Introduction

Hip fractures are a common and serious problem affecting many older adults, often leading to significant pain, loss of independence, and a decline in quality of life. With our ageing population, finding the best surgical treatments is more important than ever. This article explores two main options for treating hip fractures in the elderly: hemiarthroplasty and total hip replacement. We will look at how these procedures are performed, their outcomes, and what patients can expect during recovery — all with a focus on helping patients, carers, and health professionals make informed decisions.

Understanding Hemiarthroplasty and Total Hip Replacement

Hemiarthroplasty is a type of hip surgery that replaces only the damaged ball part of the hip joint — the femoral head — leaving the socket intact. There are two main forms: unipolar, where a single artificial ball replaces the femoral head, and bipolar, which uses a two-piece ball with an inner and outer component, allowing more natural movement and potentially reducing wear.

Total hip replacement, on the other hand, involves replacing both the ball and the socket (also called the acetabulum), offering a full joint replacement. This approach aims to restore more normal hip function but is a more complex operation.

Choosing between these options depends on many personal factors such as age, bone strength, activity levels, and overall health. According to recent research, “procedure selection can be difficult given the current evidence,” but tools like the Nottingham Hip Fracture Score (NHFS) are helping to bring more objectivity to this decision-making process.

Clinical Outcomes and What to Expect During Recovery

After hemiarthroplasty, patients often benefit from a shorter and less invasive surgery, which can be especially helpful for those with other health issues or limited mobility. Recovery tends to be quicker at first, enabling earlier movement — a key factor in reducing complications like pneumonia, which is unfortunately common after hip fractures due to inactivity.

Total hip replacement may require a longer initial recovery period but often leads to better long-term function and durability of the joint. Recovery typically involves gradually increasing weight-bearing on the leg and guided physiotherapy to improve strength and mobility week by week.

Research also shows clear differences in patient outcomes. One study found that “hemiarthroplasty patients were older ... and had higher one-year mortality (36.2% vs. 3.5%). Total hip replacement patients were more likely to be discharged home (65% vs. 39%), while hemiarthroplasty patients more often needed institutional care.” This highlights the importance of personalised treatment plans that suit the patient's overall health and rehabilitation potential.

Safety Precautions and Follow-up Care

Safety is central during recovery. Patients recovering from hemiarthroplasty are usually given specific precautions to prevent hip dislocation — such as avoiding certain hip movements — which may differ slightly for total hip replacement patients due to the different joint mechanics.

Regular X-rays are also important to monitor how well the implants are positioned and to spot any early signs of loosening or wear. Following a tailored physiotherapy protocol helps patients regain strength and safely return to everyday activities.

Notably, “within NHFS 4-6 and in some circumstances, total hip replacement was associated with lower mortality and more favourable discharge outcomes,” emphasising the value of careful patient selection and follow-up.

The Importance of Specialist Care and a Team Approach

Optimal recovery from hip fracture surgery involves a team of specialists, including surgeons, physiotherapists, nurses, and rehabilitation experts. Professor Paul Lee and the MSK Doctors’ team provide such collaborative care, combining clinical expertise with a compassionate, patient-centred approach.

Working in line with NHS standards for elderly hip care, their approach ensures that treatment is not just about the operation, but also focuses fully on functional recovery, comfort, and quality of life.

Making the Right Decision: A Patient-centred Approach

Choosing between hemiarthroplasty and total hip replacement is rarely straightforward. Surgeons, patients, and carers often need to consider many factors: the patient’s overall health, other medical conditions, mobility goals, and risk tolerance. Tools like the Nottingham Hip Fracture Score can complement existing guidelines to help identify those who are most likely to benefit from one procedure over the other.

Sometimes, surgery might not be an option, depending on health risks, and non-surgical care becomes necessary. Whatever the path chosen, shared decision-making ensures that care plans are tailored to each individual’s unique needs and preferences.

Conclusion and Responsible Advice

Both hemiarthroplasty and total hip replacement are valuable surgical treatments for elderly hip fractures, each with their own pros and cons. The best choice depends on the individual patient and their unique health situation. Personalised, expert-guided care — supported by a dedicated multidisciplinary team — is vital to achieving the best possible outcomes and helping patients regain independence.

For personalised medical advice about hip fracture treatment, please consult a qualified healthcare professional.

References

Solomon, D., Maunders, R. E., Adair, A., & James, A. (2025). Can the Nottingham Hip Fracture Score Predict Total Hip Replacement Versus Hemiarthroplasty Candidates? Cureus. https://doi.org/10.7759/cureus.94334