Joint Replacement Institute

Benefits

Following total hip replacement, joint surfaces will again be smooth and slide easily. This gives most patients pain relief, an increased range of motion, and unlimited walking ability. You may be able to take part in physical activities which before surgery were impossible. However, your hip will not be normal - remember that you will have a prosthetic joint!

Risks and Potential Complications

All surgeries have risks, so the potential benefits must be carefully weighed. Some complications are related to the surgical procedure and some are related to the delicate balance of the body which is altered during the operation.

Potential complications of any surgery include: the risks of anesthesia, bleeding, infection, blood clots, and death. With modern techniques, the risk of anesthesia related complications is very low. Epidural anesthesia (which numbs your legs) has the advantage of enhanced post operative pain relief and potentially less blood loss. If a blood transfusion is required, there is a potential risk for a transfusion reaction or disease transmission (e.g. hepatitis), and therefore, autologous blood (your own) is preferred (see section 8). Prophylactic antibiotics, strict sterile technique, and a special airflow system are used to help prevent infections which occur in less than 1% of cases.

Leg elevation, elastic stockings (TED stockings), ankle exercises, and Coumadin (blood thinning medicine) are used to help prevent blood clots. Tables 1 and 2 below list factors which can increase or decrease the risk of thromboembolic disease (blood clots). A thorough medical evaluation is required prior to surgery which can help identify other potential medical problems and, thereby, minimize those risks.

Table 1

FACTORS THAT CAN INCREASE THE RISK OF THROMBOEMBOLIC DISEASE:

Table 2

FACTORS THAT CAN DECREASE THE RISK OF THROMBOEMBOLIC DISEASE:

Potential complications which are related to hip replacement surgery include: a slight dissimilarity in length of the operated leg (inability to fully restore all of previous lost length or over-lengthening), dislocation of the hip, wear and/or loosening of the prosthesis (this is related to activity level), and growth of excess bone around the joint called "heterotopic bone" which can cause stiffness and occasionally pain. An anti-inflammatory medication such as Indocin can be used to prevent or minimize the risk of heterotopic bone. Although rare, there can be problems with healing the trochanter (a bony prominence which is infrequently removed during surgery to obtain better access to the hip joint), fracture of the bone (more common with the porous or press-fit type prosthesis), and nerve injury which can cause muscle weakness in the leg or foot.

The bone ingrowth implants may develop long-term problems related to the bone junction with the porous ingrowth areas, such as corrosion, or problems of bonding of the irregular porous layers to the components. Rarely have the implants broken. Annual follow-up visits will enable us to carefully evaluate and treat any early warning signs of problems. Also, if you have consented to participate in an FDA supervised clinical trial by receiving an investigational device, you will be expected to comply with the study’s requirements such as regular post-operative follow-up examinations.

Our experience is based on over 4,000 total hip replacements performed since 1970 and these results are continually updated. As a result, your surgeon has experience with the types of complications which can occur and he or she is making every effort to minimize them. The patient’s cooperation is very important in helping to minimize complications by banking blood (autologous) preoperatively, receiving antibiotics in the hospital to minimize infection, taking prophylactic anticoagulants,and wearing elastic "TED" stockings during and after hospitalization to minimize blood clots.

Sepsis

Patients who have had infections of hip joints may be advised to have delayed reinsertion of a total hip replacement (two operations: one for removal and one for reinsertion of the implants); or direct exchange which involves thoroughly removing the infected implants and tissue and reinserting a new implant at the same operation. While the success of these procedures has continued to increase, special precautions are recommended. These include careful monitoring and close observation in the postoperative period because there is a risk for the recurrence of infection.

Diabetes	Hyperlipidemia	Hyperthyroidism
High vitamin K diet	Malabsorption syndrome	Edema
Diuresis	Immobilization	Decreased resistance

Carcinoma	Collagen vascular disease	Congestive heart failure
Diarrhea	Fever	Hepatitis
Hypothyroidism	Jaundice	Malnutrition
Scurvy	Liver disease	Bleeding disorders
Varicose veins	Old age	Previous thromboembolic episodes