Total joint replacement is only undertaken after all non-operative measures are exhausted. Because hip replacement is an elective surgical procedure with inherent medical risk, it is essential that patients strive for optimal medical status prior to surgery.
Risks include infection, blood clots, pneumonia, stroke, heart attack, loosening of the hip, dislocation, fracture of bone or implant, injury to nerve or blood vessels, leg length discrepancy, persistent pain, and other post-operative complications. Specific information regarding these risks are detailed below. Your doctor will discuss these with you before surgery. Make sure you understand the risks and alternatives prior to surgery.
The general or regional anesthesia (spinal) used during hip replacement surgery has risks associated with it. These risks are magnified if you have abnormal general medical conditions in addition to older age, which may have affected the functions of your vital organs such as heart, lungs and kidneys. Therefore, a complete evaluation of those systems is performed prior to surgery.
Total Hip Replacement Risks
Deep vein thrombosis and pulmonary embolus: You are given medication to thin your blood in order to prevent these complications. Compression stockings are also frequently used.
Infection: Superficial wound infections may occur early on and deeper infections can occur at a later stage. The incident of infection is less than 1percent. Infections are usually treatable with antibiotic treatment. You are given antibiotics before the operation and for the first few days post operatively to prevent infections from happening.
Leg length discrepancy: It is not unusual for there to be up to 1 centimeter (cm) leg length discrepancy following hip replacement. This is quite easily tolerated. The reason there may be a discrepancy is to ensure that the hip joint is appropriately tensioned so that it does not dislocate. Initially you may think that you have a longer leg but this is often due to muscle contracture which, over time, will loosen up and your leg lengths will even out.
Hip dislocation: The risk of hip dislocation is usually less than 1 or 2 percent. Provided the components are placed correctly and the appropriate post-operative precaution measures adhered to, it is unlikely that the hip will dislocate.
Fractured femur: Very rarely the femoral bone may fracture at the time of surgery and this is usually treated immediately.
Loosening of the prosthesis: The prosthesis may loosen over time if the bone does not grow into it sufficiently or if the bearing surface wears out to produce areas around the prosthesis, leading to loosening. Should a prosthesis loosen, it can be revised. If only the bearing surface wears out, then usually only the bearing surface requires revision.
Damage to nerves and vessels: It is unusual to damage any major nerves or vessels following a hip replacement. Very rarely in hips that have been dislocated for many years, a nerve palsy may result if when the hip replacement is done the nerve joint is stretched.
Hematoma: Occasionally a bleed may occur around the hip joint following the operation that may require drainage.
Swelling: Occasionally the operated leg may remain a little swollen for a number of months but in general this tends to resolve.
Trochanteric bursitis: Occasionally following hip replacement surgery one can experience inflammation at the side of the hip joint which usually settles with either a cortisone injection or anti-inflammatories.
Joint stiffness: Very rarely extra bone can form around your hip joint which will cause it to stiffen up again (heterotopic ossification). This is usually painless but may cause some stiffness.
Your doctor will discuss surgical risks with you during your preoperative consultation. Make sure you understand these risks prior your scheduled hip replacement surgery.