Total Hip Replacement Complications

Original Editor - lucinda hampton

Top Contributors - Lucinda hampton, Rana Samy Algarhy, Kim Jackson and Vidya Acharya  

Introduction

Total hip replacements in experienced hands provide very effective outcomes, however one must be aware of the potential complications of the procedure. These can be divided into general and procedure specific, and may occur during the surgery, immediately after the surgery or after weeks, months, or years after the surgery.

Common Complications

The most common systemic complication is a deep vein thrombosis. Infection is the most dreaded complication. Leg length discrepancy is a common causes of patient dissatisfaction. Other complications include:

• Aseptic loosening: considered to be the most common indication for revision surgery
• Particle disease / histiocytic reaction / aggressive granulomatosis
• Fracture: periprosthetic fracture; cement fracture; stem fracture
• Dislocation (~5% of all replacements): dislocation of femoral head out of the cup: component dissociation: dislocation of the entire acetabular cup; dislocation of stem
• Heterotopic bone formation

• Reaction to metal: eg metal-on-metal pseudotumour, metallosis.
• Abductor muscle/tendon dysfunction e.g. tears
• Stress shielding
• Trochanteric bursitis
• Revision total hip arthroplasty
• General post-orthopaedic surgical complications eg haemorrhage, wound complications, deep vein thrombosis and pulmonary embolism, vascular injury, neurological deficit, death.

Gait abnormality after THR

Despite this great gain in functional ability and a subjective improvement in the ability of walking, gait sequences in patients undergoing THR improvement, but achieve abnormality. Many gait analysis studies have shown that gait sequences remain abnormal in the long term and are comparable to pre-operative gait. Range of motion was improved following THR, but in severe cases remained less than normal. It is important to note that hip flexion contractures, with loss of hip extension, have been shown t up to 1 year after total hip replacement, and is probably due to a combination of factors, e.g. persistent muscle weakness, scar tissue formation and learned gait patterns though the exact cause is unknown.

Dislocation after THR

Total hip replacement is a common, cost-effective, and almostly successful intervention for improving pain and disfunction associated with sever hip joint disease such as osteoarthritis., however high success rates, however, some replacements may fail. Common complications after primary total hip replacement include aseptic loosening, dislocation, prosthetic joint infection, fracture, and adverse reactions to particulate debris.

The incidence of dislocation has been reported to be from less than 1% up to 22%. More than half of dislocations occur in the first 3 months following primary total hip replacement. As the population ages and with growing volumes of primary total hip replacement procedures being done.

Dislocation can lead to severe pain, restriction of mobility, recurrent dislocation, and poor quality of life. The associated consequences of dislocation include repeated admissions to hospital and substantial financial cost to both the patient and the health-care system.

our results provide a detailed picture of the different causes of dislocation risk following primary total hip replacement. Most of the risk appears to be caused by patient-related factors (eg, sociodemographic characteristics, high body-mass index, and comorbidities), surgery-related factors (surgical approaches), and several implant-related factors.

Early recognition of these factors, along with careful planning before and after surgery, along with a multidisciplinary approach, might represent an implementable strategy by which to prevent or decrease dislocations among patients at high risk.

Resources

Orthopaedic surgeon Mr Nick de Roeck talks about possible complications that can occur with hip replacement surgery.