Comparative Outcomes Assessment: Hip Hemiarthroplasty as an Alternative to THA in Patients with Surgically Pristine Acetabulum—Is There Still a Role?

This is a retrospective review of 243 hip arthroplasties treated with either hemiarthroplasty (61 surgeries-Group 1) or total hip arthroplasty (182 surgeries-Group 2). The mid- to long-term results of relatively similar, predominately young patient cohorts were assessed annually via radiographs and the Harris Hip Scores for pain and clinical function. Groin pain persisted in 16.4% of Group 1 and 5.5% of Group 2 ( ). Thigh pain persisted in 11.5% of Group 1 and 2.2% of Group 2 ( ). Complications in Group 1 were 4/61 including 2 revisions with an overall survival rate of 96.7% versus Group 2 complication rate of 29/182 with 15 revisions and an overall survival rate of 91.8%. There were no cases of acetabular protrusio in Group 1, but 2 cases (1%) in Group 2 had cup loosening or osteolysis. Two cases were revised in Group 1 (3.2%). Both were undersized femoral stems. The fifteen revisions (8.2%) in Group 2 included loose stem (1), instability (8), infections (3), cup loosening (2), and accelerated polyethylene wear (1). Hemiarthroplasty has a higher incidence of thigh and groin pain but fewer complications compared with total hip arthroplasty. 1. Introduction The use of hemiarthroplasty was initially advocated for femoral neck fractures. Hemiarthroplasty advocates indicate ease of implantation, reduced blood loss, a lower dislocation rate, and the ease of acetabular revision when compared with conventional total hip arthroplasty (THA) [1–3]. Historically, surgeons have advocated the use of hemiarthroplasty for the treatment of degenerative arthritis, fracture, or avascular necrosis (AVN) of the hip based primarily on relatively young patient age and the benefit of preserving the acetabular bone stock for future anticipated surgeries. With the availability of newer technologies such as hard on hard bearings (metal on metal, ceramic on ceramic), highly cross-linked polyethylene, and resurfacing arthroplasties, one may consider whether hemiarthroplasty in younger patients is an operation of the past. Many patients needing hip arthroplasty suffer from hip osteonecrosis, often historically referred to as AVN, of the femoral head [4]. The clinical diagnosis of osteonecrosis is often a general one associated with multiple other conditions and with many features of hip osteoarthritis (OA) in its late stages, thus making large patient series difficult to accumulate and even more difficult to compare. Studies such as Wroblewski et al. had a series of 49 patients identified with eleven distinct diagnoses within AVN [5]. There are some longer-term studies of implant