Partial Hip Replacement Vs Total Hip Replacement
Partial hip replacement is a surgical procedure primarily used to replace only the femoral head (the ball of the hip joint), while the acetabulum (the socket of the hip) remains intact. In contrast, total hip replacement (THR) involves replacing both the femoral head and the acetabulum with prosthetic components. Due to the evolution and success of total hip replacement techniques, partial hip replacement is now performed in only a small subset of patients, typically those with specific indications.
How Common It Is and Who Gets It? (Epidemiology)
Partial hip replacement is more commonly seen in elderly patients with advanced arthritis or femoral neck fractures, especially when the acetabulum is not damaged. It is also occasionally used for patients with a significant fracture of the femoral neck that compromises the blood supply to the femoral head. Total hip replacement is more common in active individuals and those with joint degeneration that affects both the femoral head and acetabulum.
Why It Happens – Causes (Etiology and Pathophysiology)
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Osteoarthritis: The most common cause of hip joint degeneration leading to the need for hip replacement.
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Femoral Neck Fractures: Often result in disruption of blood flow to the femoral head, requiring replacement.
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Rheumatoid Arthritis: Can lead to joint destruction and the need for joint replacement.
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Trauma or Injury: Severe fractures or dislocations of the hip joint may result in arthritis, necessitating hip replacement.
Partial unipolar hip replacement X -ray.
How the Body Part Normally Works? (Relevant Anatomy)
The hip joint is a ball-and-socket joint where the femoral head (ball) fits into the acetabulum (socket). The joint is covered by articular cartilage that allows for smooth movement. Arthritis or fractures can damage the cartilage, causing pain and limited motion, which may necessitate surgery.
What You Might Feel – Symptoms (Clinical Presentation)
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Pain: Often felt in the groin or thigh, worsening with walking, standing, or certain movements.
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Stiffness: Difficulty moving the hip, particularly when trying to bend or rotate the leg.
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Decreased Mobility: Reduced range of motion, making it hard to perform everyday activities like walking, dressing, or sitting.
How Doctors Find the Problem? (Diagnosis and Imaging)
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X-rays: To examine joint space narrowing and signs of arthritis or fractures.
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MRI or CT scan: Used for detailed imaging to assess the severity of joint damage.
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Physical Exam: To assess hip motion and identify areas of pain or stiffness.
Procedure Types or Techniques (Classification)
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Partial Hip Replacement: Only the femoral head is replaced, commonly used in patients with femoral neck fractures or isolated femoral head arthritis.
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Total Hip Replacement: Both the femoral head and acetabulum are replaced, typically indicated for widespread arthritis or damage to both components.
Other Problems That Can Feel Similar (Differential Diagnosis)
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Trochanteric Bursitis: Inflammation of the bursa near the hip joint.
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Sciatica: Nerve pain radiating from the lower back or hip.
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Labral Tears: Damage to the cartilage of the hip socket that can mimic arthritis symptoms.
Treatment Options
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Non-surgical: Pain medications, physical therapy, weight loss, and lifestyle modifications.
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Surgical: Partial hip replacement or total hip replacement depending on the severity of joint damage.
Recovery and What to Expect After Surgery
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Immediate Post-op: Patients may be able to bear weight with crutches shortly after surgery. Hospital stay typically lasts 1-2 days for partial replacement, and 2-3 days for total hip replacement.
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Physical Therapy: Begins the day after surgery to regain mobility and strength. Full recovery typically takes 6-12 weeks.
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Long-Term: Most patients return to normal activities within a few months, though high-impact activities may be restricted.
Possible Risks or Side Effects (Complications)
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Infection: A risk with any surgery, particularly if proper wound care is not followed.
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Blood Clots: Deep vein thrombosis (DVT) can occur, which may lead to more serious complications.
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Leg Length Discrepancy: A slight difference in leg length after surgery.
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Dislocation: The hip implant may dislocate if not properly positioned.
Long-Term Outlook (Prognosis)
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Partial Hip Replacement: Typically provides significant pain relief and improved function for patients, though the joint may wear out faster over time as the acetabulum remains unaddressed.
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Total Hip Replacement: Lasts longer (15-20 years or more), with significant pain relief and functional improvement for most patients.
Intraoperative image of total hip replacement.
Out-of-Pocket Costs
Medicare
CPT Code 27125 – Partial Hip Replacement (Hemiarthroplasty, Replacement of the Femoral Head): $268.14
Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans coordinate with Medicare to fill the coverage gap and reduce financial responsibility.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans generally cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300, depending on your plan and provider network.
Workers’ Compensation
If your partial hip replacement is required due to a work-related injury or degenerative hip disease caused by your job, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.
No-Fault Insurance
If your hip replacement surgery is needed due to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your insurance policy.
Example
Laura Reed required partial hip replacement (CPT 27125) after a hip fracture. Her estimated Medicare out-of-pocket cost was $268.14. Since Laura had supplemental insurance through AARP Medigap, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the procedure.
Frequently Asked Questions (FAQ)
Q. What is the recovery time for partial hip replacement?
A. Recovery for partial hip replacement is typically faster than total hip replacement, with most patients returning to normal activities within 3 months.
Q. Can I drive after hip replacement?
A. Most patients can drive within 4-6 weeks, depending on the leg and recovery process.
Q. How long do hip implants last?
A. Hip implants typically last 15-20 years, though this may vary based on activity level and other factors.
Summary and Takeaway
Partial hip replacement is a less common procedure, typically recommended for patients with isolated femoral head arthritis or fractures. It offers a shorter surgery and recovery time compared to total hip replacement, but it may not be suitable for patients with widespread arthritis or joint degeneration. Total hip replacement remains the gold standard for comprehensive treatment of hip arthritis.
Clinical Insight & Recent Findings
A recent study evaluated the effect of local vancomycin powder (VP) application in reducing surgical site infections (SSIs) after partial hip replacement in elderly patients with comorbidities.
The study included 93 patients, comparing a group treated with VP and a group without. While the overall SSI rate was 6.4%, no significant difference was found between the vancomycin-treated group (5.7%) and the non-treated group (6.9%) (p=0.498).
The study suggests that while vancomycin may help in certain settings, its application in partial hip replacement for elderly patients did not significantly reduce infection rates in this cohort, particularly when ICU follow-up was involved. (“Study on vancomycin in partial hip replacement – see PubMed”).
Who Performs This Surgery? (Specialists and Team Involved)
Orthopedic surgeons specializing in joint replacement perform both partial and total hip replacements, assisted by anesthesiologists and surgical teams.
When to See a Specialist?
If you experience persistent hip pain that interferes with daily activities and have not found relief from non-surgical treatments, it may be time to consult an orthopedic surgeon.
When to Go to the Emergency Room?
Seek immediate medical attention if you experience severe pain, infection signs (fever, redness, swelling), or if the hip dislocates.
What Recovery Really Looks Like?
Recovery involves managing pain, following a physical therapy plan, and gradually returning to daily activities. Most patients regain significant function within 6-12 weeks, with minimal restrictions.
What Happens If You Delay Surgery?
Delaying surgery may lead to further joint deterioration, increased pain, and potentially more complex surgery.
How to Prevent Recurrence or Failure?
Maintain a healthy weight, avoid high-impact activities, and follow the rehabilitation plan to ensure the longevity of the hip implant.
Nutrition and Bone or Joint Health
Ensure adequate intake of calcium and vitamin D to support bone health. Avoid smoking and limit alcohol to aid healing and implant longevity.
Activity and Lifestyle Modifications
Engage in low-impact activities, avoid high-impact exercises, and follow your surgeon’s recommendations for long-term care and mobility.
For Total Hip Replacement procedure and cost information, please click here.
Do you have more questions?
What types of hip conditions or injuries are commonly treated with partial hip replacement?
Partial hip replacement is often used to treat conditions such as femoral neck fractures, avascular necrosis of the femoral head, and certain types of hip arthritis affecting primarily the femoral head.
What are the disadvantages of partial hip replacement compared to total hip replacement?
Disadvantages of partial hip replacement may include a higher risk of needing revision surgery in the future if arthritis progresses, limited durability of the prosthetic femoral head, and potential challenges in achieving optimal alignment and stability.
What are the advantages of partial hip replacement compared to total hip replacement?
Partial hip replacement may offer advantages such as preservation of bone and soft tissue, potentially faster recovery, reduced risk of dislocation, and a more conservative surgical approach for certain patients.
How do surgeons determine whether a patient is a candidate for partial hip replacement versus total hip replacement?
Surgeons consider factors such as the extent of hip joint damage, the patient’s age, activity level, bone quality, and overall health when determining the most appropriate type of hip replacement surgery.
What is the main difference between partial hip replacement and total hip replacement?
Partial hip replacement involves replacing only the damaged portion of the hip joint, typically the femoral head, while preserving the acetabulum. Total hip replacement involves replacing both the femoral head and the acetabulum with prosthetic components.
How does the risk of post-operative complications differ between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of certain post-operative complications such as dislocation and nerve injury compared to total hip replacement, as the surgery involves preserving more of the native hip anatomy and soft tissues. However, the overall risk of complications depends on various factors including patient-specific factors and surgical technique.
Are there any restrictions on driving or returning to work after partial hip replacement surgery?
Patients are typically advised to refrain from driving for a few weeks after partial hip replacement surgery until they are no longer taking narcotic pain medications and have regained sufficient mobility and strength. Returning to work will depend on the patient’s occupation and the type of activities involved, with most individuals able to resume sedentary or light-duty work within a few weeks to months after surgery.
How does the risk of periprosthetic fracture differ between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of periprosthetic fracture compared to total hip replacement, as the surgery involves preserving more of the native hip anatomy and bone stock. However, certain patient factors such as osteoporosis and implant-related factors can influence the risk of periprosthetic fracture in both procedures.
Can partial hip replacement be performed using computer-assisted navigation techniques?
Yes, partial hip replacement surgery can be performed using computer-assisted navigation techniques, which offer potential benefits such as improved accuracy in implant placement, enhanced surgical precision, and better patient outcomes. Computer-assisted navigation may be particularly useful in complex cases or for achieving optimal component alignment.
How does the risk of post-operative stiffness differ between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of post-operative stiffness compared to total hip replacement, as the surgery involves preserving more of the native hip anatomy and soft tissues. However, individual patient factors and surgical technique can influence the risk of stiffness in both procedures.
How does the choice between partial hip replacement and total hip replacement affect the risk of future revision surgery?
The choice between partial hip replacement and total hip replacement may impact the risk of future revision surgery, as partial hip replacement preserves more of the native hip anatomy and bone stock. However, factors such as implant wear, progression of arthritis, and patient-specific factors can influence the need for revision surgery over time.
What are the key factors to consider when deciding between partial hip replacement and total hip replacement?
Key factors to consider when deciding between partial hip replacement and total hip replacement include the extent of hip joint damage, the patient’s age and activity level, bone quality, overall health, surgical preferences, and the expected long-term outcomes of each procedure.
How does the recovery process differ between partial hip replacement and total hip replacement?
The recovery process may differ in terms of post-operative pain, rehabilitation duration, and return to normal activities. Partial hip replacement patients may experience a shorter recovery period and less post-operative pain compared to total hip replacement patients due to the less extensive nature of the surgery.
Are there specific exercises or physical therapy regimens recommended after partial hip replacement surgery?
Yes, patients typically undergo physical therapy after partial hip replacement surgery to improve hip strength, flexibility, and range of motion. Specific exercises may include gentle stretching, strengthening exercises, and mobility exercises tailored to the individual’s needs and limitations.
How does the risk of infection compare between partial hip replacement and total hip replacement?
Both partial and total hip replacement surgeries carry a risk of infection, but the risk may be slightly lower with partial hip replacement due to the smaller incision size and less extensive surgical exposure. However, infection risk can be minimized through strict adherence to sterile surgical techniques and antibiotic prophylaxis.
Can partial hip replacement be performed using robotic-assisted techniques?
Yes, robotic-assisted partial hip replacement procedures are available and offer potential benefits such as improved accuracy in implant placement, enhanced surgical precision, and better patient outcomes. However, not all surgeons may have access to or expertise in robotic technology for partial hip replacement.
What factors influence the choice between a cemented or uncemented prosthesis in partial hip replacement surgery?
Factors such as patient age, bone quality, surgeon preference, and implant design may influence the decision to use a cemented or uncemented prosthesis in partial hip replacement surgery. Cemented prostheses provide immediate fixation, while uncemented prostheses rely on bone ingrowth for stability.
How does the risk of leg length discrepancy differ between partial hip replacement and total hip replacement?
Partial hip replacement may carry a lower risk of leg length discrepancy compared to total hip replacement, as the surgery involves replacing only the damaged portion of the femoral head rather than altering the entire hip joint anatomy. However, careful pre-operative planning and surgical technique are essential to minimize this risk.
Are there specific dietary recommendations or supplements recommended after partial hip replacement surgery?
While there are no specific dietary restrictions following partial hip replacement surgery, maintaining a balanced diet rich in nutrients such as calcium and vitamin D can support bone health and facilitate the healing process. In some cases, healthcare providers may recommend calcium or vitamin D supplements to aid in bone healing.
How does the risk of implant wear and osteolysis compare between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of implant wear and osteolysis compared to total hip replacement, as the surgery involves preserving more of the native hip anatomy and bone stock. However, long-term follow-up and monitoring are essential to detect any signs of implant-related complications.
Can partial hip replacement be performed using minimally invasive muscle-sparing techniques?
Yes, partial hip replacement can be performed using minimally invasive muscle-sparing techniques, which aim to minimize soft tissue damage, reduce post-operative pain, and accelerate recovery. These techniques typically involve smaller incisions and less disruption to surrounding muscles and tendons.
How does the risk of blood loss and the need for transfusion differ between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of blood loss and the need for transfusion compared to total hip replacement, as the surgery involves a smaller incision and less extensive soft tissue dissection. However, individual patient factors and surgical techniques can influence blood loss and transfusion requirements.
What factors influence the choice between a metal-on-polyethylene or ceramic-on-ceramic bearing surface in partial hip replacement surgery?
Factors such as patient age, activity level, and surgeon preference may influence the choice between different bearing surface options in partial hip replacement surgery. Metal-on-polyethylene bearings are commonly used and offer durability and reliability, while ceramic-on-ceramic bearings may provide enhanced wear resistance and longevity.
Can partial hip replacement be performed as an outpatient procedure?
Yes, partial hip replacement surgery can be performed as an outpatient procedure in select patients who meet certain criteria, such as good overall health, minimal medical comorbidities, and a supportive home environment. Outpatient partial hip replacement allows patients to return home on the same day as surgery and may offer potential benefits such as reduced hospital costs and quicker recovery.
How does the risk of post-operative complications differ between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of certain post-operative complications such as dislocation and nerve injury compared to total hip replacement, as the surgery involves preserving more of the native hip anatomy and soft tissues. However, the overall risk of complications depends on various factors including patient-specific factors and surgical technique.
Are there any restrictions on driving or returning to work after partial hip replacement surgery?
Patients are typically advised to refrain from driving for a few weeks after partial hip replacement surgery until they are no longer taking narcotic pain medications and have regained sufficient mobility and strength. Returning to work will depend on the patient’s occupation and the type of activities involved, with most individuals able to resume sedentary or light-duty work within a few weeks to months after surgery.
How does the risk of periprosthetic fracture differ between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of periprosthetic fracture compared to total hip replacement, as the surgery involves preserving more of the native hip anatomy and bone stock. However, certain patient factors such as osteoporosis and implant-related factors can influence the risk of periprosthetic fracture in both procedures.
Can partial hip replacement be performed using computer-assisted navigation techniques?
Yes, partial hip replacement surgery can be performed using computer-assisted navigation techniques, which offer potential benefits such as improved accuracy in implant placement, enhanced surgical precision, and better patient outcomes. Computer-assisted navigation may be particularly useful in complex cases or for achieving optimal component alignment.
How does the risk of post-operative stiffness differ between partial hip replacement and total hip replacement?
Partial hip replacement may be associated with a lower risk of post-operative stiffness compared to total hip replacement, as the surgery involves preserving more of the native hip anatomy and soft tissues. However, individual patient factors and surgical technique can influence the risk of stiffness in both procedures.
Dr. Suhirad Khokhar
My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.
I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.
My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.
