For the majority of patients, hip replacement surgery has a successful outcome in terms of relieving pain and restoration of function. The long-term success is currently greater than 90% of replacements surviving longer than 10 years.
No surgery, however, is completely without risk and, although infrequent, significant complications can arise following hip replacement surgery. Orthopaedic surgeon Mr Nick de Roeck explains the possible complications of hip replacement and how post-operative pain is managed.
What are the possible types of complications following hip replacement?
In simple terms, complications can be defined as those specific to hip surgery and more general ones that can arise after a major operation. These can be divided into two categories.
- Deep infection around the prosthesis can occur if bacteria settle and multiply on the artificial joint. Great care is taken to avoid this but if it occurs it can lead to pain, loosening and failure of the hip replacement. This usually requires further surgery and removal of the infected replacement to successfully eradicate the infection. The risk of significant infection is around 1 in 250.
- Dislocation of the artificial ball from the socket can occur if the leg is moved to a more extreme position, particularly in the first few months after surgery. Usually, it can be managed by reducing the hip under anaesthesia. The risk of this is around 1 in 25. Occasionally the hip can dislocate recurrently and require more surgery to prevent this.
- Damage to nerves around the hip can occur which can lead to numbness or weakness in the leg or foot. The risk of this is around 1 in 100.
- Fracture of the thigh bone can occur whilst the surgery is being performed. The risk of this is higher in patients with weaker bone. The risk of this can be as high as 1 in 50.
Great care is taken to try and restore the length of the leg accurately, but on occasion, it is not possible to achieve this. Most patients adjust to the new hip and don’t notice any difference, however, a small number may require a shoe raise.
- Bleeding is inevitable after any surgery. With modern techniques, it is rare to experience significant bleeding during or after a hip replacement. However, significant bleeding can occur in about 1 in 300 patients. Rarer still is an injury to a major blood vessel, the risk is around 1 in 1000.
- All lower limb surgery carries the risk of blood clots forming. About 1 in 40 patients suffer a blood clot in the leg veins, called a deep vein thrombosis. If this moves to the lung it is called a pulmonary embolus. This can be a life-threatening problem and occurs in 1 in 250 patients. Significant precautions are taken to avoid this including use of ant-embolism stockings and blood-thinning drugs. The most important preventative factor is early mobilisation.
- Some patients struggle to pass urine naturally immediately after the surgery and require a tube or catheter to be passed into their bladder for the first 24-48 hours after the surgery.
Other medical complications can arise such as chest infection, stroke and heart attack. The key to minimising these complications is ensuring patients are as well as possible before the surgery and have all chronic health conditions optimised before contemplating major elective surgery such as hip replacement.
How much pain is there after hip replacement surgery? How is it managed?
The common anxiety for patients is the uncertainty about the extent of post-operative pain.
One of the goals of modern hip replacement surgery is to allow patients to start mobilising as quickly as possible after surgery, ideally on the day of the procedure. To allow this there is a great focus on pain control after surgery.
Patients will often undergo the surgery with a spinal block. The block slowly wears off after surgery and allows good pain relief in the immediate post-operative phase.
Modern surgery is performed in such a way as to minimise the trauma to the tissues as far as possible. The soft tissues are often infiltrated with large volumes of local anaesthetic agents to improve pain control in the first hours after surgery.
Patients are prescribed multi-modal analgesia. This means a range of pain killers and anti-inflammatory drugs are prescribed which work in different ways to maximise the pain relief for patients.
If patients are able to mobilise quickly they can usually stop the stronger painkillers within 24-36 hours of surgery and be discharged home on simple pain relief. It is sensible to continue to take pain relief regularly after discharge. This helps with sleeping and allows regular walking which are all important as part of the recovery after surgery.
Have more questions about hip replacement surgery? Do not hesitate to book an appointment with Mr de Roeck for a first consultation.