|
|
FAQ - What could go wrong?
General risks of hip and knee arthroplasty: none of the risks outlined below are common. All are relatively rare, but are mentioned as they can ruin a technically 'successful' operation.
Deep Infection : Can lead to early loosening of the implants and the need for complex reconstructive surgery. See also the section on MRSA.
Deep vein thrombosis [clots in the veins] and pulmonary embolism [clots breaking off and travelling to the lungs]. The problem here is that any measure taken to chemically thin the blood to prevent clotting, also increases bleeding, swelling and bruising. So the surgeon must constantly balance the 2 factors against each other. Every unit will have different policies, and opinion varies widely. Each patient is different and essentially an individual 'risk assessment' must be made. You can best protect yourself by getting out of bed as soon as the team will allow you to do so and working hard at rehabilitating yourself quickly. Be proactive and willing to do, if anything, more than your physio has given you to try. I am constantly surprised at patients who will use the excuse 'well no-one told me to do anything' as an excuse for passive, lazy behaviour! It is seldom possible or dangerous to 'overdo it'.
Nerve or vessel injury . Joints are surrounded by nerves and blood vessels. Even the most careful and experienced surgeon may occasionally damage one of these structures. This can lead to excessive blood loss, haematoma formation or in extreme situations, gangrene. In the case of nerves, this might result in transient numbness, or more seriously, extensive, hopefully reversible, paralysis. Sometimes the damage is direct, and then there may be a question of medico-legal negligence. But sometimes the damage is indirect and could not be anticipated. Anatomical anomalies, and pressure from retractors or wound haematomas are examples of less culpable injuries to nerves in particular. These complications are extremely rare, so this knowledge may help to make reading about them less frightening.
Intra-operative fracture of bone : Extremely rare. Except during revision (re-do) surgery. Orthopaedic surgeons use saws, hammers and drills. It is possible to be too enthusiastic or to misjudge the quality of patient's bones! It is usually possible to get around the problem, but recovery may be delayed. I.e. if the problem is recognized and the correct salvage procedure is employed, intra-operative fracture of bone is NOT a catastrophe.
Specifically related to hip surgery:
Dislocation: The 2 sides of the arthroplasty separate and the head come out of the joint. More common with total hip replacement [between 1% and 3%], almost unknown in association with hip resurfacing. The precipitating factors are complex, but following your surgeon and physiotherapist's instructions is the best protection, as is working on building up the right muscle groups.
Fracture neck of femur [resurfacing only]: the bone fractures below the femoral implant. This should occur in less than 2% of patients. It is more likely in women and patients with weak bone for any reason (old age, steroid use, hyperthyroidism, alcohol abuse, early menopause, anti-epileptic drugs). Fractures most commonly occur within the first 6 weeks, so we occasionally ask patients to be partial weight bearing during this period. Even if fracture does occur, rescuing the situation by inserting a stem into the femur is relatively straight-forward.
Metal ion sensitivity: ( aseptic, lymphocytic vasculitis and associated lesions or ALVAL) a very small proportion (estimates range from 1:1000 to 1:500) of patients may react adversely to metal ions shed from the bearing of a hip resurfacing or hip replacement using a metal-on-metal couple. The subject is currently the subject of intense research and it is not a straight-forward 'allergy'. Unfortunately, skin testing for metal allergy is not reliable in predicting ALVAL, as it seems a completely different mechanism. ALVAL causes pain and early loosening of implants. It may be more common in association with implant malposition, leading to increased metal ion formation. Implant metallurgy or manufacturing may be important. It is mentioned as you may see comment about it elsewhere, and if it does occur, the hip resurfacing will probably require revision to a metal-free bearing couple. I currently do not believe the risk of ALVAL should put any sensible patient off having a hip resurfacing if they are otherwise suitable. The benefits far outweigh the risks!
Leg length inequality . It is not always possible to get the legs exactly the same length. They may have been very different lengths before surgery! As long as the discrepancy is small, it can be safely ignored. There is argument as to what is 'small' but up to ¾" is nothing to get worked up about. The more experienced the surgeon, the more accurate he/she is likely to be.
More common but less serious problems:
Swelling, blistering or bruising . This can be alarming, but generally harmless. All resolve with time.
Superficial wound colonisation and weeping . Wounds can become colonised by bacteria without being deeply infected. In this situation, a course of oral antibiotics will resolve the problem within a few days. Weeping wounds without surrounding redness or induration should simply be dressed and watched carefully. It is a mistake to use antibiotics indiscriminately, as they may promote the emergence of resistant organisms. If in doubt, always try to contact your surgeon or the hospital first, rather than burdening your GP or family doctor!
Miscellaneous problems: Impossible to give an exhaustive list but these include, nausea, diarrhoea or constipation, urinary retention, headaches, poor appetite, insomnia and general fatigue. It is the function of the nursing, medical and physiotherapy teams to help you with all of these and devise individually tailored solutions.
