There are always risks associated with surgery, and you need to be fully aware of those risks before making your decision to proceed with an operation.
Do not hesitate to ask questions of your surgeon, anaesthetist or of other medical specialists who are managing your health in the lead up to your surgery. If you do not understand what you have been told, do not hesitate to seek clarification from us.
The vast majority of people get through the surgery with no problems at all and will be surprised at how good they feel so soon afterwards. Some will experience minor issues and occasionally there may be more serious complications. These problems are rare and most can be treated quickly and effectively. Below is a list which covers the major risks and complications you may face. Additionally, there may be other risks, particularly if you have a complex medical history or particular conditions which need to be managed by a medical specialist.
Risks associated with Hip Replacement Surgery
Infection
Superficial infection of the wound soon after surgery can occur and it is usually treated quickly and successfully with a week of antibiotics. If you are concerned about your wound or the possibility of infection in your joint then contact our rooms for advice. If you cannot reach us out-of-hours, you can contact the Mater Hospital or your GP for immediate attention. Remember, it is best not to touch your wound unnecessarily, as this is a likely way to introduce organisms to the wound.
Deep infection (infection of the prosthesis) is one of the complications of joint replacement surgery. It is very uncommon, but it can happen and patients should be aware that this is a risk of surgery. Infection can occur when you are in a hospital, or when you are at home and usually appears as pain, swelling, redness and warmth of the joint. This may be accompanied by fever and sweats. Acute deep infection may require surgical wash-out and chronic deep infection may require removal or revision of the joint. If you are concerned about the possibility of deep infection, seek immediate medical advice.
A word about other infections unrelated to the wound or joint
With regard to other infections in the body (mouth, superficial cuts on the skin etc) which are not related to your joint replacement surgery, these should be treated immediately by your general practitioner, because it is possible for an infection to spread from another part of the body to the joint replacement.
If you are having extensive dental work such as root canal therapy or treatment for a tooth abscess, you should ensure your dentist knows you have a hip replacement and provides you with appropriate antibiotics if needed. Mouth infections and tooth decay should be addressed before you have surgery to protect you from infection risk when you have joint replacement. The Arthroplasty Society of Australia has prepared a document specifically for dentists.
Loosening of implant
Loosening is a very rare complication with the modern cement-free implants we use. It is usually detected on follow-up X-rays and bone scans. Loosening can be fixed with further surgery.
Dislocation
Dislocation can occur after hip replacement surgery. Dislocation is more likely to occur during the first 6 weeks after surgery, but can happen at anytime. Dislocation usually occurs when the hip is put into a position that allows the ball of the prosthesis to come out of the socket. In the first 6 weeks it is necessary to take precautions to minimise the risk of this happening.
The physiotherapist and the nursing staff will remind you what positions are safe to reduce the risk. If a hip dislocates it is necessary to have it put back into place and sometimes it is necessary to have further surgery on the hip to prevent this from happening again. In the event of dislocation, you will be in pain and will need to call an ambulance to take you to the nearest hospital. In this event, please ask the orthopaedic registrar who assesses you in the emergency department to contact Professor Bill Walter.
Fracture
Fracture of the femur or acetabulum (peri-prosthetic fracture) can occur after the surgery particularly if the patient falls. Peri-prosthetic fracture can also result from overzealous rehabilitation in the first few months after surgery. It is important to limit the forces on your hip or knee for the first 2 months after surgery to let the body heal. This complication is more common in elderly people and in people with osteoporosis where the bone is soft.
The treatment of periprosthetic fracture may be protected weight bearing or it may be necessary to do further surgery. Fracture can occasionally occur during the surgery, particularly if your bone quality is poor and if this happens, your surgeon will place a wire around the fracture and you will be instructed to use crutches or frame for 6 weeks to give the fracture time to heal. Sometimes a wire is used as a preventative measure during surgery, if the surgeon feels there is a particular risk of fracture after surgery.
Femoral neck fracture (hip resurfacing patients only)
Patients who have resurfacing hip replacement should know there is a risk of femoral neck stress fracture (this does not occur with the total hip replacement, because the femoral neck is replaced). If you have had hip resurfacing and you experience worsening pain upon weight bearing in the first 6 to 12 months after surgery, you should visit your GP or contact Professor Bill Walter immediately.
A stress fracture may not show on X-ray and usually requires a clinical diagnosis (ie. the surgeon will examine you). After surgery, the hip should steadily improve. It is very important that if you experience worsening pain upon weight bearing, that you do not put weight on it until you have been assessed. If detected early, this can usually be treated with crutches for 6 weeks, but if it is left unchecked it is more likely to result in revision surgery.
Impaired nerve function
Numb patches on the skin near the surgical wound are common, particularly with knee replacement and with the anterior approach hip replacement. This numb patch usually becomes less obvious with time but may remain there permanently. Rarely a painful neuroma may develop.
On very rare occasions, nerves in the vicinity of the joint replacement can be stretched or injured during the operation causing paralysis of muscles in the leg (foot drop or quadriceps paralysis). This is more likely when the orthopaedic surgeon needs to correct a leg length inequality but can occur with straightforward hip or knee replacement. With time, these nerves usually begin to function again. In rare instances, there can be a permanent deficit.
Deep vein thrombosis (DVT) and pulmonary embolism (PE).
With any surgery, there is a risk of developing blood clots. This risk is increased in people who undergo joint replacement surgery. Numerous steps are taken to prevent patients from developing clots but some patients still get them. Early mobilisation is the best way to prevent clots. If you are at particular risk of DVT you will be instructed to wear TED (thromboembolic) stockings. TED stockings help reduce the incidence of blood clots. You may also receive blood-thinning medication and wear calf compression devices post operatively to help prevent blood clots from forming.
DVT is usually treated with extended use of blood thinning medications. Prior to your discharge from hospital an ultrasound may be done on both lower legs to determine if a clot is present. If a blood clot is found, it will be treated. A pulmonary embolism may occur if the clot detaches from the veins in the legs and travels to the lungs. This form of clot requires more extensive treatment. Pulmonary embolism can cause breathing difficulties and is rarely fatal. Blood clots in the legs are common occurring in around 15% of patients but pulmonary embolism is unlikely (around 1%) and fatal pulmonary embolism is extremely rare.
If you are concerned about leg swelling, or shortness of breath, after being discharged from hospital, please contact your GP or emergency department.
Stroke/Heart attack/Pneumonia resulting in death
Stroke, heart attack and pneumonia resulting in death, can occur following any anaesthesia and surgery. Fortunately they are extremely rare.
Reaction to wear debris
There is now some research which indicates that some people are allergic to the metal used in hip replacement surgery. It is more likely to occur in resurfacing hip replacement which has metal bearing surfaces. It can present as pain and swelling in the groin area years after the surgery. Patients should make an appointment to see the surgeon if this occurs. Regular follow-up can allow early detection and treatment.
Polyethylene or metallic wear debris can cause local soft tissue injury or bone loss (osteolysis) and maybe a reason for revision surgery.
Some other rare problems – Squeaking and breakage
Squeaking of hip replacements is a problem occurring in about 3% of patients. Usually, it is intermittent and a curiosity only and doesn’t bear any relationship to a patient’s satisfaction in terms of the functionality of the hip. Occasionally it may be frequent enough and loud enough to require further intervention. Ceramic is a material used in the hip implant and it may break, requiring revision surgery.