What is the step-by-step procedure for bipolar hemiarthroplasty in treating a fracture of the intracapsular neck of the femur?

From the Guidelines

Bipolar hemiarthroplasty for an intracapsular femoral neck fracture is a recommended procedure for elderly patients with limited mobility expectations, providing immediate stability and allowing early weight-bearing. The procedure involves replacing the femoral head with a prosthesis while preserving the acetabulum.

Step-by-Step Procedure:

• Patient positioning in lateral or supine position, followed by surgical site preparation and draping.
• A lateral or posterolateral approach is commonly used to access the hip joint.
• After incising the skin, subcutaneous tissue, and fascia lata, the surgeon identifies and protects the sciatic nerve, then splits the gluteus maximus fibers and externally rotates the leg to expose the short external rotators.
• These rotators are detached from the greater trochanter, and the hip capsule is incised to expose the femoral head.
• The fractured femoral head is removed, and the femoral neck is cut at the appropriate level using templates for guidance.
• The femoral canal is then prepared by sequential reaming and broaching to accommodate the prosthesis stem.
• Trial components are inserted to assess fit, stability, and leg length.
• Once sizing is confirmed, the definitive bipolar prosthesis is implanted, consisting of a femoral stem fixed with or without cement and a bipolar head that articulates with the native acetabulum.
• The hip is reduced, and stability is tested through range of motion.
• The surgical site is thoroughly irrigated, hemostasis is achieved, and the capsule, external rotators, fascia, and skin are closed in layers. This procedure is supported by recent evidence, including a study published in 2022 by the American Academy of Orthopaedic Surgeons 1, which recommends the use of cemented femoral stems in arthroplasty for the treatment of hip fractures in older adults. Additionally, a study published in 2012 by the Association of Anaesthetists of Great Britain and Ireland 1 notes that cemented arthroplasty improves hip function and is associated with lower residual pain postoperatively. However, it's essential to consider the patient's individual needs and comorbidities, as well as the potential risks and benefits of the procedure, as highlighted in a 2022 guideline by the American Academy of Orthopaedic Surgeons 1. Key considerations include:
• The patient's age and level of function
• The presence of underlying osteoarthritis
• The risk of complications associated with the procedure
• The potential benefits of alternative treatments, such as total hip arthroplasty.

From the Research

Procedure Overview

The procedure for bipolar hemiarthroplasty in treating a fracture of the intracapsular neck of the femur involves several steps:

• Preoperative preparation: The patient is prepared for surgery, which includes administering anesthesia and positioning the patient on the operating table.
• Incision and dissection: An incision is made in the skin and the fascia is dissected to expose the hip joint.
• Capsulotomy: The hip capsule is incised to access the femoral head and neck.
• Removal of the femoral head: The fractured femoral head is removed and the femoral neck is prepared for the implant.
• Implantation of the bipolar prosthesis: The bipolar prosthesis is implanted, consisting of a femoral stem and a bipolar head that articulates with the acetabulum.
• Closure: The incision is closed and the patient is taken to the recovery room.

Step-by-Step Procedure

The step-by-step procedure for bipolar hemiarthroplasty is as follows:

• Step 1: Preoperative preparation, including administration of anesthesia and positioning of the patient 2.
• Step 2: Incision and dissection to expose the hip joint, followed by capsulotomy to access the femoral head and neck 3.
• Step 3: Removal of the fractured femoral head and preparation of the femoral neck for the implant 4.
• Step 4: Implantation of the bipolar prosthesis, consisting of a femoral stem and a bipolar head that articulates with the acetabulum 5.
• Step 5: Closure of the incision and postoperative care, including pain management and physical therapy 6.

Key Considerations

Key considerations for the procedure include:

• The choice of prosthesis, with bipolar hemiarthroplasty being a common option for treating intracapsular neck of femur fractures in elderly patients 2, 3.
• The importance of proper implantation technique to ensure stable fixation and optimal outcomes 4, 5.
• The need for postoperative care and physical therapy to promote recovery and prevent complications 6.