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Complications and risks of surgery

It is extremely important to us, here at the Hip Unit, that you are fully informed about any forthcoming surgery. We would like you to take some time to read about the following risks of hip surgery and ask any questions you may have when you see us in clinic. Hip surgery is a major operation. Although complications are rare, they can still occur.

If you decided not to have a hip replacement at the present time your condition could be managed medically. This concentrates on controlling pain and improving function where possible. Drug treatment with pain killers including anti-inflammatory is often tried to control pain. Other things like losing weight, physiotherapy for muscle strengthening, range of movement exercises and using walking aides may be used to alleviate or control symptoms. However, over time the hip is likely to deteriorate, though no one can predict at what rate.

A hip replacement is generally considered when other non-surgical options can no longer restore function of relieve discomfort adequately and the pain and/or stiffness is affecting your work and daily activities.

As with all procedures, hip replacement surgery carries risks and complications.

The more common complications (2-5%) are:

  • Bleeding - This is usually small and can be stopped in the operation. However, large amount of bleeding may need a blood transfusion or iron tablets. Rarely the bleeding may form a blood clot or large bruise within the wound (haematoma). If this becomes painful, further surgery to remove it may be required. Pain - the hip will be sore after the operation. If you are in pain it is important to tell staff so that medicines can be given at regular intervals. Pain will usually improve with time, but rarely pain will be a long term problem. This may be due to altered leg length, nerve damage, or various other complications. Sometimes there is no obvious reason.
  • Prosthesis loosening/Wear - Modern operating techniques and new implants mean most hip replacements last over 15 years. In some cases, this is significantly less and the reason is often unknown but can be due to excessive wear of the cup liner or from overuse. Infection also causes loosening. If the loosening is significant a revision of the joint replacement will be needed.
  • Leg Length - Occasionally surgery may result in a difference in leg lengths. Your body will generally compensate for small differences. A shoe raise can be used if the difference is large. Rarely a further operation may be required to correct the difference.
  • Joint Dislocation - If this occurs, the join can usually be put back in place without the need for further surgery. Sometimes this is not possible and an operation is required or rarely if the hip keeps dislocating revision surgery may be necessary. You will receive instructions from your care team on activities and positions to avoid which may put you at risk of dislocation. A hip brace may be used to allow the soft tissues to heal following dislocation.
  • Urinary problems - The anaesthetic can cause difficulty in passing urine. In this case a catheter (sterile tube) may be passed in to the bladder to drain the urine and will remain in place for a day or two. Urinary tract infections are effectively treated by a course of antibiotics.
  • Constipation - This is a common complaint following surgery due to medications and immobility. It can be eased by drinking plenty of fluids, eating a well-balanced diet (including plenty of fruit, vegetables and fibre) and walking when able. If necessary it can be treated with laxatives and the nurses in hospital will be able to advise you.

Less common complications (1-2%):

  • Wound Infection - You will be given antibiotics during and after the operation and the procedure will be performed in sterile conditions with sterile equipment. Despite this, infection can occur in the wound. This can happen whilst in hospital or after you go home. The wound site can become red, hot and painful. There may also be a discharge of fluid or pus. All infections are treated by a course of suitable antibiotics although occasionally an operation may be necessary to washout the area.

Rare complications (<1%):

  • Deep Vein Thrombosis (DVT) - This is when a blood clot occurs in the deep veins of the legs (usually). This may present as red, painful and swollen legs. The risks of a DVT are greater after any surgery (but especially bone surgery). It can be easily treated with blood thinning medication. However, if not detected a portion of the clot can sometimes break off and travel to the lungs causing a pulmonary embolism (less than 1%) - a potentially fatal condition (see below-rare complications). Several precautions are used to reduce the possibility of blood clot formation. These include the wearing of TED stockings and flowtron gaiters. These are devices that keep the blood moving in the legs and stop it pooling and forming clots. Flowtron gaiters are only used in hospital when not moving around. Blood thinning medication is also given from the day after surgery. It is since our patients have started taking Rivaroxaban that our incidence of DVT has dramatically reduced, therefore it is important that you remember to take the blood thinning medication that you were prescribed to go home on. It is also important that you continue your bed exercises while you are not moving around and early mobilisation plays a vital part in the prevention of a DVT.
  • Serious infections - Rarely an infection can develop deep around the prosthesis. It would be treated by a course of suitable antibiotics and it may be necessary to washout the joint. If a major infection does not respond to antibiotics the hip implant will need to be removed and replaced at a later date or in extremely rare cases the hip may have to be left without a joint. I frequently, the infection can lead to sepsis (blood infection) and stronger antibiotics are required.
  • Altered wound healing - The wound may become red, thickened and painful (keloid scar) especially in the Afro-Caribbean population. Massaging the scar with cream when it has healed can help.
  • Nerve Damage - Efforts are made to prevent this. However, damage to nerves around the hip is a risk. This can cause temporary or permanent altered sensation along the leg. The sciatic nerve is at most risk and is identified and protected during surgery. Damage can lead to temporary or rarely permanent weakness or altered sensation in the leg.
  • Fracture of the bones of the hip - Rarely a crack or fracture can occur in the bone of the hip. Often this can be fixed during the hip replacement surgery but a later operation may be required for fixation.
  • A heart attack, stroke or chest infection - Any big operation puts a strain on your heart, brain and chest. A very small number of people have serious problems soon afterwards such as a heart attack, stroke or a bad chest infection. These can occur if you already have heart disease or a bad chest. Therefore, if appropriate, the anaesthetist will liaise with your medical team to ensure you are in the best possible condition prior to surgery.
  • Bowel obstruction - Mechanical obstruction of the small or large bowel can occasionally happen. This can often be managed medically by resting your bowel and having a nasogastric tube and fluids. If the obstruction persists, bowel surgery would be required.
  • Pulmonary Embolism (PE) - A PE is a consequence of DVT. It is a blood clot that spreads to the lungs and can make breathing very difficult. A PE can be fatal.
  • Death - This extremely rare complication can occur from any of the above complications.
    • Please do not hesitate to talk to Miss Muirhead-Allwood or one of her team if you have any concerns or questions regarding surgery.

       

Miss Muirhead-Allwood

All surgery at The London Hip Unit team is carried out by Miss Sarah-Muirhead-Allwood BSc FRCS, an internationally renowned specialist hip surgeon. Miss Muirhead-Allwood is supported by a team of registrars, nurse specialists and medical secretaries.

Contact us

The London Hip Unit
30 Devonshire Street
London
W1G 6PU

T: +44 (0) 207 908 3709
E: info@londonhip.com