HIP FRACTURE CARE · HEMIARTHROPLASTY · FRANKLIN, TN

Partial Hip Replacement Surgery
in Franklin, TN

Hemiarthroplasty for Hip Fractures · Dr. Cory Calendine, MD · Bone and Joint Institute of Tennessee

Partial hip replacement (hemiarthroplasty) replaces the femoral head with a prosthetic component while preserving your natural hip socket. It is most commonly performed to treat femur (hip) fractures. Dr. Cory Calendine performs hip hemiarthroplasty at the Bone and Joint Institute of Tennessee in Franklin, TN, serving patients and families from Nashville, Brentwood, Murfreesboro, Spring Hill, Nolensville, and communities throughout Middle Tennessee. If you or a family member has been told a hip fracture requires surgery, Dr. Calendine’s team can answer your questions and get you scheduled quickly.

BOARD CERTIFIED

AMERICAN BOARD OF ORTHOPAEDIC SURGERY

700+

HIP & KNEE REPLACEMENTS/YEAR

ANDERSON ORTHOPAEDIC

JOINT ARTHOPLASTY FELLOWSHIP

HEMIARTHROPLASTY — REPLACING ONLY WHAT IS DAMAGED

What Is Partial Hip Replacement (Hemiarthroplasty)?

The Procedure — What Is Replaced

The hip joint is a ball-and-socket: the femoral head (ball) sits inside the acetabulum (socket). In many hip fractures, it is the ball — specifically the femoral neck, the segment connecting the femoral head to the shaft of the thigh bone — that fractures. When the fracture disrupts the blood supply to the femoral head, the bone cannot heal on its own and must be replaced. If the acetabular socket is healthy, the correct procedure is to replace only the femoral head — a partial hip replacement, or hemiarthroplasty. During partial hip replacement, Dr. Calendine removes the fractured femoral head, prepares and inserts a metal stem into the thigh bone. A ceramic or metal ball component — matched to the size of the patient’s natural femoral head — attaches to the stem and articulates within the patient’s own natural acetabulum. No part of the hip socket is replaced. The result is a hip joint that moves freely, supports full weight-bearing, and restores function — using the patient’s own healthy socket as the bearing surface.

Partial vs. Total Hip Replacement

Not every hip fracture is treated with partial hip replacement. When both the femoral head and the acetabular socket are damaged — either by the fracture or by pre-existing hip arthritis — total hip replacement (replacing both the ball and socket) produces better long-term outcomes. Dr. Calendine evaluates each patient’s imaging, overall health, activity level, and acetabular condition to determine which procedure is appropriate. For younger, more active patients who sustain a femoral neck fracture, total hip replacement may be the preferred surgical option even without pre-existing arthritis — because a prosthetic ball articulating against a natural acetabulum over decades of active use can accelerate socket wear, potentially requiring a second surgery. For older patients with healthy acetabular cartilage and lower activity demands, hemiarthroplasty provides excellent functional outcomes with less surgical complexity. Dr. Calendine explains this decision clearly at every consultation.

UNDERSTANDING HIP FRACTURE TYPES AND WHEN HEMIARTHROPLASTY IS NEEDED

Hip Fracture Classification — Which Fractures Require Partial Hip Replacement?

Fracture Location: The Grade System

Hip fractures are classified by their location (on femur). This determines what treatment approach is appropriate — internal fixation or joint replacement. Understanding where the fracture occurs explains why some hip fractures are repaired with hardware while others require partial or total hip replacement.

Grade	Fracture Types	Location / Description	Typical Treatment
01	Subtrochanteric	Below the greater trochanter; does not involve the hip joint	Surgical nailing / fixation
02	Intertrochanteric	Between the greater and lesser trochanter; does not enter the joint	Surgical nailing / fixation
03	Femoral Neck	Fracture of the femoral neck; may preserve blood supply if non-displaced	Fixation (screws) if non-displaced; replacement if displaced
04	Subcapital (Femoral Head)	Fracture at the base of the femoral head; high risk of blood supply disruption	Partial OR Total Hip Replacement: depending on displacement and patient factors

Grade 4 Subcapital Fractures — The Four Types

Grade 4 subcapital fractures are further classified into four types (based on the Garden classification system) according to the degree of bone displacement. The type of displacement determines whether the fracture can be repaired with fixation hardware or whether replacement is the correct surgical approach.

Type	Displacement	Description	Treatment
01	Stable impaction	Bone fragments pressed together; contact maintained	Pins or screws
02	Non-displaced	Fracture complete but bones remain aligned	Internal fixation
03	Partial displacement	Bones displaced but some contact maintained	Fixation; replacement if healing risk is high
04	Complete displacement	No contact between fragments; blood supply to femoral head disrupted: high risk of avascular necrosis	Partial or Total Hip Replacement

Type 4 subcapital fractures are completely displaced with no remaining contact between the bone fragments. When this displacement severs the blood supply to the femoral head, the bone cannot heal and will undergo avascular necrosis (bone death) if treated with fixation hardware alone. Partial hip replacement — removing the non-viable femoral head and replacing it with a prosthetic component — is the definitive treatment that restores function and prevents avascular necrosis from progressing.

WHAT HAPPENS DURING PARTIAL HIP REPLACEMENT SURGERY

The Partial Hip Replacement Procedure — Step by Step

Anesthesia, Positioning, and Surgical Access

Partial hip replacement surgery is typically performed under general or spinal anesthesia. The procedure generally takes one to two hours. The surgical approach — anterior, posterior, or lateral — is selected by Dr. Calendine based on patient anatomy, body habitus, and the nature of the fracture.

The approach used does not change the implant or the goal of the procedure; it determines the direction from which the hip joint is accessed. In appropriate candidates, Dr. Calendine may use the anterior approach — his primary hip replacement technique — which preserves the gluteal muscles and reduces post-operative restrictions.

Positioning depends on the approach Dr. Calendine selects. The patient is placed on their side or back, and the surgical area is cleaned and draped to maintain a sterile field throughout the procedure. The incision is kept only as large as the fracture requires, giving clear access to the hip joint while protecting the surrounding muscle and soft tissue that support a faster, more comfortable recovery.

Implant Placement and Closure

Once the hip is accessed, Dr. Calendine carefully removes the fractured femoral head and trims the fractured end of the femoral neck to prepare for implant seating. The femoral canal — the hollow center of the thigh bone — is precisely shaped to accept the metal stem. The stem is inserted and secured (either press-fit into the bone or cemented, depending on bone density and quality), and the ceramic or metal ball component is attached. The ball is sized to match the patient’s natural femoral head diameter, ensuring it articulates smoothly and comfortably within the patient’s own acetabular socket

Once implant position is confirmed and the hip is reduced (ball placed back into socket), the soft tissues are carefully repaired in layers and the incision is closed. The patient is typically transferred to a recovery area and then to an inpatient room or, in appropriate cases, prepared for same-day or next-day discharge. Weight-bearing with assistance typically begins the same day as surgery — one of the significant advantages of hemiarthroplasty over fracture fixation with hardware.

WHICH PROCEDURE IS RIGHT FOR YOUR FRACTURE?

Partial vs. Total Hip Replacement for Fracture —
How Dr. Calendine Decides

The Factors That Drive the Decision

The choice between partial hip replacement and total hip replacement for a femoral neck fracture is individualized — there is no single rule that applies to every patient. Dr. Calendine evaluates a combination of clinical, anatomical, and patient-specific factors at each consultation. The goal is to select the procedure that provides the best long-term outcome for that patient’s specific situation, taking into account not just the fracture, but the condition of the acetabulum, the patient’s age and activity level, and any other medical factors that affect surgical planning.

Factor	Partial Hip Replacement (Hemiarthroplasty)	Total Hip Replacement
Acetabular socket	Healthy: no arthritis, good cartilage	Damaged or arthritic, OR healthy in younger patients
Patient age / activity	Typically older / lower activity demands	Younger / higher activity demands
Pre-existing arthritis	None: isolated fracture only	Present OR expected based on age/activity
Bone quality	Adequate acetabular bone stock	Thin acetabular bone, cysts, or structural concerns
Long-term concern	Possible socket wear over time in active patients	Complete joint replacement eliminates socket wear risk
Surgical complexity	Typically shorter procedure; less reconstruction	More complete reconstruction; longer procedure

Who Is the Ideal Candidate for Partial Hip Replacement?

The ideal hemiarthroplasty candidate is typically an older adult — often in their 70s, 80s, or older — who has fractured the femoral neck after a fall, had no troublesome hip symptoms before the fracture, and whose imaging shows a healthy acetabular socket with good cartilage. In this scenario, replacing only the femoral head delivers immediate stability and pain relief, restores weight-bearing ability, and preserves the healthy socket tissue without the additional reconstruction of a total hip replacement.

Factors that may lead Dr. Calendine to recommend total hip replacement even in older patients include: imaging evidence of acetabular arthritis or cartilage loss, thin or cystic bone in the acetabular wall, additional fractures around the hip, or a younger, more active patient who would be expected to wear the socket surface at an accelerated rate. In all cases, the decision is explained in detail — with imaging review and a direct conversation about the recommendation and why it applies to that patient specifically.

WHAT RECOVERY LOOKS LIKE AFTER PARTIAL HIP REPLACEMENT

Recovery Timeline — Partial Hip Replacement for Fracture

Early Weight-Bearing: A Key Advantage

One of the most significant clinical benefits of partial hip replacement over fracture fixation (pins or screws) is the ability to begin weight-bearing almost immediately after surgery. When a femoral neck fracture is repaired with hardware, patients are often restricted from full weight-bearing for weeks while the fracture heals — during which time they must use a walker or wheelchair and cannot stand on the operated leg. After hemiarthroplasty, the damaged bone is replaced rather than repaired, so there is no fracture healing period that requires non-weight-bearing. Most patients are walking with assistance the same day as surgery.

For elderly patients in particular, early mobilization is not just a convenience — it is a medical priority. Prolonged immobility after a hip fracture significantly increases the risk of pneumonia, deep vein thrombosis, pressure injuries, and other serious complications. The ability to stand and move early is one of the primary reasons hemiarthroplasty is preferred over fixation for displaced femoral neck fractures in older adults.

Recovery timelines vary based on individual health, age, and pre-operative condition. Dr. Calendine will discuss your expected recovery in detail during your consultation.

IF YOU OR A FAMILY MEMBER HAS EXPERIENCED A FALL

Hip Fracture Symptoms and When to Seek Urgent Evaluation

Specific Clinical Situations | Partial Hip Replacement

A hip fracture typically presents suddenly, often following a fall. The most common symptoms include:

If you or a family member is experiencing these symptoms following a fall or injury, evaluation by an orthopedic surgeon is urgent. In most cases, diagnosis is confirmed by X-ray and sometimes CT imaging. If imaging has already been completed and surgery has been recommended, Dr. Calendine’s office can review your case and get you scheduled quickly.

Related Hip & Knee Replacement Procedures

FREQUENTLY ASKED QUESTIONS

Frequently Asked Questions — Partial Hip Replacement

What is the difference between partial hip replacement and total hip replacement for a hip fracture?

Partial hip replacement (hemiarthroplasty) replaces only the femoral head — the ball of the hip joint — while preserving the patient’s natural acetabular socket. Total hip replacement replaces both the ball and the socket. For hip fractures, hemiarthroplasty is appropriate when the acetabular socket is healthy and the patient is older with lower activity demands. Total hip replacement is preferred when there is pre-existing arthritis in the socket, when the patient is younger and more active, or when other factors make a more complete reconstruction the better long-term choice. Dr. Calendine evaluates each patient’s imaging, activity level, and overall health to make this determination.

Can my family member walk after partial hip replacement surgery?

Yes — in most cases, patients begin walking with assistance the same day as partial hip replacement surgery. This is one of the most important advantages of hemiarthroplasty over fracture fixation with hardware. When a fracture is repaired with pins or screws, patients are often restricted from full weight-bearing for weeks while the fracture heals. After hemiarthroplasty, the damaged bone is replaced rather than repaired, so weight-bearing can begin almost immediately. Most patients are using a walker within hours of surgery and progress to a cane within two to three weeks. Early mobilization is both a functional benefit and a medical priority for older adults, as prolonged immobility significantly increases the risk of serious complications after a hip fracture.

How long does partial hip replacement surgery take?

Partial hip replacement surgery typically takes one to two hours. The exact duration depends on individual patient factors including anatomy, bone quality, and the surgical approach used. The procedure is followed by a recovery period in the post-anesthesia care unit (PACU) of one to two hours, and then transfer to an inpatient room or initiation of discharge planning, depending on the patient’s overall condition and support system at home. The surgery itself is generally shorter and less surgically complex than a total hip replacement, which is one reason it is often the preferred option for older or medically complex fracture patients.

What are the risks of partial hip replacement?

The risks of partial hip replacement are broadly similar to those of total hip replacement and include infection, blood clots (deep vein thrombosis), dislocation, leg length discrepancy, implant loosening, and nerve or blood vessel injury. A risk that is more specific to hemiarthroplasty over time is acetabular wear — the prosthetic ball articulating against the natural socket can, in active patients over many years, gradually wear the socket cartilage, potentially requiring conversion to a total hip replacement. This is one reason total hip replacement is often recommended for younger, more active fracture patients from the outset. Dr. Calendine discusses all procedure-specific risks at the consultation before any decision is made.

Is partial hip replacement the right surgery for my parent's hip fracture?

Whether partial hip replacement or total hip replacement is appropriate depends on the specific type of fracture, the condition of the acetabular socket, your parent’s age and activity level, and their overall health. The current page explains the fracture classification system (Grades 1–4 and Types 1–4) and the candidacy factors that guide the decision. The most reliable way to determine which procedure is right for your family member is a consultation with Dr. Calendine, who will review the imaging, explain the fracture type, and make a specific recommendation. His team can arrange consultations quickly for urgent fracture cases.

How quickly can surgery be scheduled for a hip fracture?

Hip fractures are orthopedic emergencies — the clinical evidence consistently shows that earlier surgery (ideally within 24 to 48 hours of fracture) is associated with better patient outcomes, lower complication rates, and faster recovery. Dr. Calendine’s office prioritizes hip fracture consultations and works to schedule surgery as quickly as the patient’s medical condition permits. If you have a family member who has been diagnosed with a femoral neck fracture requiring surgery, call (615) 791-2630 immediately to reach the scheduling team. The Bone and Joint Institute of Tennessee is located at 3000 Edward Curd Lane, Franklin, TN 37067, serving patients from Nashville, Brentwood, and throughout Middle Tennessee.

FRANKLIN, TN · SERVING ALL OF MIDDLE TENNESSEE

Ready to Schedule? Dr. Calendine Is
Accepting New Hip Replacement Patients.

Consultations for partial approach hip replacement at the Bone and Joint Institute of Tennessee,
3000 Edward Curd Lane, Franklin, TN 37067. No referral required.

Dr. Cory Calendine, MD

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