hemiarthroplasty hip

1. ROLE OF HEMIARTHROPLASTY--HIP
Dr Uday Kumar
MS(Orth) DNB(Orth)
Sagar Hospitals
Sindhi Hospital
Chinmaya Hospital
Bangalore
6th September 2015
Asram MC
Eluru

2. 65 year old male ---active—
No co morbidities
Fall at home
Management?

3. 75 year old lady
Fall at home
Displaced
Osteoporotic
# neck femur
Management?

4. Hemi
Total

5. Displaced Fractures
ORIF
•ORIF is an option in elderly
•Complications
• Nonunion 10 -33%
• AVN 15 – 33%
•AVN related to displacement
•Early ORIF no benefit
• Loss of reduction / fixation failure 16%

6. Prosthetic replacement
Prosthesis
Hemiarthroplasty
AMP
Bipolar
THR
Cemented
Uncemented

7. Hemi-arthroplasty of hip
Absolute indications
•Patients over 65 yrs
•Fracture neck not satisfactorily reduced
• Loss of fixation after several weeks of
operation

8. •Pathological fracture
•Old undiagnosed fracture
•Neck # with complete dislocation
of head
Absolute indications

9. Relative indications
•Advanced physiological age with life
expectancy more than 10-15 yrs
•Parkinsonism, hemiplegia or other
neurological disease.

10. Contraindications
• Active sepsis
• Active young person
• Preexisting acetabular disease (e.g.,
rheumatoid arthritis)

11. Hemi associated with
Lower reoperation rate (6-18% vs. 20-36%)
Improved functional scores
Slightly increased short term mortality
Mathew –JBJS –2010
Matsen---CORR-2014

12. --allows faster full weight bearing
--It eliminates non-union
osteonecrosis
failure of fixation risks
(>20% to 30% of cases with ORIF
require secondary surgery).
Hemi-arthroplasty vs ORIF

13. Disadvantages
•Removal of anatomical head
•More extensive procedure
--greater blood loss
-A risk of acetabular erosion exists
in active individuals

14. Hemiarthroplasty
Unipolar vs. Bipolar
•Bipolar theoretical advantages
•Lower dislocation rate
•Less acetabular wear/ protrusio
•Less Pain
•More motion

15. •Bipolar
•Disadvantages
•Cost
•Dislocation often requires
open reduction
•Loss of motion interface
•Polyethylene wear/ osteolysis

16. Cochrane review 2010

17. Hemiarthroplasty
Cemented vs Uncemented

18. Hemiarthroplasty
Cemented vs. Non-cemented
• Conclusion:
• Cement gives better
results
• Function
• Mobility
• Implant Stability
• Pain
• Cost-effective
• risk of sudden cardiac
death
• Use cement with cautionn

19. Total hip replacement

20. THR versus hemiarthroplasty
• Studies have reported better functional results
compared with hemiarthroplasty
• It eliminates the potential for acetabular
erosion

21. Sierra, CORR, 2012

22. Disadvantages over hemiarthroplasty
Include a more extensive surgical procedure
Increased implant cost
Higher risk of prosthetic dislocation
THR versus hemiarthroplasty

23. ORIF vs. cemented bipolar hemi vs. THA
37% fixation failure (AVN/nonunion)
similar dislocation rate hemi vs. THA (3%)
ORIF 8X more likely to require revision surgery
than hemi
and 5X more likely than THA
Keating et al
OTA--2012

24. CONCLUSION
--Bipolar arthroplasty is better than ORIF
for fracture neck femur in patients
between 65 to 75 years.
-- Cemented modular bipolar hemiarthroplasty
has more advantages in
in osteoporotic fractures.
--Above 75 years bipolar arthoplasty is indicated