Risks of a Hip Replacement Surgery

Leg length inequality (hip specific)

It is very 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. All leg length inequalities can be treated by a simple shoe raise on the shorter side.

Anesthesia complications

Anesthetics are necessary for performing total joint surgery. In general, most patients receive a spinal anesthetic. Some patient not suitable for spinal anesthetics receive general anesthesia. A very small number of patients have problems with anesthesia. These problems can be reactions to drugs used, problems related to their medical complications and problems due to anesthesia. Be sure to discuss the risks and concerns with your anesthesiologist.

Infection

This may occur in the hospital, after you return home or years later. This occurs in less than 1% of the patients. While many steps are taken to minimize the risk of infection, it can be avoided altogether. In the hospital, you will receive antibiotics for 24 hours during and after surgery to help prevent infection. The operating room is a filtered, clean air environment, and the limb is washed, prepared with antiseptic solution and covered with sterilized drapes.Our surgical team wears masks, sterilized gowns and two pairs each of sterilized gloves that are frequently changed. Some operating rooms have special air conditioning filters. Your surgical team may also wear special space suit like gowns.For two years, you will need to take antibiotics before undergoing even minor procedures to reduce the chances of infection in another part of your body from spreading to the artificial joint. If an infection does occur, your surgeon will have a protocol to manage it.

Blood clots

These may result from several factors, including decreased mobility following surgery, which slows the movement of blood. The blood clots can form in the legs, hips, and pelvis. Symptoms include redness and swelling of the leg, especially in the calf area, and shortness of breath.You can prevent blood clots with:

Blood thinning medications (anticoagulants) for 10 days post- operatively OR possibly 21 days if you have risk factors
Elastic support stockings to improve blood circulation
Elevating the feet and legs to keep blood from pooling
Moving toes and legs immediately after surgery
Out of bed the afternoon of surgery and then as tolerated

Fractures

This can occur when preparing the bone surfaces for and implanting the artificial components. The risk is higher when bones are weakened by previous surgery.

Pneumonia

This is always a risk following major surgery. You will be assigned a series of deep breathing exercises to keep your lungs clear.

Dislocation and instability (hip specific)

An artificial hip joint is held in place by your own muscle. Stability also depends on the position in which the hip is placed by your surgeon.Dislocation can damage the artificial joint and cause early failure and revision surgery. This is most likely to occur within the first 6-12 weeks after the surgery. There are specific precautions you must follow; while sleeping, washing, bending and toileting. As time goes on, the risks are reduced; however, some precautions remain.If your hip comes out of joint it must be put back in place. This usually requires a very brief general anesthetic while the leg is firmly pulled until the artificial hip drops back in place. You may be able to avoid further problems by avoiding at risk positions.

Hematoma

A Brownish red fluid may drain out of your incision around 2 weeks after surgery. This is a common occurrence and you should not be alarmed by this drainage. Clean the incision with hydrogen peroxide, replace the dressing and notify your surgeon.

Nerve and vessel injury

There is a 0.7 % chance of neurological stretch injury at the time of surgery. The sciatic and femoral nerve, located adjacent to the hip, is vulnerable to injury and on rare occasions may cause weakness or loss of feeling about the foot.

Loosening

The major reason artificial joints eventually fail continues to be a process of loosening where the metal or cement meets the bone. Great advances have been made to extend the life of an artificial joint, with many patients reporting excellent function for many years. If the pain of a loose joint becomes unbearable, another operation may be required to revise it.

Although every effort has been made to explain the complications there will be complications that may not have been specifically mentioned. A good knowledge of this operation will make the stress of undertaking the operation easier for you to bear.

The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery.

You must not proceed until you are confident that you understand this procedure, particularly the complications.

The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery.

You must not proceed until you are confident that you understand this procedure, particularly the complications.

American Academy of Orthopaedic Surgeons

The American Board of Orthopaedic Surgery

A total hip replacement is one of the most successful operations that orthopedic surgeons perform. A hip replacement is an elective surgery, which means patients decide if and when to have their hip replaced. As a physician, I never tell patients they have to have a hip replacement surgery, but many times surgery may offer the only possibility for pain relief. Although the surgery is elective, it is covered by most insurance companies; however, depending on your policy you maybe required to make a small co-payment. My philosophy is to give my patients as much information as they need to make informed decisions regarding their health and hip pain and then treat their hip pain according to their wishes.

A hip joint is basically a ball and socket joint. A hip replacement involves removing the ball (femoral head) and replacing it with a metal prosthetic ball. The femoral prosthesis is inserted into the hollow part of the femoral shaft. The socket of the pelvis is machined into a hemisphere and a metal hemisphere is inserted into the socket. The new metal ball and new metal socket form the new hip joint and allow the same and often times more motion than the native hip joint. The femoral and acetabular prosthesis are attached to your bones by creating a space in the bone that is slightly smaller than the metal prosthesis and then pressing the metal prosthesis into this tight space. Occasionally, the metal prosthesis is attached to the bone with bone cement. The parts are made of stainless steel, titanium, ceramic and/or polyethylene. I typically make an incision about 3-4 inches long for a hip replacement.

The purpose of this web page is to educate patients about the major aspects of hip replacement surgery. Many studies have shown that an informed patient will have less surprises and more satisfaction with their surgery. I do not intend to scare people away from getting their hip pain treated. Although the following information is a reasonable overview of what I consider the major aspects of hip surgery, it is not a substitute for a clinical consultation where I can directly answer your questions. If you would like more information, please schedule an appointment to see me.

Remember this is an artificial hip and must be treated with care. Avoid the combined movement of bending your hip and turning your foot in. This can cause dislocation. Other precautions to avoid dislocation are:

Post-op Precautions

The surgery will be performed using general, spinal or epidural anaesthesia. A combination of techniques is often used. The surgeon makes an incision along the affected hip joint, exposing the hip joint.

The femur is separated from the hipbone socket. The socket of the hip joint is exposed. It is reamed to a hemispherical surface and prepared to take the new cup (acetabular component). The new cup is a press-fit; the back of this cup is roughened to allow bone to grow into it. The femur is then exposed and the femoral head is either trimmed or reamed down to an accurate shape to take its new metal component. The metal component is attached to the reshaped femur. This new metal ball will act like the hip joint’s original ball. Then the new ball and the new socket components are joined together to form the new hip joint. The muscles and tendons are then repaired and the skin is closed. Drains are usually inserted to drain excessive blood.

Surgical Procedure

The femur is the longest bone in the skeleton. It joins to the pelvis, acetabulum, to form the hip joint.

The upper part is composed of the femoral head, femoral neck, and greater and lesser trochanters.

Femur

The pelvis is a large, flattened, irregularly shaped bone, constricted in the center and expanded above and below. It consists of three parts: the ilium, ischium, and pubis.

The socket, acetabulum, is situated on the outer surface of the bone and joins to the head of the femur to form the hip joint.

Pelvis

The thigh bone, femur, and the pelvis, acetabulum, join to form the hip joint. The hip joint is a “ball and socket” joint. The “ball” is the head of the femur, or thigh bone, and the "socket" is the cup shaped acetabulum.

The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.

The cartilage cushions the joint and allows the bones to move on each other with smooth movements. This cartilage does not show up on X-ray, therefore you can see a “joint space” between the femoral head and acetabular socket.

Introduction: Normal Anatomy

Complications can be medical (general) or specific to the hip