Complications

Very few people would like to think what could go wrong, either during or following a surgical procedure to replace the hip or knee joint.  However, it is important that patients are made aware of potential risks so that they - the patient - can ultimately decide whether surgery if for them.  The patient (with help from the surgeon) must weigh up the potential advantages against the potential disadvantages of any procedure before deciding to go ahead (and so consent).  After all, this is what we do before we make any important decision whether it be in healthcare, business or domestic decisions.

Remember, don't be afraid to ask questions, even more than once.  There are potentially many questions but in the main then include:

• What (in lay terms) is the nature of any potential complication?
• What are the chances of developing a complication?
• If the complication occurs what could be done to remedy it?
• What the chances are of fixing it, either completely or partially?

In relation to joint replacement surgery complications are sometimes considered general complications and then specific to the joint.  Complications can also be considered relatively early, within a matter of six weeks to 12 weeks and those occurring at a later time, perhaps years after the original surgery.

In relation to general complications there is a risk of death (in the region of 2 in 1,000 to 6 in 1,000 depending on age at the time of surgery) (CHECK AGAINST NJR), medical complications, for example myocardial infarction (heart attack), cerebro vascular accident (stroke), chest infection, urinary tract infection and complications related to immobility such as a pressure sore, deep venous thrombosis (blood clot in leg), pulmonary embolism (blood clot in the lung).

Complications specific to joint replacement would include a wound infection, either superficial just involving the skin or a deep infection involving the implant, (in deep infection there may not always be a superficial infection component), dislocation, post operative leg that is either longer than normal or shorter, nerve injury of the sciatic nerve, femoral nerve, very rarely vascular injury, heterotopic ossification or bone formation around the hip.

Later complications include loosening of the fixation, wear of the joint and bone loss around the femur and acetabulum, mainly as a consequence of loosening and wear and the necessity of the revision surgery.