Hip Replacement Complications

Close to 200,000 hip replacement surgeries are performed each year in the United States. Over 90% are successful with no hip replacement complications during or after surgery. But as with all surgeries, the risk of complications is always a possibility. However, complications are infrequent and often reversible.

The older the person is the higher the risk of complications. A person over 80 years old has a 20% chance of developing at least one complication after hip replacement surgery.

Hip replacement complications during surgery

Nerve damage

The sciatic nerve is at risk of being accidentally surgically cut due to its close proximity to the capsule of the hip joint. This same nerve may also become over-stretched during hip manipulation during surgery.

Depending on the extent of the nerve damage, temporary or permanent damage may result. There may be loss of muscle power and feeling in parts of the leg. It may take up to 6 months or more for recovery. Most patients have some numbness around their incision site which may be permanent.

Vascular damage

The damage involves direct trauma to the blood vessels in the area of the surgery. The damaged blood vessel can be repaired by a vascular surgeon if it is caught in time.

Femur fracture

Force is applied during the surgical procedure. This can result in a femoral shaft fracture, especially in older or osteoporotic patients. Again, the problem is addressed during surgery, but may lead to extended rehabilitation. The surgeon may place weight bearing restrictions while you are walking.

Leg length discrepancy

In some cases, it may be difficult to get the exact same leg lengths. The result is usually a longer leg on the surgical hip. It may be unavoidable and deliberate in order to improve muscle function or stabilize the hip. If there is more than a quarter of an inch difference, a shoe lift may be necessary.

In some patients, both legs are the exact same length but they think their surgery leg "feels" longer. In most cases this "feeling" goes away as the patient adjusts to their new hip.

Rarely does shortening of the leg occur. If the leg is significantly shortened after surgery, it may have dislocated.

Anesthetic complications

Complications can occur, and in rare cases even death. Your anesthesiologist will explain the risks involved prior to your surgery.

Hip replacement complications after surgery

Blood clots (DVT-deep vein thrombosis)

This is one of the most common complications after hip replacement. The most common area is in the calf. Increased leg pain is usually the most obvious symptom. Redness around the area of the clots may also occur. It's a minor problem if the clots stay in the leg. But if they dislodge, they can reach the lungs (pulmonary embolism) and can possibly result in death (very rarely).

If your surgeon suspects blood clots, he will immediately order an ultrasound to confirm or rule out clots. Most surgeons will order bed rest until the test results come back positive or negative for blood clots. He will prescribe a blood thinner. Compression boots and ankle/leg exercises help reduce the chance of blood clots.

Infection

Infection can occur during surgery or develop afterwards. It is one of the most serious risks to the joint replacement. If the infection settles deep into the joint and surrounding tissues, the new joint often has to be removed until the infection clears with treatment. If the patient develops an infection elsewhere in the body (bladder, teeth, chest), it must be controlled to prevent the possibility of it spreading through the blood to the new joint.

If you have rheumatoid arthritis or diabetes, or have been taking cortisone for a long time, you are more prone to infection in the weeks following your surgery.

Infection can occur many years after the surgery. Bacteria can travel through the bloodstream from an infection in other parts of your body (bladder infection, infected wound, kidney infection). Oral antibiotics may need to be taken before and after routine dental work years after your hip replacement operation.

Hip dislocation

The first six weeks after hip replacement is the most vulnerable time for your new hip. During this period, muscle tension is the only thing holding the metal ball in the socket. If the metal ball slips out of the socket, it's dislocated. As the hip muscles regain their strength and scar tissue forms around the ball, the risk of hip dislocation diminishes.

Traditional hip replacement requires that certain precautions be taken and some positions/movements are restricted, at least for the first 6 weeks. Your surgeon and physical therapist will instruct you in your hip precautions. Basically, the precautions are:

• do not turn your toes inward
• do not cross you legs
• do not bend your hip more than 60-90 degrees (when sitting, your knee should not be level with your hip, it should be lower)

If dislocation occurs, call an ambulance to get you to the hospital. Your surgeon will pop the hip back into place. If it happens frequently, a hip brace worn for several months will prevent further dislocations. Hip replacement using the anterior approach eliminates the need for hip precautions or restrictions of positions/movements.

Those people who are overweight or have weak muscles are more prone to dislocation. Avoid heavy exercise that puts too much stress on your new hip (running, playing basketball, tennis, heavy lifting). Instead, participate in activities such as walking, swimming, stationary bike.

Trochanteric problems

Your greater trochanter, a large boney part of your femur, is located below and to the outside of the ball of your hip joint. Many of your large hip muscles anchor on the trochanter, so it's essential for normal hip function.

During lateral approach surgery, the trochanter is detached to access the hip joint. It's then reattached. If the trochanter does not heal back on the femur bone, it remains as a separate piece. This may result in pain, weakness, and loss of hip function.

Bowel complications

Constipation frequently occurs for the first week or so after surgery. This can be caused by medication, immobility, loss of appetite, not drinking enough fluids. Stool softeners or enemas may be needed.

Urinary problems

A catheter may be inserted during surgery. Your doctor will order its removal as soon as is practical, as catheters pose an increased risk of urinary infection.

Hematoma formation

During surgery, the main areas of bleeding are controlled by cauterization. But some oozing of blood and fluids still occurs, so a drain is attached from the wound to the outside of the body. If the drain does not work as planned, a collection of blood and fluids forms in the hip area. This can cause pain, pressure, and possible infection. Your surgeon may take you back to surgery to drain the hematoma.

Loosening of the prosthesis

The harder your bones are, the longer your hip replacement will last. Hard bones create a stronger bond. People with rheumatoid arthritis and osteoporosis are more at risk.

Running and heavy impact activities can also loosen the bond of the implant. Keep your weight down, as this will put more stress on the hip joint. Every pound you gain adds three pounds of force on your hip.

Choose a surgeon who has performed many hip replacements. Talk to some of his previous patients to see how they are doing after their hip replacement. Not all surgeons are alike. I have seen a few hip revisions that were necessary only because the initial hip replacement was done poorly by the original surgeon.

Pressure sores

In the immediate days after your hip replacement, you may be spending quite a bit more time in bed. Spending a long period of time in one position can lead to pressure sores. Your heels, especially on your surgery leg, are very susceptible. A pillow or towel roll under your calves will float your heels and relieve pressure. The elderly are especially prone to pressure sores because their skin is softer and they do not move around as well. A close eye should be kept on their heels and tailbone area, and should be regularly repositioned in bed with pillows.

Blood transfusion complications

All blood intended for use in transfusions is screened for Hepatitis B virus, Hepatitis C virus, syphilis, Human T Cell Leukemia virus, and the AIDS virus. But infections still occur. Hemolytic Transfusion Reaction occurs due to incompatibility with the donors blood type. The most common cause of Hemolytic Transfusion Reaction is clerical error (mislabelled specimen or improperly identifying the patient receiving the blood).

If you plan to use your own blood for possible transfusion, let your doctor know ahead of time so arrangements can be made. Your blood can only be stored for 35 days. Collection should begin at least 10-14 days before your surgery. The final collection occurs not later than 5 working days before the surgery date. Your blood will be screened as well.

About hip revision surgery

Most people who undergo hip replacement surgery will never need to replace their artificial joint. But because more and more people are having hip replacements at a younger age, the wearing away of the joint surface can create problems. After 15-20 years of wear and tear, replacement (revision surgery) of the artificial joint is becoming more common. Revision surgery does not have as good an outcome as the initial surgery.

Consider all the hip replacement complications before you decide on surgery. This is not a complete list of risks, as there may be some rare complications not mentioned here.