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Hip

Risks of Hip Replacement

Definition
All surgeries have risks for complications and knowing what these risks are, and how they apply to your situation, is part of deciding whether or not to have surgery.

Patients can help lower their chances of risks from surgery by planning ahead.

  • Choose a doctor and a hospital that provide high-quality care.
  • Patients are suggested to speak with their health care provider long before their surgery.
  • Patients are advised to learn what they can do to help prevent problems during and after surgery.

Risks that may occur with any surgery
All types of surgery involve risks. Some of these include:

  • Breathing problems after surgery. These are more common if you’ve had general anesthesia and a breathing tube.
  • Heart attack or stroke during or after surgery.
  • Infection in the joint, lungs (pneumonia), or urinary tract.
  • Poor wound healing. This is more likely for people who are not healthy before surgery, who smoke or have diabetes, or who take medicines that weaken their immune systems.
  • An allergic reaction to a medicine that you received. This is rare, but some of these reactions may be life threatening.
  • Falls in the hospital. Falls can be a major problem. Many things can lead to a fall, including loose gowns, slippery floors, medicines that make you sleepy, pain, unfamiliar surroundings, weakness after surgery, or moving around with a lot of tubes attached to your body.

Bleeding
It is normal to lose blood during and after hip replacement surgery. Some people need a blood transfusion during surgery or during their recovery period in the hospital. You are less likely to need a transfusion if your red blood count is high enough before surgery. Some surgeries require you to donate blood before surgery. You should ask your provider about whether there is a need for that.

Much of the bleeding during surgery comes from the bone that has been cut. A bruise may occur if blood collects around the new joint or under the skin after surgery.

Blood clots
Your chances of having a blood clot form are higher during and soon after hip replacement surgery. Sitting or lying down for long periods of time during and after surgery will make your blood move more slowly through your body. This increases your risk of a blood clot.

Two types of blood clots are:

  • Deep vein thrombosis (DVT). These are blood clots that may form in your leg veins after surgery.
  • Pulmonary embolism. These are blood clots that may travel up to your lungs and cause serious breathing problems.

To lower your risk of blood clots:

  • You may receive blood thinners before and after surgery.
  • You might wear compression stockings on your legs to improve blood flow after surgery.
  • You will be encouraged to do exercises while in bed and get out of bed and walk in the halls to improve blood flow.

Possible problems with your new joint
Some problems that may occur after hip replacement surgery include:

  • Infection in your new joint. If this occurs, your new joint may need to be removed to clear the infection. This problem is more likely in people who have diabetes or a weakened immune system. After surgery, and often before surgery, you will learn what you can do to prevent infections in your new joint.
  • Dislocation of your new joint. This is rare. It most often occurs if you return to activities before you are ready. This can cause sudden pain and inability to walk. You should call your provider if this happens. It is likely that you will need to go to the emergency room. You may need a revision surgery if this happens repeatedly.
  • Loosening of your new joint over time. This can cause pain, and sometimes another surgery is needed to fix the problem.
  • Wear and tear of the moving parts of your new joint over time. Small pieces may break off and damage the bone. This may require another operation to replace the moving parts and repair the bone.
  • An allergic reaction to the metal parts in some artificial joints. This is very rare.

Other Risks
Other problems from hip replacement surgery can occur. Although they are rare, such problems include:

  • Not enough pain relief. Joint replacement surgery relieves the pain and stiffness of arthritis for most people. Some people may still have some symptoms of arthritis. For most people, surgery usually provides enough relief of symptoms for most people.

References
McDonald S, Page MJ, Beringer K, Wasiak J, Sprowson A. Preoperative education for hip or knee replacement. Cochrane Database Syst Rev. 2014;(5):CD003526. PMID: 24820247 www.ncbi.nlm.nih.gov/pubmed/24820247.

Mihalko WM. Arthroplasty of the knee. In: Azar FM, Beaty JH, Canale ST, eds. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017.

Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018;392(10158):1662-1671. PMID: 30496081 www.ncbi.nlm.nih.gov/pubmed/30496081.

Harkess JW, Crockarell JR. Arthroplasty of the hip. In: Azar FM, Beaty JH, Canale ST, eds. Campbell’s Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017.

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Scott Ashley, MD

ORTHOPAEDIC SURGEON

Scott Ashley, MD, is a board-certified, fellowship-trained orthopaedic surgeon. He specializes in sports medicine surgery, hip preservation surgery (including hip arthroscopy for treatment of hip impingement and labral tears, treatment of hip dysplasia, and other joint preserving surgeries for adolescents and adults), as well as knee and hip replacements.

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