Various complications can occur after or during the implantation of an artificial hip joint. These include injuries to nerves and blood vessels, changes in leg axis and leg length and loosening of the hip prosthesis.
Here you will find further information as well as selected specialists and centers for hip prosthesis complications.
The implantation of an artificial hip joint is not a trivial procedure. The average operation time of 60 to 90 minutes is a strain on the patient's body.
In addition, the patient is under general or spinal anesthesia during the operation. This is also a strain on the body and is associated with various risks. For this reason, a preparatory consultation takes place before the operation, in which the doctor explains the risks of the operation to the patient in detail.
The following text lists some of the most common complications and thus provides an initial overview.
X-ray image of a total hip replacement © SOPONE | AdobeStock
Every operation is accompanied by a certain amount of blood loss. Normally, a healthy organism is able to compensate for the loss of approx. 1 liter of blood without major problems. After the operation, regular blood checks are carried out and iron-containing medication is prescribed if necessary.
Major blood loss leads to severe impairment of the cardiovascular system. If this reaches a critical limit, it may also be necessary in exceptional cases to transfuse foreign blood.
This involves certain risks
associated with it. In Germany, however, strict legal regulations apply to donor selection and preservation tests. The risk of disease transmission is therefore negligible.
In addition, minimally invasive procedures are also becoming increasingly common in arthroplasty. This minimizes the risk of major blood loss.
Skin incisions represent a further, very low risk. They are necessary to reach the surgical site. The incisions interrupt the protective function of the skin.
Bacteria from the surrounding area and from the skin itself can enter the body.
To ensure that these are killed off immediately, each patient is usually injected with an antibiotic into the vein immediately before the procedure. In addition, during the operation all wound surfaces are permanently subjected to a high-pressure cleaner-like wound cleaning (jet lavage).
Nevertheless, there is a residual risk of bacteria adhering to the artificial hip joint. If the body's own defense mechanisms fail, this can lead to
of the joint. Ultimately, only a new operation with complete removal of the artificial joint parts can bring healing. However, this always means the loss of the joint.
Even long after the operation, inflammation of the artificial hip joint, a so-called prosthesis infection, is possible. Every operation (e.g. tooth root extraction) and every inflammation of the body (e.g. gall bladder, middle ear) is a risk factor. There is a risk that bacteria will wash into the artificial hip joint and trigger an artificial joint infection.
During an operation, larger blood vessels and very rarely nerves can be injured. This risk exists in particular with anatomical variants, e.g. a bypass circuit or a congenital malformation.
The nerve passes relatively close to the hip joint and knee joint. Therefore, it can be caused by
can lead to a temporary loss of function of the muscles supplied by the nerve, e.g. in the form of foot drop paralysis. These nerve lesions usually recover within a year.
The immobilization of the leg as a result of the operation can lead to thrombosis. This is a blockage of blood in the leg veins. The congestion 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 skin. This is known as post-thrombotic syndrome with trophic dermatosis.
However, the rate of thrombosis has now fallen sharply. The background to this is
Under certain circumstances, thrombosis can lead to a life-threatening pulmonary embolism. This occurs when the blood clot becomes detached and then enters the finely branched blood vessels in the lungs. There, the clot can block vessels, causing lung tissue to die.
Nevertheless, any thrombosis can theoretically develop into a pulmonary embolism.
If a blood clot blocks a blood vessel, this leads to blood congestion. This is known as a thrombosis © tussik | AdobeStock
Artificial joint parts require a certain amount of space. This can lead to changes in leg length, particularly with hip endoprostheses. This results in a lengthening of the operated leg, particularly in difficult anatomical conditions. This can happen, for example, when reconstructing the center of the hip or if the opposite side is also affected.
Lateral differences of 1 to 2 cm are not a problem. The patient can correct them by
compensate for this.
The leg length achieved depends on many factors and can rarely be influenced by the surgeon. For example, good function of the hip joint is more important than the same leg length.
The joint partners of the artificial joint have no inherent stability. Sufficient joint tension is therefore necessary for good joint function. This can be varied by selecting different joint partner sizes, inlay thicknesses and head lengths.
Only an artificial hip joint with good joint tension will function without problems later on. It is therefore possible that good joint tension can only be achieved by slightly lengthening the leg.
The body's own joint only dislocates when a great deal of force is applied. With an artificial joint, dislocation is much easier due to its mechanical properties.
This can occur particularly with large swings in movement, such as very strong flexion or strong rotation in the joint. Such a dislocation is always very painful.
As a rule, an experienced orthopaedic surgeon is able to reset the joint under a short anaesthetic without surgery. In exceptional cases, however, a surgical reduction is necessary. The likelihood of such a dislocation occurring at the Clinic for Orthopaedics and Orthopaedic Surgery is extremely low due to the surgeons' extensive experience.
Some patients tend to develop ossifications around the artificial hip joint as the wound heals. This can lead to stiffening of the artificial hip joint.
However, this risk can be minimized by regular jet lavage during the operation and prophylactic medication the day after the operation.
Patients who are known to have such a tendency may be given perioperative radiotherapy.
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 hurt after many years of freedom from symptoms. It is then time to replace the artificial hip joint. This usually involves more surgery than the primary implantation. In addition, the patients are then older than with the primary implantation, which increases the risk of surgery.
The average lifespan of an artificial hip joint is around 15 years.
As endoprostheses are made of metals, anyone can have an allergic reaction to them. These intolerances can manifest themselves in 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 hypo-allergenic prosthesis materials are available for these patients.
However, these sometimes have to be tested in advance of an operation, which takes some time.
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