Risks and Complications
Risks and complications
As with any major surgery (i.e. hip replacement), there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) or specific to the hip;
Medical complications include those of the anesthetic and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:
- Allergic reactions to medications
Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death
Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death
Hip Specific Complications
Hip Specific complications
Leg length inequality
It is very difficult to make the leg exactly the same length as the other one. Occasionally the leg is deliberately lengthened to make the hip stable during surgery. There are some occasions when it is simply not possible to match the leg lengths. All leg length inequalities can be treated by a simple shoe raise on the shorter side
Infection
Infection can occur with any operation. In the hip this can be superficial or deep. Infection rates are approximately 1%. If it occurs, it can be treated with antibiotics but may require further surgery. Very rarely your hip may need to be removed to eradicate infection.
Dislocation
This means the hip comes out of its socket. Precautions need to be taken with your new hip forever. If a dislocation occurs it needs to be put back into place with an anesthetic. Rarely this becomes a recurrent problem needing further surgery.
Fractures
A break of the femur (thigh bone) or pelvis (hipbone). This is also rare but can occur during or after surgery. This may prolong your recovery or require further surgery
Damage to Nerves or Blood vessels
Also rare but can lead to weakness and loss of sensation in part of the leg. Damage to blood vessels may require further surgery if bleeding is ongoing.
Blood clots
These can form in the calf muscles and can travel to the lung (pulmonary embolism). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your surgeon.
Wound irritation
Your scar can be sensitive or have a surrounding area of numbness. This normally decreases over time and does not lead to any problems with your new joint.
Wear
All joints eventually wear out. The more active you are, the quicker this will occur. In general 80-90% of hips survive 15 years.
Failure to relieve pain
Very rare but may occur especially if some pain is coming from other areas such as the spine.
Unsightly or thickened scar
Pressure or bed sores
Limp due to muscle weakness
Limp due to muscle weakness
Very rare but may occur especially if some pain is coming from other areas such as the spine
Although every effort has been made to explain the complications there will be complications that may not have been specifically mentioned. A good knowledge of this operation will make the stress of undertaking the operation easier for you to bear.
The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery.
You must not proceed until you are confident that you understand this procedure, particularly the complications.
Although every effort has been made to explain the complications there will be complications that may not have been specifically mentioned. A good knowledge of this operation will make the stress of undertaking the operation easier for you to bear.
The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery.
You must not proceed until you are confident that you understand this procedure, particularly the complications.
A total hip replacement is one of the most successful operations that orthopedic surgeons perform. A hip replacement is an elective surgery, which means patients decide if and when to have their hip replaced. As a physician, I never tell patients they have to have a hip replacement surgery, but many times surgery may offer the only possibility for pain relief. Although the surgery is elective, it is covered by most insurance companies; however, depending on your policy you maybe required to make a small co-payment. My philosophy is to give my patients as much information as they need to make informed decisions regarding their health and hip pain and then treat their hip pain according to their wishes.
A hip joint is basically a ball and socket joint. A hip replacement involves removing the ball (femoral head) and replacing it with a metal prosthetic ball. The femoral prosthesis is inserted into the hollow part of the femoral shaft. The socket of the pelvis is machined into a hemisphere and a metal hemisphere is inserted into the socket. The new metal ball and new metal socket form the new hip joint and allow the same and often times more motion than the native hip joint. The femoral and acetabular prosthesis are attached to your bones by creating a space in the bone that is slightly smaller than the metal prosthesis and then pressing the metal prosthesis into this tight space. Occasionally, the metal prosthesis is attached to the bone with bone cement. The parts are made of stainless steel, titanium, ceramic and/or polyethylene. I typically make an incision about 3-4 inches long for a hip replacement.
The purpose of this web page is to educate patients about the major aspects of hip replacement surgery. Many studies have shown that an informed patient will have less surprises and more satisfaction with their surgery. I do not intend to scare people away from getting their hip pain treated. Although the following information is a reasonable overview of what I consider the major aspects of hip surgery, it is not a substitute for a clinical consultation where I can directly answer your questions. If you would like more information, please schedule an appointment to see me.
Remember this is an artificial hip and must be treated with care. Avoid the combined movement of bending your hip and turning your foot in. This can cause dislocation. Other precautions to avoid dislocation are:
Post-op Precautions
The surgery will be performed using general, spinal or epidural anaesthesia. A combination of techniques is often used. The surgeon makes an incision along the affected hip joint, exposing the hip joint.
The femur is separated from the hipbone socket. The socket of the hip joint is exposed. It is reamed to a hemispherical surface and prepared to take the new cup (acetabular component). The new cup is a press-fit; the back of this cup is roughened to allow bone to grow into it. The femur is then exposed and the femoral head is either trimmed or reamed down to an accurate shape to take its new metal component. The metal component is attached to the reshaped femur. This new metal ball will act like the hip joint’s original ball. Then the new ball and the new socket components are joined together to form the new hip joint. The muscles and tendons are then repaired and the skin is closed. Drains are usually inserted to drain excessive blood.
Surgical Procedure
The femur is the longest bone in the skeleton. It joins to the pelvis, acetabulum, to form the hip joint.
The upper part is composed of the femoral head, femoral neck, and greater and lesser trochanters.
Femur
The pelvis is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below. It consists of three parts: the ilium, ischium, and pubis.
The socket, acetabulum, is situated on the outer surface of the bone and joins to the head of the femur to form the hip joint.
Pelvis
The thigh bone, femur, and the pelvis, acetabulum, join to form the hip joint. The hip joint is a “ball and socket” joint. The “ball” is the head of the femur, or thigh bone, and the "socket" is the cup shaped acetabulum.
The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.
The cartilage cushions the joint and allows the bones to move on each other with smooth movements. This cartilage does not show up on X-ray, therefore you can see a “joint space” between the femoral head and acetabular socket.
Introduction: Normal Anatomy
Complications can be medical (general) or specific to the hip