Medically Reviewed by: Dr. Vijay Kumar Sohanlal, MBBS, MS (Orthopaedics), Orthopaedic & Joint Replacement Surgeon, Founder & Owner, MAHI Multispeciality Hospitals, Kilpauk, Chennai.
Last medically reviewed: October 2026

A hip fracture can turn an ordinary day into a difficult one. Suddenly, standing, walking, or even getting out of bed may become painful or impossible. When surgery is recommended, unfamiliar terms such as hemiarthroplasty or partial hip replacement can make an already stressful situation harder to understand.

Hemiarthroplasty is a form of hip replacement in which the damaged femoral head is replaced while the natural socket is preserved, provided the socket remains suitable.

But the important part is not the word hemi. The real question is why replacing only one side of the joint may be appropriate for one patient, while replacing both sides may be more suitable for another. That decision depends on the fracture, the condition of the hip, the patient’s health and mobility, and what the surgeon is trying to achieve in the long term.

Hemiarthroplasty replaces the damaged ball while preserving the natural socket

The hip is a ball-and-socket joint.

• The femoral head forms the ball.
• The acetabulum forms the socket.

In hemiarthroplasty, the damaged femoral head is removed and replaced with an artificial component. The natural acetabulum is retained.

This differs from a total hip replacement, where both the femoral head and the damaged surface of the acetabulum are replaced.

Preserving a healthy natural surface can be a deliberate advantage. But it only makes sense when that surface is capable of continuing to function appropriately.

The fracture explains why surgery is needed; the whole hip helps determine which surgery is right

Hemiarthroplasty is particularly used for selected displaced femoral neck fractures, especially in older adults.

A fracture in this area can disrupt the blood supply to the femoral head, making successful healing of the natural femoral head less predictable in some patients. Replacing the damaged femoral head can therefore provide a way to restore a stable hip and begin rehabilitation. However, the fracture itself is only part of the decision.

Several factors are considered together:

• Condition of the acetabulum: A relatively healthy socket may be suitable for preservation, whereas significant arthritis or damage may change the surgical plan.
• Mobility before the fracture: Someone who was independently walking and active before the injury may have different functional requirements from someone who already had substantial mobility limitations.
• Overall health and frailty: Medical conditions can influence the safest surgical approach and the pace of recovery.
• Bone quality: Bone strength can affect implant fixation and postoperative management.
• Existing hip disease: Pre-existing arthritis or other joint problems may make total hip replacement more appropriate in selected patients.

This is why the same fracture does not necessarily lead to exactly the same operation for every patient.

The condition of the socket can change the entire treatment plan

The artificial femoral head in a hemiarthroplasty moves against the patient’s natural acetabulum. That makes the condition of the socket an important part of surgical planning.

If the socket is relatively healthy, preserving it may avoid replacing a joint surface that is still functioning well. If there is significant acetabular arthritis or other joint damage, however, replacing only the femoral head may not address the entire problem. In selected patients, a total hip replacement may therefore provide a more appropriate reconstruction.

Clinical Insight

The goal is not to replace as much of the hip as possible. It is to replace what needs replacing while preserving what can still function well.

That principle helps explain why hemiarthroplasty and total hip replacement should not be viewed as competing procedures where one is universally “better.”

Unipolar and bipolar designs offer different ways to reconstruct the hip

Hemiarthroplasty implants are commonly described as unipolar or bipolar.

The choice is not simply a matter of choosing the more technologically advanced option.

Implant design is selected according to the patient’s anatomy, bone quality, clinical situation and the surgeon’s assessment.

What happens during hemiarthroplasty

Although surgical techniques vary according to the patient and the surgeon’s approach, the procedure generally follows several important stages.

Preoperative assessment → anaesthesia → removal of the damaged femoral head → preparation of the femur → implant placement → stability and alignment assessment → closure → rehabilitation

During the operation, the surgeon is not simply placing an implant.

Important considerations include:

• Implant sizing: The prosthesis needs to correspond appropriately to the patient’s anatomy.
• Fixation: Cemented or uncemented fixation may be considered depending on factors such as bone quality and the surgical plan.
• Stability: The reconstructed hip should remain stable through an appropriate range of movement.
• Leg length and hip mechanics: Restoring appropriate biomechanics is an important part of reconstruction.

The technical goal is therefore broader than replacing a fractured bone. The reconstruction needs to provide a stable, functional hip that can support rehabilitation.

Recovery begins with getting safely mobile again

After hemiarthroplasty, recovery is not simply a matter of waiting for the incision to heal.

For many patients, particularly after a hip fracture, safe mobilisation and rehabilitation are important parts of treatment.

The pace is highly individual.

A patient’s age, previous mobility, muscle strength, nutritional status, medical conditions and confidence with walking can all influence recovery. For older adults, recovery may also involve addressing osteoporosis, fall risk and the physical effects of hospitalization not just the hip itself.

The real benefit is restoring useful movement

The success of hemiarthroplasty should not be judged only by whether an implant has been placed successfully.

For the patient, the meaningful goals are more practical:

• Restoring a stable hip: This creates a foundation for progressive rehabilitation.
• Addressing the damaged femoral head: The fractured or compromised component is replaced rather than relying on a femoral head that may not heal reliably.
• Preserving the natural socket when appropriate: A healthy acetabulum does not necessarily need to be replaced.
• Supporting independence: The broader goal is to help the patient regain useful mobility and return to meaningful daily activities.

Expert Insight

A technically successful operation is only one part of recovery. The larger goal is helping the patient regain safe function and independence.

Like every major joint replacement, hemiarthroplasty has potential risks

Hemiarthroplasty is an established surgical procedure, but it is not risk-free.

Understanding these possibilities is not a reason to fear surgery. It helps patients recognise why appropriate surgical planning, rehabilitation and follow-up matter.

Hemiarthroplasty and total hip replacement are chosen for different clinical reasons

There is no single procedure that is right for every patient.

This table should not be interpreted as a rigid rulebook. The final decision is individualized after assessing the patient, the hip and the expected functional demands.

Long-term recovery depends on more than the implant

An implant is an important part of hemiarthroplasty, but it is not the entire treatment.

Long-term function can be influenced by:

• Appropriate patient selection
• Implant design and fixation
• Accurate positioning and stable reconstruction
• Bone quality
• Rehabilitation and muscle recovery
• Nutrition and general health
• Fall prevention
• Management of osteoporosis and other underlying conditions

This is particularly important after hip fractures because many patients are recovering from more than a broken bone. They may also be dealing with weakness, reduced confidence, loss of mobility or other health conditions.

Clinical Pearl

The best outcome is not simply an implant that looks good on an X-ray. It is a patient who can use that reconstructed hip safely and meaningfully in everyday life.

When hemiarthroplasty may not be the complete answer

A hemiarthroplasty preserves the natural acetabulum, but preservation only makes sense when that socket is suitable. If a patient has significant pre-existing acetabular arthritis, substantial joint damage or other factors that make preservation less appropriate, total hip replacement may be considered.

Similarly, a patient’s functional requirements and overall health can influence the decision.

This is why the discussion should never be reduced to:

“Which replacement is better?”

The more useful question is:

“Which reconstruction best matches this patient’s hip and long-term needs?”

That shift in thinking is central to good joint replacement planning.

Choosing the operation with the whole patient in mind

Hemiarthroplasty can sound complicated when first introduced, but its basic principle is straightforward: replace the damaged femoral head while preserving the natural socket when that socket remains suitable. The difficult part is deciding whether that principle fits the individual patient.

That requires looking beyond the fracture to the condition of the acetabulum, bone quality, previous mobility, existing arthritis, overall health and functional expectations. The goal remains simple: treat the damaged part appropriately, preserve healthy structures whenever possible, and help the patient return to safe and meaningful movement.

Read More: Knee Replacement Implant.