What is partial hip replacement?
Partial hip replacement—usually called hemiarthroplasty—replaces the broken femoral head and neck with a stem and ball while keeping the patient’s natural acetabular socket. In contrast, total hip replacement also places a cup and liner in the socket.
This operation is most often used after a displaced intracapsular femoral-neck fracture in an older adult. It should not be confused with partial knee replacement, and it is not usually the standard elective operation for widespread hip arthritis.
The operation is only one part of care. Pain control, delirium prevention, nutrition, osteoporosis assessment, fall prevention, medical optimisation and early rehabilitation are all important.
Who may be considered?
NICE and AAOS guidance support replacement arthroplasty for displaced intracapsular hip fractures in suitable older adults. Choosing between hemiarthroplasty and total hip replacement depends on the fracture pattern, pre-fracture walking ability, expected independence, cognition, medical fitness, life expectancy and dislocation risk.
When may total replacement be considered instead?
NICE advises considering total replacement for people who previously walked independently outdoors with no more than a stick, do not have a condition making the procedure unsuitable and are expected to remain independently active beyond two years. That does not make total replacement automatically better; hemiarthroplasty is a less complex operation and may fit patients whose health, function or expected benefit favours the smaller reconstruction.
Information needed quickly
The treating team needs the fracture X-rays, time of injury, pre-fracture mobility, living arrangements, cognition, medication—including blood thinners—and major heart, lung, kidney or neurological conditions. Surgery is commonly targeted promptly after admission once correctable medical problems have been addressed.
Key points for this treatment
How the operation works
Under spinal or general anaesthesia, the surgeon removes the fractured femoral head and prepares the upper femur for a stem. A metal or ceramic ball is attached to the stem and moves against the natural socket. For older adults with a displaced femoral-neck fracture, AAOS guidance supports cemented femoral fixation because it is associated with better patient-reported outcomes and a lower risk of a further fracture around the implant.
The operation may use an anterior, lateral or posterior route. Approach, head design and fixation must be selected by the treating team; the label “partial” does not mean risk-free or minor surgery.
When the plan can change
Unexpected socket damage, fracture anatomy, implant stability or other findings can alter the plan. The consent discussion should explain whether conversion to total replacement or additional fixation could be required.
Recovery after fracture surgery
The aim is usually to allow early weight bearing and mobilisation, but the surgeon’s instructions take priority. A multidisciplinary team may include orthopaedics, geriatric medicine, anaesthesia, nursing, physiotherapy, occupational therapy, dietetics and fracture-liaison services.
Recovery reflects both the operation and the original fracture. Some people do not regain their previous strength or independence. International transfer after an acute fracture requires medical clearance, reliable assistance and an agreed handover plan.
Risks and warning signs
Risks include infection, blood clots, bleeding, delirium, chest or urinary infection, pressure injury, dislocation, fracture around the implant, nerve or blood-vessel injury, leg-length difference, socket wear and later loosening. Frailty and existing disease can add substantial medical risk.
Breathlessness, chest pain, fever, wound drainage, increasing calf swelling, a sudden painful change in hip position, a fall or new inability to stand needs urgent medical review.