Why are second and third time operations (revisions) not as good as the first time? HIGHER COMPLICATION RATE. These complex revision operations are MUCH RISKIER than the first time a hip is replaced. All the risks associated with first-time hip replacements are present, but the chances of COMPLICATIONS OCCURRING ARE INCREASED. Bone availability. The more times a joint is replaced, the less bone there is for the surgeon to work with. Special implants are required. The surgery is more extensive. Muscle weakness. The hip recovers from surgery less predictably with more operations. A weak hip or pelvis puts the patient at risk for dislocation and walking with a persistent limp. IF I PUT OFF SURGERY, WILL MY HIP DETERIORATE? Deterioration of the bone is rare, but can occur. The surrounding joints, such as the back, knees, and the other hip are NOT COMPROMISED and will NOT BE DAMAGED; however, the added stress may irritate these areas due to limp or weak hip muscles. Are there risks to the surgery? Yes, total joint replacement surgery is a major operation and there are some risks. The risks are rare due to experience and expertise in the field. According to the American Academy of Orthopaedic Surgeons, approximately 300,000 hip replacement operations are performed each year in the United States and less than 10 percent require further surgery. New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements. Numerous measures are undertaken to reduce the chance of a complication. Are most patients satisfied with total hip replacement? Yes. About 90% of all patients are satisfied with their new hip. This is a very high figure, actually, compared with other kinds of surgery. Yet, about 10% of all patients operated on with the total hip replacement have been dissatisfied with the result of the operation. These are results of a national survey. Dissatisfied patients in this group: Remaining pain in the joint that interferes with sleep (about 5%) unequal leg length (about 1%) instability in the new hip joint (about 5% with traditional approaches and 0.02% for the Direct Anterior Approach. Complications occur in approximately 3% of all cases. Possible risks and complications include: 1. Infection Occurs in 3% of cases despite using sterile techniques. If infection occurs early (less than 6 weeks after surgery), then a revision surgery that is less extensive may be all that is needed. However, if the infection occurs after this time period the implants will have to be removed and the infection treated before the implants are put back in. 2. Blood clots 3. Leg length differences 4. Fracture of the bone 5. Dislocation 6. Excess bone formation around the hip socket This is rare, but can occur. It is also called heterotopic ossification. In rare circumstances it would require surgery to remove the extra bone that has formed. 7. Early loosening/early failure of the implant 8. Blood loss requiring a transfusion of blood products 9. Nerve damage 10. Continued pain/thigh pain This is due to bone ingrowth in a cementless prosthesis. It usually improves with time. 11. Stress related conditions The stress of surgery can increase the risk of heart attack or stroke. 12. Late complication: loosening due to osteolysis The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation.
Posted on: Wed, 05 Mar 2014 06:31:06 +0000
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