Hip replacement surgery can be a godsend for those who suffer from chronic, end-stage arthritis. Removing arthritic joint surfaces and replacing them with artificial components can mean a significant improvement in quality of life. For all the benefits that hip replacement surgery provide people with severe degenerative joint disease, this procedure does not come without potential risks and complications.
Infection
One of the most devastating complications of any joint replacement surgery, let alone hip replacement, is infection. Certainly, infection can be a postoperative complication, but even more disturbing is the late-onset infection, those that can occur months, even years after the initial replacement surgery.
A decreased immune system as seen in patients with diabetes and other auto-immune diseases, which cause the body to attack itself, can cause infection. Seeding, a process in which bacteria from other locations on or within the body are transported via the blood stream to the site of the hip replacement, can also cause infection. Microorganisms settle in the hip area, where there is little defense because of the artificial components that lack blood supply. Therefore, critical antibiotics cannot adequately work because of the inability to reach the metallic and plastic components that can harbor the bacteria.
According to a May 2008 article in "Orthopedics Magazine" on OrthoSuperSite.com, infection rates for total hip replacement range from 0.2 percent to 2.2 percent for initial, primary procedures.
Prosthetic Loosening
Another complication of hip replacement is loosening of the components. Similar to infections, loosening can occur early after the surgery, or months afterward. In cases in which the components are cemented into place by special bone cement, loosening can occur in areas where the cement comes into contact with bone or with the surfaces of the components.
Prosthetic components that are considered a press-fit for purposes of encouraging the patient's bone to attach to the components while healing, called bio in-growth, can also loosen due to not having been cemented into place or because of improper sizing or insertion at the time of surgery.
Implant Breakage
In some cases, the use of space-age plastic spacers between two metallic components in the hip can result in breakage of that plastic over time. This can occur due to a variety of factors, including too thin a spacer or impact from activity that is too vigorous or injury such as a fall. In rare instances, the stem of the component that is inserted into the femur, or thigh bone, can break from unusual or abnormal stress on the metal due to morbid obesity, high-impact activities or faulty manufacturing processes.
Blood Clots
One very important potential complication of hip replacement surgery is the formation of blood clots within the deep veins of the lower extremities. The term commonly used for this condition is deep vein thrombosis. The clot can be potentially dangerous in that if it is of sufficient size, there is the risk that part, or all, of the clot can break away from its location and travel to the patient's heart and/or lungs, causing a serious complication known as pulmonary embolism. In rare cases, a pulmonary embolism is fatal.
Peri-Prosthetic Fracture
Peri-prosthetic fractures refer to injuries, namely broken bones, that occur around or near the components of a hip, according to OrthoSuperSite.com. The fracture occurs in such a manner as to involve the component, requiring surgical intervention to fix the problem. Fractures that involve the femoral, or thigh, bone component are the most common, while fractures in the pelvis which involve the acetabulum, or cup-shaped socket, are rarer.
Peri-prosthetic fractures frequently require surgery to stabilize the bone to allow for proper healing. If the injury is severe enough to dislodge or otherwise alter the proper positioning of the component, that component may have to be removed and re-inserted or be replaced with a component more suitable for this type of scenario.
References
- The Hip and Knee Institute: Arthritis of the Hip Joint
- The American Academy of Orthopaedic Surgeons: Total Hip Replacement
- Georgetown University Hospital: Complications of Hip and Knee Replacement
- Mayo Clinic: Hip Replacement: Risks
- Ortho SuperSite: Risk Factors in Total Joint Arthroplasty: Comparison of Infection Rates in Patients with Different Socioeconomic Backgrounds
