When undergoing any type of surgical procedure you are subject to various risks and complications. Although joint replacement surgery is quite safe and predictable, you should be aware of any possible complications and your surgeon will advise you of these.
When you return home, contact your doctor if:
- You have any pain which doesn’t settle with pain relief
- You have swelling that doesn’t reduce with elevation
- Your wound area becomes red or you feel unwell
Possible Serious Complications
Infection
This is one of the serious complications of a joint replacement. Infection may be superficial or deep around the prosthesis. Infection can occur early, while in hospital, or when at home, and usually presents with pain, swelling, redness and warmth in the joint. Deep infections around the prosthesis may require removal of the arthroplasty. Thankfully, deep infections are rare, occurring in less than 0.5%. Superficially infections if they occur are usually treated with oral antibiotics for five to seven days. The following steps are taken to reduce the risk of infection:
- Keep your wound dressing intact
- Take care not to wet your wound
- Use medications as and if advised by your surgeon
Late infection
Infection can spread through the blood from any part of the body to a joint replacement. This can occur many years after the surgery. To prevent such an infection antibiotics should be given for any extensive dental surgery, tooth abscess or root canal therapy. Any systemic infections such as urinary tract infection should be treated aggressively with antibiotics. If any further surgery is required you should be covered with prophylactic antibiotics.
Dislocation
A total hip replacement and is an unconstrained prosthesis, which means that the two who components are not connected. These may dislocate if the hip is put in the position that allows the ball to come out of the socket. In the first six weeks precautions needs to be taken to avoid the risk of this happening. Your physiotherapist, occupational therapist and nursing staff will assist you in avoiding the positions and reduce the risk of dislocation.
Fracture
Fracture of the femur or acetabulum is possible during or after surgery. This is more common in elderly patients who may be suffering from osteoporosis. Depending on the position of the fracture and the stability of the prosthesis further treatment usually requires a re-operation and further fixation with a period of protected weight bearing.
Nerve or vessel injury
Nerves and vessels, especially the sciatic nerve are very closely apposed to the joint. These may be stretched or damaged during the operation, which may cause paralysis or numbness of the leg. This may occur in patients who have had considerable deformity, especially with large leg length discrepancies.
Bearing surface wear
The traditional bearing surface for a total hip arthroplasty was a metal on polyethylene articulation (metal on plastic). This would wear over time which led to osteolysis or resorption of bone after 10 to 15 years. Modern bearing surfaces such as the latest generation ceramic on ceramic have wear rates of a hundred times less than the metal on polyethylene articulation. Theoretically these bearing surfaces should last much longer.
Ceramic fracture
Although the ceramic bearing services have superior wear characteristics, they are quite brittle and have an incidence of ceramic fracture of one in a thousand in the earlier generation of ceramics.
Deep Venous Thrombosis (DVT)
Deep Venous Thrombosis can occur when blood flow becomes sluggish within the veins of the lower limbs, leading to clot formation (thrombosis). The symptoms of DVT may include pain, redness and swelling in the lower leg. There are several ways to reduce the risk of developing DVT. They include:
- Lower limb exercises (e.g. foot and ankle exercises)
- Early mobilisation
- Support stockings
- Medication (tablets and or injections)
Pulmonary Embolism (blood clot)
Pulmonary Embolism occurs when a blood clot breaks off and goes to the lung. You may be spending more time than usual in bed and therefore less active during your post surgery recovery period. This can result in the slowing of blood flow around the body, potentially leading to blood clots. To reduce the likelihood of this happening:
- Early active mobilisation is the best help
- Wear support stockings
- Elevate both legs higher than your heart for at least half an hour twice a day
- Take blood thinning medication if advised by your doctor
