Information for Patients

Information for patients photo

9 Complications:

 

Complications are fortunately uncommon after hip replacement surgery. It is estimated that 95% of people having the surgery describe their replaced hip as excellent afterwards. Indeed the majority of patients will get to a state known as the “forgotten joint” where they are not aware that it is an artificial hip. There are however complications. These can be grouped into common (2-5%), less common (1-2%) and rare (less than 1%) complications.

 

Common (2-5%)


Blood clots: A deep vein thrombosis (DVT) is a blood clot in a vein. These may present as red, painful and swollen legs (usually). The risks of a DVT are greater after any surgery (and especially bone surgery). Although not a problem themselves, a DVT can pass in the blood stream and be deposited in the lungs (a pulmonary embolism – PE). This is a very serious condition which affects your breathing. Your doctors may give you medication through a needle to try and limit this risk of DVT’s from forming. Some centres will also ask you to wear stockings on your legs, while others may use foot pumps to keep blood circulating around the leg. Starting to walk and getting moving is one of the best ways to prevent blood clots from forming.


Bleeding: This is usually small and can be stopped in the operation. However, large amounts of bleeding may need a blood transfusion or iron tablets. Rarely, the bleeding may form a blood clot or large bruise within the wound which may become painful and require an operation to remove it.


Pain: The hip will be sore after the operation. If you are in pain, it’s important to tell staff so that medicines can be given. Pain will improve with time. Rarely, pain will be a long term problem. This may be due to altered leg length or any of the other complications listed below, or sometimes for no obvious reason.


Prosthesis wear/loosening: Modern operating techniques and new implants, mean that most hip replacements last over 15 years. In some cases, this is significantly less. The reason is often unknown. Implants can wear from overuse. There is still debate as to which material is the strongest. The reason for loosening is also unknown. Sometimes it is secondary to infection. This may require removal of the implant and revision surgery.


Altered leg length: The leg which has been operated upon, may appear shorter or longer than the other. This rarely requires a further operation to correct the difference or shoe implants.


Joint dislocation: If this occurs, the joint can usually be put back into place without the need for surgery. Sometimes this is not possible, and an operation is required, followed by application of a hip brace or rarely if the hip keeps dislocating, a revision operation may be necessary.

 

Less Common (1-2%):


Infection: You will be given anti-biotics just before and after the operation and procedure will also be performed in sterile conditions (Theatre) with sterile equipment. Despite this there are still infections (1 to 2 ½ %). The wound site may become red, hot and painful. There may also be a discharge of fluid or pus. This is usually treated with antibiotics, but an operation to washout the joint may be necessary. In rare cases, the implants may be removed and replaced at a later date. The infection can sometimes lead to sepsis (blood infection) and strong antibiotics are required.

 

Rare (less than 1%):


Altered wound healing: The wound may become red, thickened and painful (keloid scar) especially in Afro-Caribbean people. Massaging the scar with cream when it has healed may help.


Nerve damage: Efforts are made to prevent this, however damage to the nerves around the hip is a risk. This may cause temporary or permanent altered sensation along the leg. In particular, there may be damage to the Sciatic Nerve. This may cause temporary or permanent weakness or altered sensation of the leg.


Bone Damage: The thigh bone may be broken when the implant (metal replacement) is put in. This may require fixation, either at the time or at a later operation.
Blood vessel damage: The vessels around the hip may rarely be damaged. This may require further surgery by the vascular surgeons.


Pulmonary embolism: A PE is a consequence of a DVT. It is a blood clot that spreads to the lungs and can make breathing very difficult. A PE can be fatal.
Death: This rare complication can occur from any of the above complications.

 

5 THE SURGICAL JOURNEY

 

Consultation


You will have usually been referred by your General Practitioner. He most likely would have had X-rays at some stage. If these had been arranged fairly recently by your General Practitioner, we will obtain the films. If these are not the appropriate X-rays, or are over six months old, you will normally have an X-ray immediately prior to your clinic appointment.

 

During the consultation your condition will be assessed, the X-rays reviewed and a discussion on the management of the problem will take place. The pros and cons of surgery against conservative treatment will be discussed and if surgery is decided upon, the most appropriate form of surgery will be discussed, taking into account advantages and disadvantages of the surgery. At the end of the consultation a decision may be made to go ahead with surgery or alternatively it can be left for you to think about prior to making a decision later.

 

Occasionally it will be necessary to do further tests on you prior to making a decision and these will be arranged following the initial consultation.