The vast majority of total hip replacement surgeries are successful, however, complications do occur. Patients should learn about the signs and symptoms of potential surgical complications so that they can be caught early and addressed quickly.

Below is a list of some potential complications. In rare instances, these complications are life threatening. A small percentage of patients require a second, revision surgery.

Complications Involving Anesthesia

Like any major surgery involving general anesthesia, there is a low risk of strokes, heart attacks, pneumonia, and blood clots. Getting out of bed shortly after surgery and moving (under doctor supervision) and following physical therapy guidelines will decrease the chances of blood clots.

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Hip Dislocation

Experts estimate between 3 and 4% of hip replacement patients have at least one episode of hip dislocation, making it the single most common complication to hip replacement surgery.15 When the hip joint dislocates, the head of the femur comes out of its socket in the acetabulum.

The head of the femur can usually be returned to its proper place without surgery. For more than 40% of patients who suffer hip dislocation, it is a one-time event.16 If a new hip repeatedly dislocates then a second surgery to stabilize the new hip may be necessary.

Dislocation is the most common in first 6 to 8 weeks after hip replacement surgery and can occur when:

  • The legs are crossed passed the midline, or center of the body. After surgery, patients are given an "abductor pillow" to put between their legs to help prevent the patient from crossing his or her legs.
  • The hip is bent past about 80 or 90 degrees. For this reason, patients are discouraged from leaning forward while sitting down or in bed.
  • The affected leg turns or rotates inwards.17

Dislocation is more likely for patients who:

  • Are female
  • Are 80 years of age or older
  • Are alcoholic
  • Have had a previous hip surgery
  • Have weak muscles surrounding the hip

Certain other physical traits and surgical factors can also make a person more likely to suffer hip dislocation after hip replacement surgery. Patients should talk to their surgeon to find out if they are at a higher risk for it.

Infection

A survey of Medicare data between 2006 and 2008 found that patients 65 and older who elected to have hip replacement surgery had an infection rate of about 1%. Of those, 60% had a superficial wound infection and while 40% had a more serious systemic infection.18

To reduce the risk of infection, antibiotics are routinely given at the time of surgery. Rarely, the implant is at the source of the infection. If this happens, the implant must be surgically removed, antibiotics are administered for 6 weeks. After the infection is resolved a second hip replacement surgery may be performed.

While the risk of infection decreases as the surgical wounds heal, it never completely goes away. People are advised to tell their dentists about their joint replacements, because any dental procedure carries a small risk of bacterial infection. Antibiotics taken ahead of time can prevent bacterial infections. Viral infections such as the flu are not a risk to the implant.

Other Risks and Complications

  • Inflammation and swelling. Inflammation and swelling represent the body's healing response to surgery and some degree of swelling may be present in the affected leg for up to several months following surgery. A doctor can prescribe medication to counter the inflammation and swelling. However, a sudden increase in leg swelling along with calf tenderness may be the first sign of a blood clot. Patients experiencing these symptoms in the weeks to months following surgery should promptly call their surgeon or seek other medical attention.
  • Legs may be slightly different lengths after surgery. Surgeons plan and operate very carefully to make sure the affected leg is the correct length. In some cases the leg may be made slightly shorter or longer to optimize joint stability. Small differences in leg length can be remedied with special shoe inserts. Notably, the affected leg may initially feel longer, because the patient is used to standing and walking on an arthritic hip that has suffered a loss of joint space. In these cases, the patient just needs time to get used to the new hip.
  • Hip stiffness. Some people develop scar tissue around the new hip that hinders flexibility and makes the new hip feel stiff. This is most common in people who had limited flexibility before surgery.
  • An allergic reaction to the bone cement used. If bone cement is used to adhere the hip prostheses to the existing bone, there is a small risk of an allergic reaction to the bone cement. In these cases the bone cement and prosthesis must be removed. In extremely rare cases, this allergic reaction can be fatal.19
  • Damage to structures around the joint. Any of the soft tissue (muscles, ligaments, and tendons) around the hip may be damaged during the surgery. In rare cases, there is damage to the surrounding arteries, veins, and/or nerves, resulting in leg weakness or decreased feeling in the leg.
  • Increased pain. Rarely, people experience more hip pain after the surgery than before surgery.

According to a study examining Medicare data20, between 2006 and 2008 10.9% of hip replacement patients were readmitted to the hospital for any reason (i.e., reasons both related and unrelated to the hip surgery) within 90 days of hip replacement surgery and 0.8% of hip replacement patients died during that same time period.

These risks increase with age and are higher for people who have other medical conditions, such as heart disease. The study's authors did not provide data to compare hospital admission and mortality rates for a control population that did not undergo hip replacement surgery.

References:

  1. Blom AW, Rogers M, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Dislocation following total hip replacement: the Avon Orthopaedic Centre experience. Ann R Coll Surg Engl. 2008 Nov;90(8):658-62. Epub 2008 Sep 30. PubMed PMID: 18828962; PubMed Central PMCID: PMC2727808.
  2. See Full References
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