COMPLICATIONS OF HIP REPLACEMENT SURGERY

Hip replacement surgery is one of the most effective interventions in modern medicine. It is generally safe, routine and reproducible. However, there some complications associated with it that you need to be aware of in order to consent to surgery.

Infection

<1% of patients will suffer a deep infection to a joint replacement at the time of surgery as a result of organisms introduced during the operation.  Infection can also occur late and be spread by the bloodstream from different sites.  Once established infection can be difficult to eradicate without removing the prosthesis and results can be poor.

Deep Vein Thrombus / Pulmonary Embolism

These complications are common after joint replacement surgery but rarely cause symptoms or need treatment.   Only about 1% of patients will become symptomatic and require treatment for a DVT. About 1 in 1000 patients will require treatment for a PE. This is a serious condition where a clot travels to the lungs. 

The risk of these conditions is minimised by the use of spinal anaesthesia, reducing operating time, using mechanical devices during and after surgery to move the blood in the veins and also drugs such as heparin or aspirin.

Dislocation

This is where the ball of the hip replacement comes out of the socket; it usually needs to be relocated in theatre. It is a very rare occurrence in Dr Roche's practice due to careful planning, surgical technique and using large bearing sizes.

Leg length Discrepancy

Every effort is made to replace the joint in its correct anatomical position, through careful planning.  Often this is by replacing the components in the same position as the native hip.  Occasionally a hip needs to be lengthened to compensate for a hip that has become worn over time.  Often patients feel their hips are different lengths after surgery because they have been walking with a worn hip or twisted spine. This sensation usually settles down within a couple of weeks.

Occasionally it is not possible to make a hip stable without lengthening the leg; this is rare and in the majority of patients the difference will be less than 5mm.

Fracture

Fracture is rare and occurs in less than 1% of operations, it is usually recognised at the time of surgery and addressed. It is more common with uncemented implants as they require a tight fit for initial stability. It also occurs more frequently with revision or complex surgery.

Anaesthetic Complications

These may occur as a result of the stress placed on the body during surgery. They are minimised by careful pre-operative screening but patients with pre-existing conditions such as diabetes or heart disease are at greater risk. Interventions such as weight loss or stopping smoking can help to reduce the risk.

Loosening

Loosening of implants can cause them to fail; this is often associated with wear of the joint creating debris that stimulates the body to resorb bone around the implant.

Wear

The bearing surface of all joint replacements wears over time. Modern UHMWP and ceramics help to reduce this. The amount of wear is a direct function of the amount of work done by the joint and is usually dependent on weight and activity.

Damage to Nerves or Vessels

This is a very rare complication affecting less than 1 in 1000 patients.