Hip Hemiarthroplasty

What is Hip Hemiarthroplasty?

Hip hemiarthroplasty is a surgical procedure done to fix an intracapsular fracture of the hip. It involves removing the femoral head and neck. Then, put a combination of prosthetics which includes a head, a neck, and a cemented stem.

Instruments and software that you may need during the procedure.

Trays.

  • Hip hemiarthroplasty tray
  • Stryker 6/7/8
  • Plug trials
  • Femoral rasps
  • Femoral basic instruments
  • Unipolar instruments

Softwares.

  • Hip pack
  • Crepe (optional)
  • Big ioban
  • Shark
  • Pulse lavage
  • 1L PNSS
  • Saw blade (Please check surgeon’s preference; some likes wide blade, while others like the narrow one.)
  • Femoral brush (Mr OKB like femoral tip instead of the brush)
  • Suction catheter (f10 or f14)
  • Ribbon gauze
  • Optivac cement 80
  • 1 vicryl (9465) x 2
  • 2 polysorb
  • 3 monocryl
  • Skin glue
  • Mepilex dressing

The procedure in a glance.

The procedure is done the following order (but may change as per circumstances or surgeon’s preference):

  1. Skin preparation and draping.
    • Ground sheet.
    • U drape.
    • Foot drape.
    • Leggings.
    • Crepe (This is per surgeon’s preference. Some doesn’t use crepe.)
    • Hip drape.
    • Top drape.
    • Small ioban – may assist the surgeons by holding the leg.
    • Big ioban.
    • Set up your light handles, diathermy, suction, and pulse lavage.
  2. Skin incision and fracture site preparation.
    • You may need the following instruments: scalpel, mayo scissors, norfolk and norwich, langenbecks, spikes, hohmann’s, charnley retractor, bristow.
  3. Removal of the femur head.
    • Saw blade, nibbler, osteotome, mallet, cork screw, head measure, and have a skid handy.
    • Have a small ready for the acetabulum.
    • Some surgeons like to trial the head using unipolar trial heads on a handle.
    • Determine head size.
  4. Femoral preparation.
    • Box chisel and mallet
    • Femoral reamers, starting from the smallest.
    • Plug sizer
    • Femoral rasps/sizer and handle; and have a t-handled charnley spoon ready.
    • Once they have determined the femoral stem size, they may trial it with a langenbeck and/or trial head.
    • When they are happy, they will install the cement plug and will prep the femur using the following: femoral brush (or tip for Mr OKB), suction catheter, and ribbon gauze (some surgeons will use the smallest plug sizer to introduce the ribbon gauze into the femoral cavity).
  5. Cement and prosthesis.
    • Change gloves.
    • Always ask the surgeon if they’re happy for you to mix cement. It is also crucial to inform your runner and the anesthetic team that you will be cementing soon.
    • Mix the cement:
      • Mix for 30 seconds
      • Install nozzle and attach into the cement gun
      • Ideally, the surgeons will start introducing the cement 2 minutes after mixing.
    • Prosthesis:
      • Stem
        • Have the stem introducer ready (some surgeon would only use a mayo scissor to introduce the stem)
        • Gillies and mcdonald’s handy on the working table.
        • Ideally, will let the cement settle for 10 minutes.
    • Neck
      • Trial neck attached to a head trial.
      • Once they are happy, they will install the neck using the impactor and mallet.
    • Head
      • Impactor and mallet.
  6. Skin closure.
    • 1 vicryl x 2
    • 2 vicryl
    • 3 monocryl
    • skin glue
    • mepilex
    • Always make sure that you have checked the diathermy site and overall skin quality of the patient after the procedure; most important, sign out.