About 1% of patients will develop a complication after surgery. Some of the most common complications are outlined below:
A. SURGICAL COMPLICATIONS
Infection around a hip replacement is a difficult complication to address. A bug can get into the hip joint a) at the time of the operation or (b) carried in the patients' circulation (blood borne contamination) Mr. Lawrence takes certain precautions including the use of intra-venous antibiotics and the operation is conducted in a specially ventilated theatre.
If an infection develops in the joint, 2 or three operations will be required to put things right. Firstly , the joint is opened and washed out. The infection may be successfully treated by this simple measures in about 25% of cases.
In the majority of cases, the hip joint will have to be removed for a minimum period of 6-8 weeks. During this time, the patient will require crutches or a frame to walk. Once the infection has been treated (90%) of cases, a new hip joint is inserted. There is never a guarantee of success with the second operation and recurrence of infection may occur in 5-10% of patients. The key to success is avoiding infection in the first place by being vigilant and by using good surgical technique.
Following a hip replacement, it possible for the hip to dislocate (come out of joint). This usually occurs during the first 6 weeks following surgery and often relates to an awkward twist or excessive bending of the hip joint. The problem usually occurs just the once.
3. LIMB LENGTH DISCREPANCY
It is possible that one leg is slightly longer than the other after the hip replacement. On occasion, the legs were not equal length to start with, or the pelvis was tilted because of curvature of the spine. Differences that existed before the operation may sometimes feel worse after the operation.
4. DAMAGE TO NERVES AND BLOOD VESSELS
The femoral nerve, sciatic nerve and main blood supply to the leg lie close to the hip joint. Injury to these structures may occur but the incidence is very low.
Over a period of years, the implants may lose their fixation to the pelvic bone or thigh bone, and as a result patients may develop pain in the groin and thigh.
If a fall after a hip replacement is heavy enough, then the bones around the hip replacement may break. This is a rare complication and usually requires further surgery to treat it.
B. MEDICAL COMPLICATIONS
There are risks associated with every major operation. The risk varies from patient to patient depending on the physical fitness before the surgery. Fit, healthy, active patients are at least risk. Your fitness for the surgery before the operation will be assessed by your heart tracing and blood results and previous medical history. Unfortunately none of these investigations are 100% accurate, and as a result some unexpected events may occur.
Medical complications that may be encountered include:
1. BLOOD CLOT FORMATION
Any operation will increase the risk of blood clot formation in the limbs because the blood becomes a little 'thicker and stickier'. On occasion, the blood clot may travel to the lungs in which case the complicatiion may be life threatening. The overall risk of this complication is of the order of 1-3 in 1000 patients. Every attempt is made to minimise this risk including the use of leg pump devices, heparin, and aspirin. Getting up out of bed and walking after the surgery is also very important to encourage a good blood flow through the legs.
2. HEART ATTACK AND IRREGULAR HEART RHYTHM
These complications are completely unpredictable. Some patients may have an unrecognised heart condition that only comes to light under the stress of surgery.
The risk of developing a stroke after an operation depends on the quality of the pre-existing blood supply to the brain. It is unlikely that a fit and active patient will develop this complication whereas a patient with high blood pressure, who smokes heavily, and has furred up arteries will be at greater risk.
4. CHEST INFECTION
Because patients undergoing surgery are less mobile than normal and their breathing pattern may be altered slightly, they are at greater risk of developing a chest infection. This is , however, surprisingly rare and can be easily treated with physiotherapy and antibiotics.
5. FAILURE TO PASS URINE
Men are particularly prone to develop retention of urine following hip surgery. The risk is greatest in patients that have enlarged prostate glands. A combination of decreased mobility, pain from the hip joint and a spinal anaesthetic is often enough to upset the waterworks. Should you be unable to pass urine for a period of 6 hours or so, a tube would normally be inserted into the bladder and your urine may be collected in a bag. Usually this is a short lived problem but on occasion, some patients may require prostate surgery at a later date.