What are the possible complications of surgery?

Total hip replacement surgery is a relatively safe procedure. However, it is important that you understand that no surgery is without risks. Luckily, complications from total hip replacement are uncommon, and the risks appear to be even less with the Minimally Invasive technique. Additionally, choosing a surgeon with significant experience in total hip replacement reduces the risk of complications. In short, more than 95% of patient undergoing total hip replacement obtain a good result with absolutely no problems or complications. Although there is no way that all of the possible complications can be listed here, the most common and /or worrisome complications are:

  • Dislocation Since use of the “Capsular Noose” technique, developed by Dr. Swanson in 2002, the risk of dislocation of the artificial hip has been reduced from 3-4% to <1%. However, if dislocation were to occur it is most likely during the first 6 weeks after surgery, and you will be taught specific precautions to follow during this period. After 6 weeks, the risk of dislocation goes down significantly, although Dr. Swanson suggests that you follow one very simple, basic precaution for the rest of your life to further minimize the risk of dislocation. As a general rule, it is always safe to flex the hip past a 90-degree angle if you have rotated the knee outward enough that you can see the inside part of the knee-keep this rule in mind at all times.If you have sudden onset of pain in the hip or are unable to bear any weight on the leg, you need to call 911 to be brought to the emergency room for an x-ray. Usually, the hip can be put back in place by traction on the leg after an intravenous sedative in the emergency room or anesthetic in the operating room. If your hip dislocates more than 2-3 times, it may require surgery to stabilize the hip.
  • Blood clots can occur in the veins of your legs after any type of hip or knee surgery (“deep venous thrombosis,” or DVT). Although most clots may not even cause symptoms, occasionally a blood clot can travel to your lungs where it can cause more serious problems (“pulmonary embolus,” or PE). You will go home with elastic stockings (TED’s) to prevent blood from “pooling” in your legs and to prevent excessive swelling of the legs. After hospital discharge, these stockings can be removed a few hours at a time for comfort, but you should try to wear them as much as reasonably possible. At four weeks post-op you may begin to remove your TED’s at night. You will require assistance to put on or remove your TED’s.You will also take an adult aspirin twice daily for 6 weeks (or sometimes a more potent blood thinner) to thin your blood a bit. Aspirin is a mild blood thinner that helps prevent blood clots in the legs. Patients at higher risk for blood clots may require home injections for 4-6 weeks. You or a family member will be taught how to administer these injections prior to leaving the hospital. Additionally, you should try to move your ankles up and down frequently (ankle pumps) as this exercise promotes circulation in the legs.If you notice excessive leg swelling, elevate the leg for a few hours to see if it goes away. If it does not, call Dr. Swanson; he may want to send you to the hospital for a simple test to check for a blood clot. Call Dr. Swanson immediately if you are having any difficulty breathing or discomfort in your chest, either which could be a sign of a blood clot traveling to your lungs (“pulmonary embolus”).
  • Nerve damage can occur in a very small number of patients, generally 1% or less. This may either cause difficulty raising the ankle and toes (called a “drop foot”), or weakness in the thigh muscles causing the knee to buckle with weight. It may also cause some numbness in the thigh, leg, ankle, or foot. Approximately half of all nerve palsies will resolve spontaneously and fully; the other half may leave some permanent weakness in the knee or ankle. Occasionally, a patient may need to wear a lightweight plastic brace inside the shoe to support the ankle; however, this is quite uncommon.
  • Infection can occur with any surgery, and total hip replacement is no exception. Although the incidence of infection is low (around ½%), it can be a serious problem, and therefore, additional measures are taken during and after surgery to minimize the risk of infection. If you do develop a deep infection in the hip, it may mean that you will need more surgery, such as removal of the prosthesis, 6 weeks IV antibiotics, and then replacement of the hip once the infection is gone. Patients at slightly higher risk of infection include diabetics, obese patients, patients with certain types of arthritis including rheumatoid arthritis, patients on steroids, and patients who have had prior surgery or infection in the hip. Superficial infections in the incision area are not uncommon and are much less serious. If you notice any redness or drainage around the incision, or recurring fevers, chills, or sweats, call Dr. Swanson immediately.
  • Leg length discrepancy is a possibility with total hip replacement. Much care and pre-operative planning goes into ensuring that your post-operative leg lengths are equal. However, leg lengths can be off by up to ¼ inch or so in some cases. Most patients will not notice a discrepancy of ¼ inch or less, and it is rare that you would need to use a shoe lift for such a small leg length discrepancy. On a rare occasion, and for various reasons, the post-operative leg lengths may be more than ¼ inch different. Usually this is either the result of a fixed obliquity of the pelvis because of a spinal curvature, or the need to lengthen the leg with certain anatomy types to tighten the muscles and reduce the risk of dislocation. We will do everything possible to ensure that your final leg lengths are equal; however, if we have to choose between a leg length discrepancy vs. a dislocating hip, we will usually choose to lengthen the leg a bit in order to minimize the risk of dislocation. Again, this occurs extremely rarely.
  • Wound Healing Problems can occur in a few patients, particularly diabetics, patients with circulatory problems, and the obese. Often these problems require no further surgery and go on to resolve spontaneously. However, it is occasionally necessary to return to the operating room to debride and close the portion of the wound that is not healing.
  • Fracture It is remotely possible to fracture the femur or hip socket with total hip replacement. If a fracture occurs, it may require lengthening the incision to place cables around the fractured femur, and a period of non-weight-bearing after surgery for 6 weeks or so.
  • Loosening/Wear No artificial joint replacement will last forever. Although we expect your total hip replacement to last 20 years or longer, this varies depending on body weight, activity level, implant type, and surgical technique. If your hip replacement fails, it can usually be revised to a new hip replacement.
  • Death The most severe complication of any surgical procedure is death. However, the risk of dying during surgical procedures is extremely remote unless you have very serious medical problems such as end-stage heart or lung problems. If this is the case, the risks will be discussed with you to allow you to make an informed decision about surgery.
  • Although the list of potential complications is long and many are not covered here, the risk of each specific complication is quite small. The anesthesiologist will discuss the potential risks of anesthesia with you. Overall, total hip replacement is a safe procedure with very predictable results, giving good pain relief and restoration of function while having a low risk of complications.

    Reducing the Risk Of Dislocation

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