pain, and high complication rates. In very rare cases where a patient is too unwell for surgery, palliative management may be discussed.
Hip fracture surgery is usually performed within 36 hours of admission. Rapid pre-operative assessment is performed including blood tests, heart tracing, and chest X-ray. Optimisation of medical conditions is important.
The aim is to relieve fracture pain, allow early mobilisation, and restore independence. Most patients can walk with support within a day or two of surgery. The procedure is well-established with predictable outcomes.
Many patients do not return to their pre-fracture level of mobility. This reflects the overall frailty associated with hip fractures.
Expected around the hip in the early weeks.
Risk is present despite preventive measures.
Confusion is common in older patients after surgery, particularly those with existing cognitive impairment.
The hip may dislocate, particularly in the early weeks. Precautions help reduce this risk.
Approximately 1–2%. May require further surgery.
Chest infection, heart problems, kidney injury, and other medical complications are more common in frail elderly patients.
The metal ball may gradually wear the natural socket over time, potentially requiring conversion to a total hip replacement in the future.
Fracture around the implant.
Usually performed under spinal anaesthesia, which avoids the risks of general anaesthesia in elderly patients. General anaesthesia is used when spinal is not suitable. The anaesthetist will discuss options with you and your family.
Mobilisation with a physiotherapist begins on the day of or day after surgery. Most patients walk with a frame initially, progressing to a stick. Hospital stays vary from a few days to several weeks depending on overall health and recovery. Many patients benefit from ongoing rehabilitation, either in hospital or in a community setting.
Follow-up is arranged at six weeks with an X-ray. Ongoing support from rehabilitation services as needed.
In less active older patients, a hemiarthroplasty is quicker, simpler, and has a lower dislocation rate. For more active patients with a longer life expectancy, a total hip replacement may be recommended.
This varies widely. Some patients go home within a few days; others need several weeks of rehabilitation. The team will keep you informed.
Most patients who were walking before the fracture will walk again, though often with more support than before. Early mobilisation and rehabilitation are key.