ROLE OF HEMIARTHROPLASTY--HIP

Dr Uday Kumar MS(Orth) DNB(Orth) Sagar Hospitals Sindhi Hospital Chinmaya Hospital Bangalore

6th September 2015 Asram MC Eluru

65 year old male ---active—No co morbiditiesFall at home

Management?

75 year old ladyFall at home

DisplacedOsteoporotic# neck femur

Management?

Hemi

Total

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%

Prosthetic replacement

Prosthesis

HemiarthroplastyAMP

Bipolar

THR Cemented

Uncemented

Hemi-arthroplasty of hip

Absolute indications

• Patients over 65 yrs

• Fracture neck not satisfactorily reduced

• Loss of fixation after several weeks of operation

• Pathological fracture

• Old undiagnosed fracture • Neck # with complete dislocation of head

Absolute indications

Relative indications

• Advanced physiological age with life expectancy more than 10-15 yrs

• Parkinsonism, hemiplegia or other neurological disease.

Contraindications

• Active sepsis

• Active young person

• Preexisting acetabular disease (e.g.,

rheumatoid arthritis)

Hemi associated with

Lower reoperation rate (6-18% vs. 20-36%)

Improved functional scores

Slightly increased short term mortality

Mathew –JBJS –2010Matsen---CORR-2014

--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

Disadvantages

• Removal of anatomical head

• More extensive procedure --greater blood loss

-A risk of acetabular erosion exists in active individuals

HemiarthroplastyUnipolar vs. Bipolar

• Bipolar theoretical advantages• Lower dislocation rate• Less acetabular wear/ protrusio• Less Pain• More motion

• Bipolar• Disadvantages

• Cost• Dislocation often requires open reduction

• Loss of motion interface• Polyethylene wear/ osteolysis

Cochrane review 2010

HemiarthroplastyCemented vs Uncemented

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

Total hip replacement

THR versus hemiarthroplasty

• Studies have reported better functional results compared with hemiarthroplasty

• It eliminates the potential for acetabular erosion

Sierra, CORR, 2012

Disadvantages over hemiarthroplasty

Include a more extensive surgical procedure

Increased implant cost

Higher risk of prosthetic dislocation

THR versus hemiarthroplasty

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 alOTA--2012

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

Thank you