hip replacement adverse outcomes

This operation involves replacing the ball of the thigh bone (femoral head) and the socket in the pelvis (acetabulum) with an artificial hip joint.  The most common reason for performing this operation is to relieve pain.  There are two broad categories of hip replacement: cemented and uncemented.  In addition a variety of materials are used in the components of a hip replacement.  Your surgeon will discuss which is considered the most suitable for you.

 The following list covers most of the common and/or serious risks of total hip replacement.  However, you need to remember that the vast majority of patients have a good or excellent outcome from this operation and you need to keep in perspective the small chance of any of these events below occurring against the likely benefits of this operation.

INFECTION: Infections can either be close to the skin surface (superficial) or deep in the wound (deep).  The risk of a superficial wound infection is approximately 5 in 100 (5%) and usually can be treated with antibiotics alone.  The risk of a deep infection is less than1 in 100 (1%) and if this occurs further surgery and time in hospital may be required.

 NERVE DAMAGE:  The sciatic nerve can be injured during surgery, (0.5% or 1 in 500 patients) resulting in numbness and weakness in the leg.  Even more rarely other nerves can be injured, eg, the femoral nerve which would result in thigh weakness and leg numbness.

 DISLOCATION:  The hip replacement can dislocate (the components slide out of joint).  There is around a 3-4% risk of this happening and most frequently it occurs within the first 6 weeks of surgery.  Occasionally further surgery may be required to prevent this from recurring.

 BLEEDING/HAEMATOMA:  Occasionally excessive bleeding may occur.  The blood may then accumulate and form a clot (haematoma).  The risk of developing an haematoma is less than 5%.  Infrequently the haematoma may need to be surgically drained.

 DVT or PE: DVT (Deep Vein Thrombosis) refers to clots forming in the deep veins of the legs.  DVT's which cause symptoms occur in less than 5% (5 in 100) patients.  Clots may travel from the deep veins in the legs and lodge in the blood vessels in the lungs (PE or Pulmonary Embolus).  When this happens it may cause no symptoms at all but occasionally it can cause breathlessness and chest pain.  Extremely rarely ie, less than 1 in 10000 (0.001%) it can cause sudden death.

 SWOLLEN LEG:  After hip replacement generalised swelling (oedema)  of your legs may be present for many months  The leg on the side of the hip replacement is usually worse affected..  The swelling will gradually subside over time.

 LEG LENGTH DISCREPANCY:  Occasionally (less than 10%) your leg may be lengthened or shortened after hip replacement surgery.  This is usually within 1 cm of the other side (unless you have significant inequality in your leg lengths prior to surgery).  Sometimes it is necessary to use a shoe raise to balance the leg lengths.  Equal leg lengths CANNOT be guaranteed after hip replacement surgery.

 FRACTURE OF THE FEMUR:  This is more common with uncemented implants (approx 1% with cemented and 3-4% with uncemented).  Further surgery and/or time in hospital may be required.

 PERSISTING PAIN:  Pain to some extent can be experienced for up to 1 year after surgery.  In 1% of cases pain can persist indefinitely with no obvious cause.  Occasionally pain can be referred from other regions to the hip.

EARLY FAILURE OF IMPLANTS:  We expect that you should get at least 10 years from the artificial joint before it needs further replacement.  Sometimes for unexplained reasons hip replacements fail earlier and need to be revised (re-done).

Please also note that it has been shown that smoking significantly increases the risks and complications of surgery and reduces the chance of a successful outcome.