Risks and complications
The decision to proceed with surgery is made when the advantages of surgery outweigh the potential disadvantages. This decision is made by you, in discussion with your specialist, your family doctor your spouse and family.
As with any major surgery, there are potential risks involved.
It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) in nature or specific to the hip.
Medical Complications include those related to the anaesthetic and your general wellbeing.
Your anaesthetist will plan your anaesthetic with you prior to the surgery to ensure this is the safest and most appropriate method for you to have your surgery.
Serious medical problems can lead to ongoing health concerns, prolonged hospitalization or rarely death.
A risk of a fatal event within 3 months of joint replacement surgery is approximately one per 3,000 patients. The commonest causes of fatality is heart attack, stroke, or pulmonary embolus.
Often, medical complications are due to underlying pre-existing health conditions, but may also occur unexpectedly with no known risk factors.
Serious medical complications include:
- Heart attack or stroke
- DVT or pulmonary embolus (clots in leg or lung). These clots can form in the calf muscles and can travel to the lung. A range of preventative measures are taken during and after surgery.
- Allergic reaction to medications or wound dressings
- Urinary tract infection, change in bladder habit including urinary frequency or retention, kidney failure
- Gastro-intestinal upset including nausea, vomiting, constipation, diarrhoea, bowel obstruction
- Respiratory issues such as pneumonia, shortness of breath.
Specific Hip Complications
Specific complications include
Infection can occur with any operation. The infection may be limited to the wound, and this case it is referred to as superficial. If this occurs it can be treated with antibiotics and usually does not require further surgery.
More concerning, is a deep infection, where bugs invade the tissue and in and around the hip joint itself. In this situation, further surgery is almost always required. Infection rates are approximately 1% or less. Very rarely your hip replacement implant may need to be removed to eradicate infection.
This means the ball of the hip comes out of its socket. This is painful and unmistakable if it occurs. An ambulance needs to be called with treatment at the narrowest emergency department to manipulate the hip back into joint. The riskiest time for this is the first 3 months after surgery. This is because the muscles have not fully recovered from the arthritic state or the healing after surgery. There are restrictions on your mobility for the first 3 months after surgery for this reason. After 3 months there are no specific restrictions. Rarely this becomes a recurrent problem needing further surgery.
Damage to nerves or blood vessels
Rarely, damage to nerve or blood vessels can occur during the surgery. At worst, this 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.
The surgical wound itself usually heals reliably into a thin, pale, almost invisible wound approximately 15 cm long. It can however broaden or remain pink or purple rather than a white colour. This is entirely due to individual differences in healing between patients.
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.
It is usually tender to lie on the operated hip for 2-3 months after surgery. This is because the wound is situated over the bony prominence of the hip. This will decrease over time.
Unusually, a condition called fat atrophy can cause a depression in the contour of the buttock in response to the incision. There is no way to predict or prevent this.
More commonly, the operative site remains swollen for 6-8 weeks after surgery and will gradually diminish.
It is possible to adjust your leg length during hip replacement surgery. Usually, if the affected hip has resulted in a short-leg, one of the aims of surgery is to correct this, and achieve equal leg length. Careful digital planning is performed prior to the surgery based on your x-rays. It is however 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. Any residual leg length inequality can be treated by a simple shoe raise on the shorter side.
Like any mechanical part, all joint replacement will eventually wear out. However, with modern materials, our current generation of hip replacements are expected to last on average well in excess of 20 years. Obviously this cannot be guaranteed for any individual, and many factors such as body type, level of activity, age at surgery will have a bearing on this. Luckily, as this occurs, moderate hip replacements are usually easily able to be updated with a partial revision or a full replacement if necessary (although obviously this does require further surgery).
We arrange long-term follow-up with an x-ray every 5 years, even if you are feeling 100%, to ensure there is no undue wear or loosening of the implant developing.
Hip replacement surgery will reliably relieve pain that arises from inside the hip joint. All of the arthritic bone is removed, therefore, it cannot be because of ongoing pain.
However a proportion of pain may come from structures around the hip joint, and these of course cannot be expected to be relieved by simply replacing the ball-and-socket joint.
The commonest cause of residual pain around the hip replacement is due to wearing out of the tendons that control the hip joint itself. These same muscles and tendons control the new hip replacement. There is no surgical treatment for the of these tendons, so if this sort of pain persists, the treatment usually involves medication, physiotherapy and rehabilitation.
The lumbar spine (low back) is also a cause of pain that appears to originate around the hip. Usually, this can be determined prior to surgery. Obviously, pain arising from the low back will not be relieved with a hip replacement operation. However, if an arthritic hip is particularly stiff, it often puts a lot of load on the low back, and freeing up the hip with a hip replacement can actually improve low back pain brackets although this can of course not guaranteed).
A limp can be caused by several reasons. If it is as a consequence of hip joint arthritis itself then this has a very high probability of being relieved with the surgery.
If the limp is due to shortening of the leg caused by the arthritis, and this is able to be corrected at the time of surgery, then this type of limp will also improve with surgery.
A limp may also be due to muscle weakness from disuse. That is, the hip is too painful to use normally, and the muscles get weak. As long as the muscles themselves are OK, then this type of limp will also improve after hip replacement surgery.
However, a limp that is caused by a problem with the muscles themselves, the muscle attachment to the hip, or a neurological disorder is unlikely to recover.
Fractures (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
Spelling out all of these potential complications does of course make the prospect of surgery even more daunting.
Rest assured, surgery is never recommended water undertaken if you are Surgeon and anaesthetist judged that the risks outweigh the benefits.
Nevertheless, if you have specific concerns about any of the above, please discuss with your specialist prior to committing in proceeding with surgery.