From the Guidelines
Total hip replacement is generally preferred over hemiarthroplasty for patients with unstable femoral neck fractures, as it may offer a functional benefit at the risk of increasing complications, according to the most recent guideline from 2022 1. The main difference between hemiarthroplasty and total hip replacement lies in the extent of the replacement: hemiarthroplasty replaces only the femoral head, while total hip replacement replaces both the femoral head and the acetabulum.
- Hemiarthroplasty is typically considered for elderly patients with limited mobility and lower functional demands, as it offers advantages such as shorter surgical time, less blood loss, and lower initial costs.
- Total hip replacement, on the other hand, is more suitable for younger, more active patients, or those with pre-existing arthritis affecting the acetabulum, as it provides better long-term outcomes with higher patient satisfaction and lower reoperation rates. Key factors to consider when deciding between these procedures include the patient's age, activity level, bone quality, life expectancy, and the condition of the acetabular cartilage, as emphasized in the 2022 guideline 1. In terms of specific patient subsets, total hip replacement may be more beneficial for patients with unstable femoral neck fractures who are likely to have higher functional demands, while hemiarthroplasty may be more suitable for those with lower functional demands and limited mobility. Ultimately, the choice between hemiarthroplasty and total hip replacement should be individualized based on the patient's unique needs and circumstances, taking into account the potential benefits and risks of each procedure, as recommended by the 2022 guideline 1.
From the Research
Difference between Hemiarthroplasty and Total Hip Replacement
- Hemiarthroplasty involves replacing only the femoral head with a prosthetic, while total hip replacement involves replacing both the femoral head and the acetabulum with prosthetics.
- Hemiarthroplasty is often used to treat fractures of the femoral neck, while total hip replacement is used to treat conditions such as osteoarthritis and rheumatoid arthritis.
Comparison of Outcomes
- A study published in 2010 2 found that there were no significant differences in functional outcomes, revision rates, or mortality between patients who underwent hemiarthroplasty and those who underwent total hip replacement for displaced intracapsular fracture of the femoral neck.
- However, the study found that patients who underwent total hip replacement had higher intra-operative blood loss and longer surgery times, and were more likely to experience dislocations.
Indications for Total Hip Replacement
- Total hip replacement is typically indicated for patients with advanced osteoarthritis of the hip, who have not responded to conservative treatment and have high subjective distress due to symptoms 3.
- Patients with rheumatoid arthritis may also be candidates for total hip replacement, although they may be at higher risk of complications such as revision, hip dislocation, and periprosthetic infection 4.
Patient Selection
- The decision to perform total hip replacement should be made jointly by the physician and patient, taking into account the patient's individual circumstances and expected treatment benefits and risks 3, 5.
- Patients should be well-informed about the risks and benefits of surgery, and should have realistic expectations about the outcomes of treatment.
Subset of Patients
- Hemiarthroplasty may be more suitable for older patients (aged 70 years and over) with fractures of the femoral neck, due to lower intra-operative blood loss and shorter surgery times 2.
- Total hip replacement may be more suitable for patients with advanced osteoarthritis or rheumatoid arthritis, who have not responded to conservative treatment and have high subjective distress due to symptoms 3, 4.