Various complications can occur during or after the implantation of an artificial hip joint. These include, among other things, nerve and blood vessel injuries, changes in leg alignment and leg length, and loosening of the hip prosthesis.
Here you will find further information as well as a selection of specialists and centers for hip prosthesis complications.
The implantation of an artificial hip joint is not a minor procedure. The average duration of the surgery—60 to 90 minutes—places a considerable strain on the patient’s body.
In addition, the patient is under general or spinal anesthesia during the surgery. This, too, places a strain on the body and carries various risks. For this reason, a detailed preoperative consultation takes place before the procedure, during which the doctor reviews the patient’s medical history to address any potential comorbidities, explains the complication rate, and describes the planned surgical technique.
The following text lists some of the most common complications and thus provides an initial overview.
Total hip replacement on an X-ray © SOPONE | AdobeStock
Every surgical procedure involves some degree of blood loss, the extent of which can vary depending on the surgical technique. Normally, a healthy body is clinically capable of compensating for the loss of about 1 liter of blood without major problems. After the procedure, regular blood tests are therefore performed, and iron supplements are prescribed if necessary.
Significant blood loss can lead to a marked impairment of the cardiovascular system. If a critical threshold is reached, a blood transfusion may be necessary in exceptional cases.
However, this is associated with certain surgical risks, such as:
However, due to strict legal requirements for donor selection and comprehensive blood testing, the risk of such disease transmission is negligible in Germany.
Minimally invasive procedures have become increasingly important in joint replacement surgery, as they can significantly reduce the risk of major blood loss.
Skin incisions pose another, very low risk. They are necessary to access the surgical site. The incisions compromise the skin’s protective function.
Bacteria from the surrounding environment as well as from the skin itself can enter the body.
To ensure these are killed immediately, each patient is typically given an intravenous antibiotic injection immediately before the procedure. In addition, during the operation, all wound surfaces are continuously cleaned using a high-pressure jet irrigation system (jet lavage).
Nevertheless, there remains a residual risk that bacteria will colonize the artificial hip joint. If the body’s own defense mechanisms fail, this can lead to
. Ultimately, the only way to achieve healing is through another surgery involving the complete removal of the artificial joint components. However, this always results in the loss of the joint.
Even postoperatively—that is, long after surgery—inflammation of the artificial hip joint, known as a prosthetic infection, is possible. Any medical procedure (e.g., tooth extraction) and any inflammation in the body (e.g., gallbladder, middle ear) is a risk factor. There is a risk that bacteria will spread to the joint replacement and trigger a prosthetic joint infection.
During surgery, major blood vessels and, very rarely, nerves may be injured. Such neurological complications are among the surgical risks that can occur, particularly in cases of anatomical variations, such as a collateral circulation or a congenital malformation.
The nerve runs relatively close to the hip and knee joints. Therefore, even
lead to a temporary loss of function in the muscles innervated by the nerve, e.g., in the form of foot drop. These nerve injuries usually resolve within a year.
The surgical immobilization of the leg can lead to thrombosis. This refers to a buildup of blood in the leg veins. The buildup is caused by small blood clots that can block the veins.
This is accompanied by painful swelling of the leg. A thrombosis can lead to permanent damage to the leg veins and the skin. This is referred to as postthrombotic syndrome with trophic dermatosis.
However, the complication rate for thrombosis has since decreased significantly. This is due to
It becomes dangerous when a blood clot breaks loose and enters the finely branched blood vessels of the lungs. There, it can cause a pulmonary embolism, which, in the worst case, is life-threatening. Nevertheless, the risk remains very low thanks to modern preventive measures.
If a blood clot blocks a blood vessel, it leads to blood congestion. This is referred to as thrombosis © tussik | AdobeStock
Artificial joint components require a certain amount of space. This can lead to changes in leg length, particularly with hip replacements. Especially in cases with complex anatomical conditions, the operated leg may be lengthened. This can occur, for example, during hip center reconstruction or in the presence of a concomitant condition on the opposite side.
Differences of 1 to 2 cm between the legs do not pose a problem. The patient can compensate for them with
.
The resulting leg length depends on many factors and is rarely within the surgeon’s control. In addition to anatomical conditions, the prosthesis components used—such as head lengths, inlay thicknesses, and joint partner sizes—also play an important role.
The joint components of the artificial joint do not have inherent stability. Therefore, sufficient joint tension is necessary for good joint function. This can be adjusted by selecting different joint component sizes, inlay thicknesses, and head lengths.
Only an artificial hip joint with good joint tension will function properly in the long term. Consequently, it may be the case that good joint tension can only be achieved by slightly lengthening the leg.
Precise positioning is crucial for the long-term stability and function of the hip replacement. Even minor deviations can adversely affect the load on the prosthesis, thereby increasing the risk of premature wear or loosening. The position of the acetabulum plays a particularly important role here, as it significantly influences the range of motion and stability of the joint. The goal of every surgery is not only to reduce pain but also to restore function and mobility as fully as possible, so that patients can benefit from a safe and durable hip joint in the long term.
The body’s natural joint dislocates only when subjected to very great force. With an artificial joint, dislocation is much more likely due to its mechanical properties.
This can occur particularly during large ranges of motion, such as very severe flexion or strong rotation of the joint. Such a dislocation is always very painful.
As a rule, an experienced orthopedic surgeon can reduce the joint under brief anesthesia without surgery. In exceptional cases, however, surgical reduction is necessary. The likelihood of such a dislocation is extremely low at the Clinic for Orthopedics and Orthopedic Surgery due to the surgeons’ extensive experience.
As part of the wound healing process, some patients are prone to developing bone growths around the artificial hip joint. This can lead to stiffening of the hip prosthesis.
However, this risk can be minimized through regular jet lavage during surgery and prophylactic medication on the day after surgery.
Patients known to be prone to this condition may be treated with perioperative radiation therapy.
Artificial hip joints can become loose. This is often due to a reduction in the load-bearing capacity of the bone in which the prosthesis is anchored. This is referred to as hip prosthesis loosening.
If the prosthesis loosens, it begins to cause pain after many years of being symptom-free. At that point, it is time to replace the hip prosthesis. This usually involves a more extensive surgical procedure than the initial implantation. In addition, patients are older at this stage than they were at the time of the initial implantation, which increases the surgical risk.
The average lifespan of a hip prosthesis is about 15 years.
Since endoprostheses are made of metals, anyone can, in principle, have an allergic reaction to them. These intolerances can manifest as pain and premature loosening of the artificial hip joint.
Patients with a confirmed metal allergy, in particular, should inform their doctor of this at an early stage. Special, hypoallergenic implants are available for these patients and can be selected on an individual basis.
However, these sometimes need to be tested prior to surgery, which takes some time.
1. What are the most common complications following hip replacement surgery?
Common complications can include blood loss during surgery, infections around the implant, nerve or vascular injuries, leg length discrepancies, prosthesis dislocations, and loosening of the implant. However, thanks to modern surgical techniques and careful postoperative care, these risks are relatively rare.
2. What is a prosthesis dislocation, and how is it treated?
A dislocation is when the artificial joint replacement pops out of place. It can be caused by extreme movements, improper weight-bearing, or improper positioning of the prosthesis components. In most cases, repositioning under brief anesthesia is sufficient; repeat surgery is necessary only in exceptional cases.
3. How can you recognize an infection after hip replacement surgery?
Typical signs of infection include pain, redness, swelling, or persistent wound discharge. Fever may also occur. Infections are among the more serious complications, as in the worst-case scenario they may require revision surgery—that is, replacement of the prosthesis.
4. Can allergies or intolerances affect a hip replacement?
Yes. Some patients have allergic reactions to certain metals or materials used in the implants. This can lead to pain, inflammation, or premature instability. If you have a known metal allergy, you should inform your doctor early on so that special hypoallergenic prosthesis materials can be used.
5. What can you do yourself to avoid risks?
Thorough preparation and follow-up care are crucial. This includes disclosing all pre-existing conditions and allergies during the preoperative consultation, consistently taking thrombosis prophylaxis, and attending regular follow-up appointments. Consistent rehabilitation focused on building muscle strength also helps prevent dislocations and loosening of the prosthesis in the long term.
Every physician listed in the Leading Medicine Guide has attained the highest level of training and certification within their respective medical specialty society. Furthermore, we contacted this physician based, among other factors, on their case volume (surgeries, treatments, and therapies), which we determined by cross-referencing various publicly available sources. Following discussions with the selected physicians and the directors of the medical facilities, as well as a subsequent internal review, they were admitted to the Leading Medicine Guide.
The quality assurance of the Leading Medicine Guide is further ensured by 8 admission criteria. Each member must meet at least 6 of them:
