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Complications & Risks - Hip Replacement

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 afterwards. Some will experience minor issues and occasionally there may be more serious complications. These problems are rare and most can be treated quickly and effectively. There are risks associated with this surgery and it is important that you know about them. If at any time, you have concerns about any of the following, please talk to us. This list covers the major risks and complications and serves as an information guide only. There may be other risks depending on your health which may occur when having surgery.

Infection

Superficial infection of the wound soon after surgery can occur and it is usually treated quickly and successfully with a week of antibiotics. If you are concerned about your wound or the possibility of infection in your joint then contact our rooms for advice. If you cannot reach us out-of-hours, you can contact the Mater Hospital or your GP for immediate attention. Remember, it is best not to touch your wound unnecessarily, as this is a likely way to introduce organisms to the wound.

Deep infection (infection of the prosthesis) is one of the complications of joint replacement surgery. It is very uncommon, but it can happen and patients should be aware that this is a risk of surgery. Infection can occur when you are in hospital, or when you are at home and usually appears as pain, swelling, redness and warmth of the joint. This may be accompanied by fever and sweats. Acute deep infection may require surgical wash-out and chronic deep infection may require removal or revision of the joint. If you are concerned about the possibility of deep infection, seek immediate medical advice.

Other infections in the body. As a rule, any infection in the body should be treated immediately by your general practitioner, because it is possible for infection to spread from another part of the body to the joint replacement.

Remember to tell your dentist

If you are having extensive dental work such as root canal therapy or treatment for a tooth abscess, you should ensure your dentist knows you have a hip replacement and provides you with appropriate antibiotics if needed. Arthroplasty Society of Australia has prepared a document specifically for dentists

Loosening of implant

Loosening is a very rare complication with the modern cement-free implants we use. It is usually detected on follow-up X-rays and can be fixed with further surgery.

Dislocation

Dislocation can occur after surgery. Dislocation is more likely to occur during the first 6 weeks after surgery, but it can happen at anytime. 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. In the event of dislocation, you will be in pain and will need to call an ambulance to take you to hospital.

Fracture

Fracture of the femur (peri-prosthetic fracture) or acetabulum can occur during surgery, or after the surgery particularly if the patient falls. This complication is more common in elderly people and in people with osteoporosis where the bone is soft. The treatment of periprosthetic fracture may be protected weight bearing or it may be necessary to do further surgery.

Fracture can occasionally occur during the surgery, particularly if your bone quality is poor and if this happens, your surgeon will place a wire around the fracture and you will be instructed to use crutches or frame for 6 weeks to give the fracture time to heal. Sometimes a wire is used as a preventative measure during surgery, if the surgeon feels there is a particular risk of fracture after surgery.

Femoral neck fracture (hip resurfacing patients only)

Patients who have resurfacing hip replacement should know there is a risk of femoral neck stress fracture (this does not occur with the total hip replacement, because the femoral neck is replaced). If you have had hip resurfacing and you experience worsening pain upon weight bearing, you should visit your GP or contact Dr Walter immediately. Stress fracture may not show on X-ray and usually requires a clinical diagnosis (ie. the surgeon will examine you). After surgery, the hip should steadily improve. It is very important that if you experience worsening pain upon weight bearing, that you do not put weight on it until you have been assessed. If detected early, this can usually be treated with crutches for 6 weeks, but if it is left unchecked it is more likely to result in revision surgery.

Impaired nerve function

On very rare occasions, nerves in the vicinity of the joint replacement can be stretched or injured during the operation causing paralysis (footdrop) and/or numbness of the leg. This generally occurs when the orthopaedic surgeon needs to correct the joint in order to implant the prosthesis. With time, these nerves usually begin to function again. In rare instances, there can be a 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. If you are at particular risk of DVT you will be instructed to wear TED (thromboembolic) stockings. TED stockings 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. DVT is usually treated with extended use of blood thinning medications. Prior to your discharge from hospital an 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 clot 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 unlikely (around 1%) and fatal pulmonary embolism is extremely rare.

Stroke/Heart attack/Pneumonia resulting in death

Stroke, heart attack and pneumonia resulting in death, can occur following any anaesthesia and surgery. Fortunately they are extremely rare.

Reaction to metal debris

There is now some research which indicates that some people are allergic to the metal used in hip replacement surgery. It is more likely to occur in resurfacing hip replacement which has metal bearing surfaces. It can present as pain and swelling in the groin area years after the surgery. Patients should make an appointment to see the surgeon if this occurs. Regular follow-up can allow early detection and treatment.

Some other rare problems - Squeaking and breakage

Squeaking of hip replacements is a problem occurring in about 1% of patients. Usually it is intermittent and a curiosity only and doesn't bear any relationship to a patient's satisfaction in terms of the functionality of the hip. Occasionally it may be frequent enough and loud enough to require further intervention. Ceramic is a material used in the hip implant and it may break, requiring revision surgery.

Remember to tell your dentist

If you are having extensive dental work such as root canal therapy or treatment for a tooth abscess, you should ensure your dentist knows you have a hip replacement and provides you with appropriate antibiotics if needed. Arthroplasty Society of Australia has prepared a document specifically for dentists which can be found on their website.

Info for Dentists

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