THR - Total Hip Replacement
Complications
Approximate THR surgical risks
|
Risk % |
1 in |
Procedure |
Risk |
|
16.6667% |
6 |
Spinal |
Hearing loss |
|
5.0000% |
20 |
Operation |
Dislocation (in first 5 years) |
|
4.0000% |
25 |
Operation |
Bone forming in muscles |
|
3.3333% |
30 |
Epidural |
Low blood pressure |
|
2.5000% |
40 |
Operation |
Blood clot (DVT) |
|
2.5000% |
40 |
Operation |
Loosening (in first 5 years) |
|
2.0000% |
50 |
Operation |
Split in femur |
|
1.4286% |
70 |
Operation |
Infection |
|
1.0000% |
100 |
Epidural |
Headache from spinal fluid bag puncture |
|
1.0000% |
100 |
Operation |
Nerve damage |
|
1.0000% |
100 |
Spinal |
Headache from spinal fluid bag puncture |
|
0.5000% |
200 |
Epidural |
Pins and needles (up to 12 weeks - 0.33% to 1.0%) |
|
0.5000% |
200 |
Operation |
Heart attack |
|
0.4000% |
250 |
Operation |
Blood clot in lung |
|
0.2500% |
400 |
Epidural |
Respiratory depression |
|
0.2000% |
500 |
Epidural |
Toxicity |
|
0.1000% |
1,000 |
Epidural |
Pins and needles (over 6 months) |
|
0.1000% |
1,000 |
Operation |
Blood vessel damage |
|
0.0200% |
5,000 |
Spinal |
Unexpected high hblock |
|
0.0111% |
8,975 |
Epidural |
Significant permanent harm (0.0082% to 0.0174%) |
|
0.0100% |
10,000 |
Epidural |
Seizure |
|
0.0100% |
10,000 |
Epidural |
Serious complication |
|
0.0061% |
16,400 |
Epidural |
Paralysis |
|
0.0056% |
18,000 |
Epidural |
Unexpected high hblock |
|
0.0050% |
20,000 |
Epidural |
Blood clots |
|
0.0033% |
30,000 |
Epidural |
Bladder nerve damage |
|
0.0033% |
30,000 |
Epidural |
Infection |
|
0.0021% |
48,000 |
Spinal |
Paralysis |
|
0.0020% |
50,000 |
Epidural |
Nerve damage |
|
0.0020% |
50,000 |
Spinal |
Nerve damage |
|
0.0020% |
50,000 |
Spinal |
Significant permanent harm (0.0016% to 0.0026%) |
|
0.0011% |
91,000 |
Spinal |
Death |
|
0.0010% |
100,000 |
Epidural |
Cardiovascular collapse |
|
0.0010% |
100,000 |
Epidural |
Death |
|
0.0010% |
100,000 |
Epidural |
Permanent nerve damage |
|
0.0010% |
100,000 |
Spinal |
Cardiovascular collapse |
|
0.0010% |
100,000 |
Spinal |
Infection |
|
0.0010% |
100,000 |
Spinal |
Permanent nerve damage |
|
0.0010% |
100,000 |
Spinal |
Spinal abscess |
|
0.0005% |
200,000 |
Spinal |
Blood clots |
DVT and PE
The most severe consequence of deep vein thrombosis (DVT) is a fatal pulmonary embolism (PE). The risk is reduced by the use of mechanical means (compression stockings, and inflating cuffs) and with anticoagulant medication (warfarin, heparin, rivaroxaban, aspirin), and by mobilising the patient as early as possible.
As your legs swell after THR, compression stockings need to be checked to ensure that they do not indent the calf, reversing the pressure gradient.
Anticoagulant medication is normally continued for some 4 to 6 weeks.
It has now been found that hours of box set binge viewing raises the risk of dying from a blood clot. http://www.telegraph.co.uk/news/2016/07/25/netflix-and-chill-could-lead-to-fatal-blood-clots-study-suggests/
Loosening
Total Hip Replacements (THR) loosening most frequently occurs in patients who were under 60 years of age at the time of their primary operation. Older patients have a higher chance of dying before revision is required whereas the converse applies in those under fifty. Loosening of the prosthesis can be very painful and can lead to immobility and failure of the hip joint. The risk of loosening is approximately 3% at 11 years after the operation.
Revision
About 1 in 8 of all total hip replacements requires revision within 10 years; and about 60% of these are due to wear-related complications. Most revisions occur in patients who were aged under 65 years at the time of primary operation, and usually some seven years after the hip replacement operation.
Catheter
Urinary infection and retention of urine can be painful, and may require the patient to be fitted with a catheter. This is a simple if unpopular, routine procedure.
Dislocation
Dislocation of the hip is extremely painful and can occur at any stage but usually occurs in the early days. Surgery to relocate the hip joint incurs a tremendous cost to the health care system and the patient has to go through a lengthy recovery period.
Wound Infection
Wound infection can be a serious problem, and may require additional surgery to enable the surgeon to clean out the wound. Sometimes the wound will weep a fatty necrosis which is natural and not an infection.
Here is an excellent guide to spotting the differences between a good wound that is healing, and an infected wound.
https://advancedtissue.com/2013/12/3-ways-know-difference-healing-infected-surgical-wounds/
Bone
Bone forming in muscles is known medically as heterotopic ossification. This is reported as occurring in 33% of hip replacement patients, but is rarely a serious problem.
Antalgic gait
Antalgic gait is a walking gait that develops as a way to avoid pain. It is a good indication of weight-bearing pain, following THR associated with groin, thigh and other leg pains. [CelsB]
Lateral approach
Abductor muscle weakness is a common outcome following a direct lateral approach and can cause a Trendelenburg gait. This usually results from failure of the repaired division of the gluteus medius tendon.
Overall result
Overall, about 80% of patients get a good result following THR with improved mobility and loss of debilitating osteoarthritic pain.
Noises
Ceramic hip replacements can squeak in about 15% of cases. [Michael TN1UK]
About 2% of ceramic inserts can have pieces break off which can then lead to catastrophic failure.
Loosening
Early replacement hardware had the potential to loosen from the bone attachment. Devices were devised with holes in them to promote bone growth through the holes in the hope that it would grow through the hole and hold the device securely. Unfortunately the Austin Moore devices did not prove as successful as expected. Modern devices use a special bone-like coating to encourage the bone to attach securely to the metal device.
Wear
Modern hip joints are usually made of four components, an Acetabular shell with a separate liner inside it, and a femoral stem with a separate head fitted. Wear rates have been cut over the years by using different materials for the acetabular 'cup' insert, and the femoral head 'ball', firstly by using ceramic femoral heads with polyethylene liners, and then ceramic femoral heads with ceramic or ultra-high molecular weight polyethylene (UHMWPE) liners. Larger diameter heads have reduced wear rates and the risk of dislocation. Metal heads and liners (Metal on Metal, or MoM) were used for a time, but problems with metal fragments mean these have all needed to be replaced.
Osteolysis
Bone loss caused by a reaction to plastic debris following wear of earlier polyethylene liners over time.
Tears
Surgeons repair whatever they cut during surgery, however sometimes, for whatever reason, the cut tissues don't heal even though they have been stitched together. They may also start to heal and then tear again. Sometimes older people's tissues don't heal as well, or possibly something else in the hip prevents the tissues from healing by interfering mechanically. Regardless of the reason, when there is disability and pain from torn tendons/muscles, an orthopedist should be able to diagnose it, both from what the muscles cannot do and what tests results say. [AnnieK]
Risk
An interesting article on the misunderstanding of risk from the BBC website.
http://www.bbc.co.uk/news/magazine-35432071
Here is a British Medical Journal article from 1997 that outlines reasons for surgery and the causes of failures.http://ard.bmj.com/content/56/8/455.full
[leah35183]
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Page last updated: 10 August 2018