complications

Last reviewed 01/2018

• thromboembolism - deep vein thrombosis and pulmonary embolism are risks due to twisting of the leg during operation, stasis etc. Early mobilisation and prophylactic anticoagulation help to prevent these problems. Without preventive measures, about 1-2% of patients die from pulmonary embolism and about 50% experience venous thrombosis.

• infection - occurs in about 1% of cases especially in the the very old, those with rheumatoid arthritis or psoriasis, or patients on immunosuppressive therapy. It can be early - causing pyrexia, malaise, and invariably, failure - or late, from the bloodstream or urinary tract. Organisms not generally regarded as pathogenic may be involved, for example, Staph. epidermidis. Infection may be prevented by adequate prophylactic antibiotics, or by using cement impregnated with antibiotics such as gentamicin. Meticulous antiseptic technique during the operation should be observed. Established infection is treated with antibiotics and removal of the infected prosthesis.

• aseptic loosening of either the acetabular socket or the femoral stem - the most common cause of long term failure. Often associated with violent twisting stresses. The patient may complain of hip pain on walking but diagnosis requires radioisotope scanning.

• dislocation - about 1%, often due to incorrectly placed prostheses - cases unresponsive to conservative measures may require revision

• fracture

• hypertrophic bone formation - occurs in about 20% of cases. Aetiology unknown but risk factors include ankylosing spondylitis, skeletal hyperostosis.