Surgical Procedure for Hip Replacement: Understanding Bipolar Hemiarthroplasty and Its Outcomes
In the realm of orthopedic surgery, bipolar hemiarthroplasty (BHA) stands as a popular treatment for femoral neck fractures, a type of hip fracture that accounts for nearly half of all hip fractures. This surgical procedure is particularly common among older adults, leading to up to 300,000 hospitalizations annually in the United States.
BHA is a less complicated procedure compared to total hip replacement (THR), boasting a shorter operative time and lower cost. The surgery involves making an incision along the outer aspect of the thigh, exposing the fractured site, removing the femoral head, hollowing out the inside of the femur, placing the metal stem of the prosthesis, attaching the artificial prosthetic head, checking the joint's stability and range of motion, and closing the incision.
After BHA surgery, individuals may be asked to sit or stand with support, walk with support within 4-5 days of the procedure, and take blood thinners to prevent deep vein thrombosis. People can usually resume their daily activities by about 6 weeks after BHA surgery, with physical therapy aiming to restore movement and expected joint function.
However, BHA poses potential risks including blood clots, infection, dislocation, injury to nerves or vessels, and mortality. The success rate of BHA for treating femoral neck fractures involves several outcomes such as reoperation (failure) rate, mortality, and implant survival. Reoperation rates with BHA are relatively high, often due to dislocation or mechanical complications, with about twice the odds compared to other treatments.
Mortality rates within 1 year remain elevated, particularly in older adults undergoing BHA, reflecting the frailty of this patient population. Regarding the average lifespan (survival) of the implant, typical radiographic and clinical follow-up in some studies averages around 8 months to several years, with some data showing up to 5 years of follow-up for survival and dislocation rates. Implant survival varies with patient factors, surgical technique, and prosthesis type, but long-term durability beyond 5 years in older adults is somewhat limited due to patient comorbidities and complications.
Recent research has shown that BHA can reduce the incidence of cerebrovascular accidents and improve early weight-bearing among older adults. Despite the risks, BHA is generally effective for older adults, making it the standard treatment for femoral neck fractures. THR might be preferable for active elderly adults due to its superiority for hip function and quality of life, but it has a longer operative time and a higher risk of dislocations.
As with any surgical procedure, it is essential for individuals undergoing BHA to follow postoperative precautions such as avoiding bending and twisting the hips, preventing the operated leg from crossing the midline, keeping the feet facing forward, using pillows to prevent leg crossing while sleeping, avoiding sitting on low chairs, and avoiding hip movements beyond 90 degrees when seated. After BHA surgery, individuals are required to stay in the hospital for a few days for recovery and physical therapy.
[1] Xu, X., et al. (2022). Bipolar hemiarthroplasty versus total hip arthroplasty for femoral neck fracture: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 17(1), 1-13. [2] Kanis, J. A., et al. (2008). The WHO Fracture Risk Assessment Tool (FRAX): development, validation, and application. Osteoporosis International, 19(10), 1479-1491. [3] Nguyen, C. T., et al. (2016). Mortality following hip fracture: a systematic review and meta-analysis. The Journal of Trauma and Acute Care Surgery, 81(2), 255-265. [4] Söderman, B., et al. (2010). Long-term follow-up of bipolar hemiarthroplasty for femoral neck fractures: a prospective study. The Journal of Bone and Joint Surgery, 92(10), 2187-2194.
- Joint procedures, such as bipolar hemiarthroplasty (BHA), are commonly used to treat hip pain caused by femoral neck fractures, which account for about half of all hip fractures.
- The success of BHA for treating femoral neck fractures can be measured by various factors, including reoperation rates, mortality, and implant survival, with reoperation rates being relatively high in some cases.
- Science and medical research continue to provide insights into treatment options, showing that BHA can reduce the incidence of cerebrovascular accidents and improve early weight-bearing among older adults.
- Chronic diseases like chronic kidney disease and other medical conditions may limit the long-term durability of implants beyond 5 years after BHA surgery in older adults.
- Fitness and exercise, along with therapies and treatments, are crucial for patients after BHA surgery to restore movement and expected joint function, with physical therapy often being required for up to 6 weeks.
