Total Hip Joint Replacement Risks

A hip replacement is one of the most commonly performed orthopaedic surgeries and is usually very successful in treating hip arthritis- relieving pain and restoring hip function. Most people who undergo a total hip joint replacement do not suffer any complications however, it is important to remember that any surgical procedure involves risks. Some of these complications are serious so it is important that you and your surgeon discuss these carefully to ensure that for you, the potential benefits outweigh the risks.

More common complications (affecting 2-5% of patients) include:

  • Pain
    The hip will be sore after the operation. If you are in pain, it is important to tell staff so that medicines can be given. Pain will improve with time. Rarely, pain will be a chronic problem and may be due to any of the other complications listed below, or, for no obvious reason. Rarely, some replaced hips can remain painful.
  • Bleeding and bruising.
  • A blood transfusion or iron tablets may occasionally be required.  Rarely, the bleeding may form a blood clot or large bruise within the hip which may become painful  and require an operation to remove it.
  • Deep Vein Thrombosis (DVT)
    A DVT is a blood clot in a vein. The risk of developing a DVT are greater after any surgery (and especially bone surgery). DVT can pass in the blood stream and be deposited in the lungs (a pulmonary embolism). Your surgeon may give you medication to try and limit the risk of DVTs from forming, may ask you to wear stockings on your legs or to use foot pumps to keep blood circulating around the leg. Starting to walk and moving early is one of the best ways to prevent blood clots from forming.
  • Abductor Muscle Weakness
    May occur after the operation, especially if the muscle is weak before the surgery. These muscles on the side of your hip are important for strength and stability. Weakness can make you limp or fatigue on that side. If this happens it is usually temporary and muscle strengthening sees it improve. Rarely the muscle does not recover and the limp or weakness will remain.
  • Prosthesis Wear
    With modern operating techniques and new implants, hip replacements last many years. In some cases, they fail earlier. The reason is often unknown. The plastic bearing is the most commonly worn away part.
  • Numbness

Less common complications (affecting 1-2% of patients) include:

  • Infection
    You will be given antibiotics at the time of the operation and the procedure will also be performed in sterile conditions with sterile equipment. Despite this, infections still occur (1-2%). This is usually treated with antibiotics and an operation to washout the joint may be necessary. In rare cases, the prostheses may be removed and replaced at a later date.
  • Leg Length Difference
    Every attempt is made to get the legs the same length. However, it is important that you also have a stable hip that doesn’t dislocate. Sometimes the leg needs to be longer or shorter. Most patients don’t notice or care. Some patients find this very troubling and may require a shoe raise or (in extreme cases) even revision surgery.
  • Dislocation
    Your new hip joint can be at risk of dislocating (coming out of joint). Modern techniques are usually successful at creating a very stable safe hip. If you do dislocate – you usually have to go to hospital and have it put back in joint. Rarely you might need another operation to adjust or change the hip to make it more stable.

Rare complications (affecting less than 1% of patients) include:

  • Pulmonary embolism (PE)
    A PE is the spread of a blood clot to the lungs and can affect your breathing. This can be fatal.
  • Altered wound healing
    The wound may become red, thickened and painful (keloid scar) especially in patients of certain races.
  • Nerve Damage
  • Damage to the nerves around the hip is a risk. This may cause temporary or permanent altered sensation around the hip or down the leg. There may also be damage to the  nerve which may cause temporary or permanent weakness of the lower leg or foot.
  • Bone Damage
    Bone may be broken when the prosthesis (false joint) is inserted. This may require fixation, either at time or at a later operation.
  • Blood Vessel Damage
    The vessels around the hip may be damaged and may require further surgery.