Hip Replacement: Risks and Activity
Risks for Total Hip Replacement
It is important that you understand that there are risks associated with any major surgical procedure and total hip replacement is no exception. These risks include the risk of death. That’s true of any major surgical procedure requiring anesthesia and blood transfusion. The risk of death in our hospital for total hip replacement is in the order of 1 per 750 or 1,000 cases so that you can see that the risk is very small, but it’s not 0. The specific risk for you will depend upon your general medical condition, your age, and the difficulty of the surgical procedure,but the risk of death itself is really very small.
There are, however, some other risks which are a little bit larger. For example, there is about a 1% risk that your hip will dislocate in the immediate post-operative period. This may come from an inadvertent false movement in which the socket of the hip prosthesis becomes disengaged from the ball (femoral head).
In the vast majority of these cases, this can be treated by manipulation and would not require another surgical procedure. It might require some relaxation, it might even require a short anesthetic. But again, this risk is relatively small, being about 1% of all the cases that are operated on.
A major potential risk is the risk of infection. Again, in this hospital, the risk of infection is in the order of 1 per 200 cases and we do many things to keep this risk very low. You will be receiving an antibiotic on the morning of surgery and this will be continued for 24-36 hours after surgery.
There are other preventive measures that will also be undertaken to reduce the possibility of infection. In spite of the measures, a very small percentage of patients will develop an infection and that generally can be treated by antibiotics and cured. But occasionally, rarely, it might result in the hip prosthesis having to be removed.
There is also some risk of an infection elsewhere in your body after the surgery settling in the hip and therefore we strongly recommend that patients who have total joint replacement take antibiotics whenever they have infections in another area and particularly if they are going to have extensive dental work. Antibiotics do not need to be taken for routine cleaning or simple fillings. We will provide you with a card indicating what needs to be done if you can give this to your doctor or to your dentist should that be necessary.
There are a host of other possible complications. If you review series of several thousand you will see literally dozens of possible complications that could take place. However, these complications take place with exceeding rarity. Things such as muscle ruptures, pulling off of the tendon, injuries to nerves and blood vessels, superficial infection and opening of the wound, and other things of this nature may occur. They don’t occur very often, but they can occur.
One of the things that could occur is the loosening of the prosthesis. This loosening would not happen suddenly, but it would be a gradual process and it would be characterized by discomfort. In most instances, if a prosthesis becomes loose, it can be corrected but that usually means further surgery. Now what is the nature of this risk? That depends on several circumstances. We think in general, it’s probably a cumulative risk of about 1% per year, so that if you have your prosthesis for 20 years, the possibility of loosening over that 20 years could be as high as 1 in 5. If you have your prosthesis for 10 years, it could be 10%.
Risks Associated with Minimally Invasive Surgery
MIS Hip Joint Replacement is less invasive than conventional Total Hip Replacement, but it is still a major surgery. It takes little additional time to complete and may result in advantages for the patient.
As with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications, the vast majority of which can be successfully avoided or treated. In fact, the complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients. Besides infection, possible complications include blood clots, lung congestion or pneumonia. The risks that are normally encountered in conventional hip joint replacement remain.
To a certain extent, what the patient needs to realize is that an artificial hip can never be as good as a normal hip. There is always the potential that it may get infected at some date in the future. It will not tolerate the same kinds of physical stresses that the normal hip will tolerate.
We strongly recommend against physical activity such as tennis, running,contact sports, things that can contribute to loosening of the hip through a physical process and the physical force applied to the hip that results in motion between the prosthesis and the bone and loosening and pain. But this is the reason that one has to be cautious about actually performing a total hip replacement and why it should only be applied to those patients who have severe symptoms.