There are risks associated with this surgery. The vast majority of people get through the surgery with no problems at all and will be surprised at how good they feel so soon after the surgery. Some will experience minor issues and occasionally there may be more serious complications. As orthopaedic surgeons with a great deal of experience, we know how to handle the various problems which can arise. We don't wish to cause undue worry, but prefer to fully inform patients about some of the unlikely problems.
This is one of the complications of joint replacement surgery. It is not common, but it can happen and patients should be aware that this is a risk of surgery. Infection may occur just in the wound or deep inside around the prosthesis. Infection can occur when you are in hospital or when you are at home and usually presents as pain, swelling, redness and warmth of the joint. Occasionally this is accompanied by fever and sweats. Deep infection may require removal of the joint. Deep infection is a very rare complication at the Mater Hospital, occurring in less than 0.3% of patients having a primary joint replacement. Superficial infection is more common and is usually treated with a week of antibiotics. If you are concerned about your wound or the possibility of infection in your joint then contact your surgeon for advice.
It is possible for infection to spread from another part of the body to the joint replacement. This may occur several years after the surgery. To help prevent such an infection you should be given antibiotics if you have extensive dental work such as root canal treatment or if you have a tooth abscess. It is not necessary to have antibiotic coverage for minor dental procedures or routine dental cleaning. Antibiotics should be given if you have a urinary tract infection or are having surgery. It is extremely important that an infection in a joint replacement be treated promptly with antibiotics.
Loosening of implant
Loosening is a very rare complication with the modern cementless implants which we use.
Dislocation can occur after surgery. It usually occurs when the hip is put into a position that allows the ball of the prosthesis to come out of the socket. In the first 6 weeks it is necessary to take precautions to minimise the risk of this happening. The physiotherapist and the nursing staff will remind you what positions to reduce the risk. If a hip dislocates it is necessary to have it put back into place and sometimes it is necessary to have further surgery on the hip to prevent this from happening again.
Fracture of the femur (thigh bone) or acetabulum (hip bone) can occur during or after the surgery. This complication is more common in elderly people and in people with osteoporosis where the bone is soft. Occasionally your surgeon will place a wire around the femur to help prevent this. The treatment of periprosthetic fracture may be protected weight bearing or it may be necessary to do further surgery. The risk of periprosthetic fracture of the femur for the average patient is less than 1% in the first year and less than 1% in the next 10 years.
Impaired nerve function
Rarely, nerves in the vicinity of the joint replacement are stretched or damaged during the operation causing paralysis (footdrop) and/or numbness of the leg. This generally occurs when the orthopaedic surgeon needs to correct considerable deformity in order to implant the prosthesis. With time, theses nerves usually begin to function again There is rarely some permanent deficit.
Deep vein thrombosis (DVT) and pulmonary embolism (PE).
With any surgery there is a risk of developing blood clots. This risk is increased in people who undergo joint replacement surgery. Numerous steps are taken to prevent patients from developing clots but some patients still get them. While in hospital and for a short period following your surgery you will wear TED (thromboembolic disease) socks. The TED socks help reduce the incidence of blood clots. You may also receive blood thinning medication and wear calf compression devices post operatively to help prevent blood clots from forming. Prior to your discharge from hospital a doppler ultrasound is done on both lower legs to determine if a clot is present. If a blood clot is found it will be treated. A pulmonary embolism may occur if the thrombus detaches from the veins in the legs and travels to the lungs. This form of clot requires more extensive treatment. Pulmonary embolism can cause breathing difficulties and is rarely fatal. Blood clots in the legs are common occurring in around 15% of patients but pulmonary embolism is rare (around 1%) and fatal PE is extremely rare.
Stroke/Heart attack/Pneumonia resulting in death
These complications can occur following any anaesthesia and surgery. Fortunately they are extremely rare.
A hip replacement is a mechanical device that will wear over time. The bearing materials we now use are so advanced now that this is less likely to be a problem - and we only use the best available materials. Before other bearings were available in Australia (prior to 1997) we used polyethylene bearings. Some polyethylene bearings from the early 1990s are wearing out and causing osteolysis (absorption of the bone) after 8 to 15 years. The modern bearing surfaces are made of the best available material to minimise the effects of the wear. It seems that these bearings will last a lot longer. We use ceramic-on-ceramic for most conventional hip replacements. Ceramic-on-ceramic bearings have the lowest wear of any material available to with a wear rate 100 times less than the old polyethylene. Resurfacing hip replacements are made of a metal-on-metal bearing with wear rates between ceramic-on-ceramic and polyethylene.
Ceramic-on-ceramic is not an option for knee bearings. The modern polyethylenes that we now use for knee replacements are longer wearing than the old material but we expect them to wear out after between 10 and 20 years in active patients.
We monitor the rate that the joint is wearing when you attend for your regular follow up appointments with a current X-ray.
Squeaking and breakage
Squeaking of hip replacements is a rare problem occurring in about 1% of patients. Usually it is intermittent and a curiosity only. Occasionally it may be frequent enough and loud enough to require further intervention. Ceramic is a brittle material and rarely it may break requiring revision surgery. The incidence of this complication is around 1 per 1000 every 10 years.