At the beginning of the 20th century, hip injuries were often treated with immobilization or bed rest, but this led to serious complications such as clots or ulcers. Famed surgeon Ortho Austin Moore introduced the first hip prosthesis in 1940 to stabilize femoral neck fractures, and it was the first partial metal implant (Austin-Moore prosthesis).
Partial hip replacement accounts for about 30–40% of hip replacements, and most patients undergoing partial hip replacement are over 65 years of age, with success rates of more than 90%.
What is a partial hip replacement?
A partial hip replacement is similar to a total hip replacement in that it involves replacing the damaged parts of the hip joint with parts made of metal, plastic or ceramic, and may be recommended by a surgeon if the socket area of the hip joint is still intact and the damage or disease is limited only to the ball-shaped femoral head at the top of the thighbone. A total hip replacement replaces both the head and neck of the femur as well as the acetabulum, while a partial hip replacement replaces only the head and neck of the femur, leaving the acetabulum intact, offering a shorter surgical time and less risk compared to a total one.
Partial joint replacement is a less complex procedure that generally gives satisfactory results for less active older patients. This surgery is often used to repair hip fractures and is a good option when the hip socket is still functional and intact, and there is no need for a total joint replacement. Partial hip replacement can be performed using a minimally invasive technique, which means only small incisions are needed.
The reported outcomes of total hip replacement in femoral neck fractures are improving, and for this reason, it is increasingly favored in displaced fractures, especially in more active elderly patients, and is also recommended for patients with pre-existing osteoarthritis in the hip joint.
Materials used in the artificial joint head (metal, ceramic)
Artificial hip joints are usually made from a combination of metal (titanium or cobalt), ceramic, or plastic (polyethylene) materials. Types of partial hip replacement materials include the following:
- Metal-on-plastic: This type, known as metal-on-polyethylene, is the most common, with the femoral head made of metal and the socket made of plastic (polyethylene). The main advantage of this type is that it is easy to manufacture and has a long shelf life. Although technological advances have reduced the risks, one potential disadvantage is an immunological reaction caused by particles from friction.
- Ceramic-on-plastic: In this type, the head of the joint is made of ceramic, and the socket is made of polyethylene. It is usually used for people who are allergic to metal components, and as with the previous type, plastic particles can cause an immune reaction. This type is also preferred for younger patients due to its durability, making it suitable for an active lifestyle.
- Ceramic-on-ceramic: In this type, the ball is made of ceramic, and the cavity is also lined with ceramic. Its advantage is that it is less likely to interact with the body compared to other types, but its disadvantage is that it may make a “squeaky” sound when moving, and in rare cases, the ceramic may break.
How is partial hip replacement surgery performed?
Before undergoing hip replacement surgery, the doctor will talk about what you can do to prepare for the surgery, this may include tips such as stopping smoking, eating a healthy diet, and exercising before and after the surgery, the doctor may order a blood test, x-rays, urinalysis to detect infections, and an electrocardiogram (ECG) to check the health of the heart. The patient will receive either local anesthesia in the spine or general anesthesia, and the type of surgery performed usually depends on factors such as the extent of the hip joint damage, the cause of the damage, and the patient’s overall health status.
The procedure involves replacing the femoral head with an artificial implant made of a strong, polished metal or ceramic material. The original socket in the hip joint, known as the acetabulum, remains unchanged, and the femoral stem is inserted in a similar manner to that used in total hip replacement surgery and can be cemented or uncemented.
Life expectancy of an artificial joint
It is common to last from 10-20 years, and may reach up to 25 years in 50-60% of patients, but this depends on the age of the patient who underwent surgery and the type of hip joint used, as the duration of the artificial hip joint depends on several factors, including:
- Patient’s age at the time of surgery
- The patient’s general health status before the procedure
- How active the patient wants to be after surgery
- Type of material used to manufacture the artificial joint
Because younger patients are more active, their hip joint is subjected to more stress than older patients, which can affect their longevity.
Difference between cemented and uncemented joint stabilization
These two partial hip replacement techniques differ in the way the artificial joint is attached to the remaining natural bone, and here is a simple explanation of each method:
Partial hip replacement using cement: The surgeon uses a special bone cement to fix the artificial joint to the surface of the bone. This cement becomes a paste-like substance that acts as a medium between the artificial joint and the bone, and the fixation ability becomes strong and secure. This method is characterized by immediate and fast fixation, allowing you to start walking and weight-bearing earlier and is suitable for quick recovery, but the cement becomes less flexible over time, and the best candidates for this type of replacement are the elderly, those with limited mobility and activity, or those suffering from osteoporosis.
Cementless partial hip replacement: The artificial joint is designed with a micro-porous surface that contains small protrusions, and this surface allows natural bone to grow around and within it, forming a kind of “natural interlocking” between the joint and the bone. This technique has the advantage of providing a natural fusion between bone and joint and minimizing the risk of infection or cement breakage, but it takes longer for the joint to stay in place (3 months or more), and the best candidates for this replacement are young, active adults or people who do not suffer from osteoporosis.
Why is a partial hip replacement preferred in some instances?
Partial hip replacement is often performed in elderly patients with multiple diseases and limited mobility. This surgery takes less time and involves less blood loss compared to total hip replacement surgery. Partial hip replacement surgery usually takes only about an hour. Because the duration of the surgery is shorter, there may be fewer complications associated with major surgeries such as hip replacement.
Partial hip replacement involves replacing only the damaged part of the hip joint, usually the femoral head, while preserving the socket (acetabulum), which preserves the soft tissues next to the thigh, speeds recovery, reduces the risk of dislocation compared to total hip replacement, and causes less pain.
Recovery after partial hip surgery
Recovery from partial hip replacement surgery takes several months. After surgery, the patient will spend three to five days in the hospital with painkillers, and nurses and physiotherapists will help the patient to start walking as soon as possible (mostly after 24 to 48 hours) after the operation so that the patient can return home as soon as possible with the initial need for crutches or a walker.
You can usually return home if the wound is healing well and you can move around safely, and you should talk to your occupational therapist about how to manage daily activities and home exercise programs that will help strengthen your hip in the long run. It is normal to experience some pain and swelling in the legs at first. These symptoms usually improve within a few weeks, and you can rely on painkillers during this period.
The role of rehabilitation in improving surgical outcomes
Rehabilitation is crucial to ensure a successful recovery after partial hip replacement surgery. By using less invasive surgical methods, tissue damage is minimized and the healing process is accelerated. Patients who undergo hip replacement surgery in this manner typically experience less pain and recover more quickly. It is very important to move and walk patients shortly after surgery, as brisk walking after 24-48 hours reduces the risk of DVT and promotes healing.
Physical therapy is essential for restoring strength and flexibility and reducing joint stiffness. Exercises are designed to gradually improve the range of motion and rebuild muscle strength without putting excessive pressure on the new hip joint, and effective pain control allows patients to fully participate in rehabilitation exercises, which helps speed up the recovery process.
Possible complications after partial hip replacement
Partial hip replacement is a common and safe procedure; however, as with any type of surgery, there are risks:
- Leg clots (DVT): Blood clots or deep vein thrombosis can occur after hip replacement due to how blood flows and clots form after surgery, and anticoagulants can be given to help. To minimize the risk of blood clots, compression stockings may be required.
- Wound infection: There is a small chance that the hip wound may become infected after surgery, leading to hip arthritis. This is usually treated with antibiotics. If the infection spreads deep into the hip joint, the patient may need additional surgery.
- Hip dislocation and wear: Sometimes a hip joint can become dislocated after a hip replacement. This is not common, but it can be painful or cause swelling. Some people may also hear clicking or popping sounds coming from the joint. Modern hip joints are designed to last at least 15 years, but they can wear out over time, causing pain or swelling, and if the joint becomes dislocated or swollen, the patient will need another surgery to repair it.
- A difference in leg length (rarely): Hip replacement can sometimes mean that the leg with the hip replacement is slightly longer than the other leg, which the surgeon avoids as much as possible, and the difference is often so small that most people don’t notice it.
- It also includes joint instability, anemia due to blood loss, superficial and deep infections, issues with dislocation of joint components, and there is a potentially debilitating risk of fracture of the adjacent bone or damage to nerves and blood vessels externally.
The cost of partial hip replacement surgery in Turkey compared to other countries
Turkey has recently become one of the best destinations for medical tourism in the world, especially in the fields of orthopedic surgery and joint replacement, thanks to the low cost while maintaining high quality, the cost of a partial hip replacement operation costs between 7000 to 10000 US Dollar approximately, which is an acceptable cost compared to destinations such as America, which ranges between 30,000 to 50,000 dollars and Europe between 12,000 to 18,000 dollars approximately.
Turkey also relies on specialized doctors trained in various countries of the world, which makes its hospitals internationally accredited and equipped with the latest devices and technologies, which provides high speed in accessing treatment and booking the operation within just a few days or weeks.
In conclusion, partial hip replacement surgery is a safe and effective treatment option, especially for elderly individuals suffering from femoral fractures or joint issues. Thanks to continuous advancements in surgical techniques and implant materials, it offers highly successful outcomes with excellent pain relief, improved mobility, and faster recovery.
Although some risks exist, proper surgical planning, consistent post-operative follow-up, and tailored rehabilitation programs significantly enhance recovery and quality of life. Today, Turkey has become a preferred destination for partial hip replacement due to its combination of affordable costs, high surgical success rates, and patient safety.
Sources:
- Hospital for Special Surgery. (n.d.). Joint Replacement: Implant Bearing Surface Materials-History, Effectiveness & Future
- NHS. (2024, March 6). Hip replacement
