Total Hip Arthroplasty for Femoral Neck Fractures 

Definitive Reconstruction vs. Palliative Hemiarthroplasty 

This analysis examines the transition from palliative Hemiarthroplasty to definitive Total Hip Arthroplasty (THA) in acute femoral neck fractures. As a long-standing proponent of trauma-based THA, Dr. Saminathan Suresh Nathan outlines the technical maneuvers required to manage osteoporotic "eggshell" bone, prevent intra-operative fracture, and restore mechanical stability—challenges that frequently lead to the inferior "Hemi" compromise in institutional settings. 

The Hemiarthroplasty Compromise

In many trauma systems, Hemiarthroplasty is the default procedure for displaced femoral neck fractures. While often justified by "reduced surgical time," it is frequently a consequence of institutional deskilling. Surgeons who have not mastered acetabular preparation in the context of acute trauma settle for a "half-hip" replacement.

• Mechanical Dishonesty: Hemiarthroplasty articulates a metallic head directly against native acetabular cartilage. This inevitably leads to acetabular erosion (cotyloiditis), protrusion, and chronic pain in patients who outlive their implant.

• The Systemic Fallback: The procedure is often delegated to mid-tier residents because it avoids the complexity of the acetabulum. This creates a cycle where consultants lack the proficiency to offer a superior THA for trauma cases.

The Technical Minefield of THA in Trauma

Performing a THA for an acute fracture is significantly more demanding than an elective replacement for osteoarthritis. We prioritize THA because it offers superior long-term function, provided the surgeon can navigate the following reconstructive hurdles:

• Osteoporotic "Eggshell" Bone: Fractured bone lacks the hoop strength of arthritic bone. Achieving primary stem stability without causing a catastrophic periprosthetic fracture requires meticulous femoral preparation and specialized implant selection.

• Loss of Anatomical Landmarks: Without an intact femoral head and neck for reference, establishing correct leg length and lateral offset is a precision exercise. Failure leads to significant limb-length discrepancy and gait instability.

• Soft Tissue Instability: In acute trauma, the capsule and surrounding musculature are often compromised. Achieving stability requires perfect component orientation (anteversion and inclination) to prevent post-operative dislocation—a margin of error that is nearly zero in the "mush" of a trauma bed.

• Malposition Risks: The soft, fatty marrow of the elderly femur offers little resistance to surgical instruments, making Varus/Valgus malalignment a constant risk that must be mitigated through advanced tactile and visual feedback.

Conclusion: Restoring the Mechanical Axis

We reject the "safe compromise" of Hemiarthroplasty for active patients. By applying the reconstructive principles of Revision Arthroplasty and Oncology, we manage the risks of bone loss and instability to provide a definitive, high-performance Total Hip. This approach ensures the patient is not just "stabilized," but functionally restored without the looming threat of acetabular wear.

Clinical Authority and Training

The surgical techniques utilized at this practice are the result of over 25 years of frontline execution in Arthroplasty and Limb Salvage. Having served as an International Trainer and Chairman of the Clinical Competency Committee, we mentored the current generation of surgeons on the strict mechanical principles of precision and soft-tissue balancing. We apply these exact, uncompromising standards to your reconstruction. Learn more about our Academic Distinctions here.

Uncompromising care requires clinical independence. We operate outside standard network panels to ensure your treatment is tailored entirely to your clinical needs, not corporate quotas. Verify your coverage here.