Hemiarthroplasty for Femoral Neck Fracture

Indications

Neck of Femur Fractures, radiograph of the hips after hemiarthroplasty
Radiograph of the hips after hemiarthroplasty. Image by Carl Jones, Nikolai Briffa, Joshua Jacob2 and Richard Hargrove, Wikimedia Commons, CC BY 4.0.
  • Displaced intracapsular fracture in older lower demand patients
  • Total hip replacement preferred for active, independent, cognitively intact patients
  • The ACSQHC Hip Fracture Care Clinical Care Standard sets surgery within 48 hours of presentation
  • Unipolar or bipolar head choice has little effect on outcome

Position

  • Lateral decubitus
  • Secure pelvic supports and pad pressure areas

Operative Steps

  1. Posterior approach with capsule and short external rotator repair, or anterolateral approach
  2. Remove the femoral head and measure its diameter
  3. Neck cut about 1 cm above the lesser trochanter
  4. Prepare the femur and trial for leg length, offset and stability
  5. Cemented stem reduces periprosthetic fracture and thigh pain (WHiTE 5)
  6. Cement with care given bone cement implantation syndrome risk
  7. Repair capsule and close
  8. Use an uncemented stem only if the patient cannot tolerate cementation
  9. Lavage and dry the canal and use a cement restrictor
  10. Communicate with the anaesthetist before cement insertion

Postoperative Care

  • Full weight bearing
  • Hip precautions as per approach
  • Orthogeriatric care, VTE prophylaxis, osteoporosis treatment
  • Mobilise on day 1
  • Check haemoglobin and delirium screen
  • Bisphosphonate or denosumab before discharge or at follow up

Complications

  • Dislocation
  • Periprosthetic fracture
  • Bone cement implantation syndrome
  • Acetabular erosion
  • Acetabular erosion with time in active patients
  • Delirium and medical complications
  • 30 day mortality around 5 to 10%

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.