Regardless of the type of material used in the hip replacement surgery, there are certain risks associated with the procedure. Blood clots in the legs which travel to the lungs are known as pulmonary emboli, and, while relatively rare, can lead to respiratory failure and even death of the patient. The following complications can also occur in those who undergo hip replacement surgery:
· Urinary difficulty
· Hip dislocation
· Hip joint infection
· Excessive scarring
· Bone fracture during surgery or post operative
· Leg length discrepancy
· Femur fracture
· Vascular or nerve injuries
· Heterotopic ossification
· Limited motion of the hip following surgery
· Loosening of the implant device, eventually leading to prostheses failure
· Risks associated with anesthesia including pneumonia, liver toxicity and heart arrhythmias
Infection of the hip joint, while relatively uncommon, can be devastating. Approximately 1-2% of patients who undergo hip replacement surgery will develop an infection; if the infection cannot be controlled, removal of the artificial joint could be required. Patients suffering from rheumatoid arthritis, diabetes, alcoholism, obesity, or those taking drugs which suppress the immune system are at a greater risk of infection.
There is a risk during artificial hip implantation of the operated leg being lengthened or shortened, thus creating a discrepancy in leg length. While this is not a common result of the surgery, it can occur. Generally speaking, more experienced surgeons are less likely to create a leg length discrepancy in a patient undergoing hip implant surgery than a new surgeon or a surgeon-in-training. If the discrepancy is significant, revision surgery may be required.
A crack, split or break in the thigh bone during the surgical procedure is known as fracture of the femur and can occur during the insertion of the implant device. The problem is usually treated with cable or wire fixation to allow the femur to heal. Vascular injuries can occur when the screws which hold the acetabular cup in place penetrate an artery or vein, while nerve injuries can be caused when the nerves surrounding the hip are injured during cauterization, incision or stretching. When nerves are damaged, permanent or temporary numbness can occur.
Heterotopic ossification causes bone to form in places bone is not generally present, particularly in muscles adjacent to the surgical site. Men, and those who have developed secondary osteoarthritis after a traumatic event, are particularly at risk for developing heterotopic ossification. The new bone may need to be excised, as it can cause problems for the patient, including chronic pain. Loosening of the hip implant is caused—in some cases—by an allergic reaction to bone cement debris, or debris from polyethylene, or metal implants. Younger, more active recipients of hip implants are more likely to experience loosening of the device as are those who have undergone a prior hip surgery.
Hip dislocation may well be the most common problem which follows hip replacement surgery. The artificial ball and socket is typically smaller than the natural ball and socket; because the overall muscle structure of the hip has been weakened, when the hip is placed in specific positions, the artificial ball can become dislodged. The positions most likely to cause hip dislocation include pulling the knee towards the chest and rotating the leg outward or inward significantly.
While hip replacement surgery using a metal-on-plastic, ceramic, or polyethylene implant device is generally quite successful, the success of the procedure can significantly affected by the rehabilitation period following the surgery. Rehabilitation will begin almost immediately following the surgery; the patient will begin working with a physical therapist and will continue working at their home or in a local gym.
Issues to Consider Following Hip Replacement Surgery
Hip replacement is major surgery, meaning patients will need to take it easy the first few days after surgery. Generally speaking, by eight weeks post-op you should be weight-bearing with little support. This amount of time gives the joint the protection it needs, and, if you received an implant with a porous coating rather than screws, the bone will need time to grow into that coating. Patients may be prescribed pain medication, antibiotics and blood thinners (to help prevent blood clots from forming in the veins of the thigh and calf). It is especially important to take all your antibiotics in order to prevent any bacterial infections from settling in your joint implant. Many people lose their appetite and feel nauseous for a couple of days and will be given instructions on breathing exercises which keeps the lungs and chest clear. While it is important that patients are up and about as soon as possible following the surgery—in order to keep the blood flowing in your legs—there are certain things to be aware of.
When climbing stairs (which should be limited until healing is well on its way), the unaffected leg should always step up first, then the affected leg should be brought up to the same step, continuing this way to the top of the stairs. The process is repeated going down the stairs. Depending on what type of work the patient does, it could be as long as 3-6 months before full-time employment is resumed. Try not to cross the legs for the first eight weeks following surgery, and don’t bend at the waist beyond ninety degrees. Try to keep the affected leg facing forward, and don’t kneel on either the affected or unaffected leg. Try not to turn the feet excessively inward or outward, and while exercises should be continued, they should be limited if the muscles begin to ache.