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News Letter

Potential Complications Following Hip Replacement Surgery Print E-mail

As with all major surgical procedures, complications can occur. Some of the most common complications following hip replacement are:

  • Thrombophlebitis
  • Infection
  • Dislocation
  • Loosening
  • Myositis Ossificans
This is not intended to be a complete list of the possible complications, but it includes the most common problems.

Thrombophlebitis

Thrombophlebitis, sometimes called Deep Venous Thrombosis (DVT), can occur after any operation, but is more likely to occur following surgery on the hip, pelvis, or knee. DVT occurs when the blood in the large veins of the leg forms blood clots within the veins. This may cause the leg to swell, become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung, where they get lodged in the capillaries of the lung and cut off the blood supply to a portion of the lung. This is called a pulmonary embolism. (Pulmonary = lung, embolism = fragment of something traveling through the vascular system). Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible!

Some of the commonly used preventative measures include:

  • Pressure stockings to keep the blood in the legs moving.
  • Medications that thin the blood and prevent blood clots from forming.

Infection

Infection can be a very serious complication following an artificial joint surgery. The chance of getting an infection following total hip replacement is approximately 1%. Some infections may show up very early - before you leave the hospital. Others may not become apparent for months, or even years, after the operation. Infection can spread into the artificial joint from other infected areas. Your surgeon may want to make sure that you take antibiotics when you have dental work, or surgical procedures on your bladder and colon, to reduce the risk of spreading germs to the joint.

Dislocation

Just like your natural hip, an artificial hip can dislocate (where the ball comes out of the socket).

There is a greater risk just after surgery, before the tissues have healed around the new joint, but there is always a risk. The therapist will instruct you very carefully how to avoid activities and positions, which may cause a hip dislocation. A hip that dislocates more than once may have to be revised (which means another operation) to make it more stable.

Loosening

The major reason that artificial joints eventually fail continues to be a process of loosening where the metal or cement meets the bone. There have been great advances in extending how long an artificial joint will last, but all will eventually loosen and require a revision. A loose hip is a problem because it causes pain. Once the pain becomes unbearable, another operation will probably be required to revise the hip.

Myositis Ossificans

Myositis ossificans is a curious problem that can affect the hip after both a primary hip replacement and a revision hip replacement. The condition occurs when the soft tissue around the hip joint begins to develop calcium deposits. "Myositis" means inflammation of muscle and "ossificans" refers to the process of ossification or the formation of bone. This can lead to a situation where the bone actually can form completely around the hip joint. This leads to stiffness in the hip resulting in much less motion in the hip joint than normal. It also causes pain in the hip joint.

Myositis ossificans is more common in people who have a long history of osteoarthritis with multiple bone spurs. Something about the genetic makeup in these people make them more likely to produce bone tissue. Major reconstruction operations, such as revision surgery, seem to do more damage to the surrounding tissues than primary hip replacements. The operation is simply longer and harder to do. This also seems to make it more likely that calcium deposits will form.

The treatment for myositis ossificans may actually begin before you get it. In cases where your surgeon feels that you are at high risk for developing the condition, he may recommend medications such as Indomethacin? be taken following surgery. This medication reduces the tendency for bone to form and may protect you from developing myositis ossificans.

A much more effective method that has been used a great deal is to prevent the development of myositis ossificans using radiation treatments immediately after surgery. These are the same type of radiation treatments used to treat cancer. Several short radiation treatments, begun the day after surgery and continued for 3-5 days, seem to drastically reduce the risk of developing myositis ossificans. If myositis ossificans forms anyway, treatment will depend on how much it affects your hip, how much pain it causes, and how much it restricts motion. In some severe cases, you may choose to have a second operation to remove the calcified tissue that has formed. This is usually followed by radiation treatments to prevent the calcium deposits from returning

 

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Community Talk July 28, 2014 6:30pm

Join Dr. Nicholas Abidi, M.D., Dr. Peter Reynolds, M.D. and  Dr. Christian Heywood, M.D. as they discuss knee and hip pain and the available treatment options.

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