It’s worth remembering that Total Hip Replacement or THR is one of the most successful hip operations in orthopaedic surgery. Having said that – as with all major operations – there is a risk of complications. In most cases, these are minor and temporary, but they can sometimes be serious and very occasionally life threatening.
Before entering into hip replacement surgery, you will have a thorough consultation with our surgeon, Jeremy Latham. Your surgeon and anaesthetist will also discuss any complications of hip replacement surgery with you before your operation.
What are the risk factors?
High blood pressure, heart disease or diabetes can increase the risk of having a heart attack or stroke after surgery.
Complications of hip replacement
Bruising and Bleeding
The most common complications are bruising near or oozing from the wound. The leg can also remain swollen for several weeks after surgery.
Deep Vein thrombosis (DVT)
Occasionally a blood clot (deep vein thrombosis DVT) can develop. The treatment for DVT is warfarin, an anticoagulant, which is taken for several months. On very rare occasions a DVT can travel to the lungs (a pulmonary embolism), which can cause collapse and occasionally death, but the risk of this happening is very low (approximately 1 in 1000). We take lots of precautions to reduce the risk.
deep infection
This happens in a very small number of cases (0.5%) and can require further surgery. Sometimes we will need to remove some or all of the components of the hip replacement to clear the infection.
leg length discrepancy
It is possible for your leg to be shortened or lengthened after hip surgery and you might need an insole to compensate for this. The risk of this happening is low (1%).
dislocation
If you twist your hip excessively or have a fall, it is possible to dislocate your hip. This is painful to correct and so requires a general anaesthetic. Sometimes we may also need to do another operation to sort out the problem. The risk of dislocation is low (0.5%) and becomes much lower beyond the six-month mark.
nerve injury
The sciatic nerve can become injured during the operation, resulting in permanent pain and weakness in the leg. The risk of this happening is very low (0.02%).
wear & loosening
Modern hip replacements are very durable. There is good evidence to show that about 80% of hip replacments will last for 20 years or more. Obviously if you were to run marathons, or do lots of heavy, manual work, your hip replacment won’t last as long. The younger you are when you have surgery, the more likely it is that you hip might wear out in your lifetime. We will discuss this with you during the consultation.
Failed hip surgery and suffering with pain after a hip replacement
Hip surgery is usually very successful, and most patients are delighted with the outcome of their operation. Pain after hip replacement/resurfacing surgery is not uncommon, and it usually goes away after a few months. If it persists, this indicates that there might be a potentially serious problem. Quite often the pain can grumble on for many months, and this is very frustrating, particularly when no obvious cause is found. In these cases, patients and surgeons often ask for a second opinion to see whether or not hip revision surgery is necessary.
We understand that it is disappointing if hip replacement complications arise, but prompt investigations and expert treatment are essential if further problems are to be avoided. Here in Southampton we have experts in radiology, microbiology and clinical chemistry who have helped us to develop efficient pathways for the investigation and treatment of pain after hip replacement/resurfacing.
If there is a serious problem with the hip replacement/resurfacing, then revision hip surgery might be necessary. We see an increasing number of patients with pain after metal on metal hip replacement/resurfacing, and this is usually caused by a reaction to the metal ions produced by the hip implants. Revision hip surgery is almost always necessary to get rid of the problem. Revision surgery is usually more complicated than the original hip replacement/resurfacing operation. Special equipment and implants are often used to rectify the specific complications and to overcome the challenges of having to remove the original hip implants. Revision hip surgery has developed into a sub-speciality of orthopaedic practice which reflects the fact that these operations require specialist skills and training.
Because we have treated more people with hip replacement/resurfacing complications than most centres, we have developed a great deal of experience in hip revision surgery, and we are happy to say that there is almost always a good outcome following surgery.
If you are experiencing pain after a hip replacement or resurfacing operation or it simply doesn’t feel ‘right’, you should tell your surgeon about your symptoms. If you would like a second opinion, please ask your GP for a referral to Jeremy Latham and he will be happy to see you as soon as possible.
