What is bipolar hemiarthroplasty?

Bipolar hemiarthroplasty is a type of surgery for femoral neck fractures of the hip. A prosthetic joint with two bearings is used to replace the damaged joint. The bearings allow the head to move around when in motion so that it does not rub or cause friction on the hip joint.

Hip fractures are a joint event in the elderly and send millions of people to the hospital in the United States annually, as many as 300,000 times. These fractures can then affect one's ability to be mobile, mental status, and independence. Hip fractures may also lead to significant morbidity and even death.

Femoral neck fractures cause approximately half of all hip fractures. BHA is considered the gold standard for femoral neck fractures.

BHA is the replacement of diseased hip joints with artificial joint prostheses.

However, if the femoral neck is fractured, doctors advise hip arthroplasty in patients with this type of hip fracture. This is defined as displaced femoral neck fractures, or DFNF, meaning part of the top of the thigh bone, commonly known as the femur, breaks off. Typically, the blood vessels supplying the femoral head will tear and cut off blood supply to the "ball" of the ball-and-socket hip joint.

In some cases, it may involve replacing the hip socket coupled with the femoral head, collectively called total hip replacement (THR). In other instances, surgeons may use hemiarthroplasty, which means only the femoral head is replaced.

There are two classifications of hemiarthroplasty implants:

Unipolar and Bipolar.

BHA provides a bipolar prosthesis with two joints, and most of the movements occur in the inner bearing between the prosthesis head and the plastic liner of the bipolar head.

Unipolar hemiarthroplasty is available in one piece where movement is observed in between the hip, prosthesis, and socket of the hip.

Who is a potential candidate for bipolar hemiarthroplasty?

There are many hip fracture treatments. The option would depend on the age and activity level, the site of the fracture, and bone stability.

Doctors prescribe BHA if the criteria for THR still need to be met. These criteria include:

• Ability to mobilize independently outdoors
• Only one walking stick is needed or less
• The patient must be mentally fit
• Physically fit and able to undertake surgery with no complications

What to expect during surgery?

BHA is surgery that should be carried out under general anesthesia. The patient will thus be asleep. Below are the steps of BHA surgery.

The surgeon makes an incision on the outer side of the thigh to access the hip joint.

The surgeon is going to expose the fractured site, remove the femoral head from the acetabulum-the "socket" of the "ball and socket" hip joint-and then detach it from the rest of the femur.

They would penetrate the innerside of the femur, fill it with a hollowed-out space, and then insert the stem of the metal from the prosthesis.

After setting the stem, a plastic prosthetic head made solely of plastic will be set up and then fixed onto the bipolar head.

They will test the stability and mobility of the joint before suturing closed the incision covered by bandages.

The surgeon will insert a vacuum drain in the hip region to drain some fluids in the hip region for 48 hours. The surgeon also uses pillows to position the thighs so that the leg does not bend inward.

What happens after bipolar hemiarthroplasty?

A hemiarthroplasty is a procedure that requires the patient to remain in the hospital for a couple of days to recover and receive some physical therapy. The objectives are to restore as much movement as possible and have expected joint function. Most patients begin their active physical treatment on the very next day or as soon as they feel well enough-after surgery.

Healthcare providers can advise the patient to sit or stand with aid for 1–3 days from the date of surgery and walk on aid within 4–5 days from the date of surgery. Doctors can also give blood-thinning drugs to prevent deep vein thrombosis. Patients can take these drugs 12 hours before the surgery until 35 days from the date of the surgery.

How long is the recovery period in bipolar hemiarthroplasty?

The patient will be furnished with specific care instructions throughout the healing process for the hip. These usually depend on the particular recommendations by a healthcare professional but include the following:

• Avoid bending and twisting in the hips
• Avoid crossing the operated leg over the midline
• Feet forward
• Support the legs with pillows, not to cross them when lying down
• Avoid low chairs and hip flexion beyond 90 degrees when seated.
• Use of crutches, raised toilet seats, and grabbers. Some people can resume their activities 6 weeks after the procedure.

What are some side effects of bipolar hemiarthroplasty?

Just like any other surgery, bipolar hemiarthroplasty does involve some danger. These include;

• Blood clots: This may form in the deep veins of the legs or pelvis days after the procedure. Physicians will give the patients blood thinners to prevent the formation of blood clots.
• Infection: The patient may be given antibiotics before and after surgery to prevent infection.
• Dislocation: The risk of dislocation of the hip, which is less common with BHA, is also more common with THR and unipolar hemiarthroplasty; however, it is more common now.
• Damage to nerves or vessels: The nerves or vessels may be accidentally cut or stretched during the surgery, which is not common.
• Mortality: Early mortality within the first year following hip fracture surgery is high, with an estimated range of 15-36%. Possible predictors of mortality at the time of surgery include advanced age, male gender, clinical comorbid conditions, and cognitive impairment.

How long until I can walk again after surgery?

Following the resolution of the anesthesia, a patient can walk with aids for a couple of hours. However, it will take about six weeks for them to get back into their normal activities without any aid.

How long does bipolar hemiarthroplasty last?

A good BHA is expected to last an average duration of 12.5 years.

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