Unfortunately there is no such thing as a risk-free surgery, just as a road accident can always happen. In surgery as well as in driving, complications or accidents can range from the simplest to the most serious and can therefore be life-threatening.
If the anaesthetic consultation has already informed you of the main specific risks (see Hospitalisation ; Anaesthesia ; The consultation), prosthetic hip surgery includes risks that must be addressed.
The best known and often most feared complication is the dislocation of the prosthesis.
When the surgeon uses a classic prosthesis (see the different types of PTH) the rate of dislocation is on average 6%.
But Doctor PUCH uses either double mobility prostheses (see PTH to DM) with a dislocation rate of 0.01%, or large ceramic head prostheses with a dislocation rate of 1 to 2%.
Depending on the choice made, there will be no ban, keeping in mind the right rules of caution! Consequently, a certain number of dangerous movements will be prohibited for a period of about 6 to 8 weeks (see the instructions for caution in simple mobility).
Infection is a rare but serious complication.
However, this risk is minimised by preoperative precautions which aim to search for and treat any unknown infectious sites (dental and urinary in particular) and to ensure that the skin is perfect on the day of the operation. Antibiotics will be administered as a preventive measure during the operation : this is called antibiotic prophylaxis.
Infection can occur even a long time after the surgery by contamination from a distant infection. To prevent a late infection, you will therefore have to treat infections for the rest of your life and take good care of your skin by avoiding any wounds that would be a gateway for bacteria. You are strongly advised not to smoke during the healing period, as smoking significantly increases the rate of infection.
An infection of the prosthesis usually leads to a new surgery.
Inequality of the lower limbs
The aim of your surgeon will be to make your two lower limbs equal because in a large majority of cases the limb on the side of the coxarthrosis is shortened due to wear and tear of the cartilage and sometimes of the bone (see the radio image in the General tab).
This is not always very easy because the two limbs are not always equal and despite the pre- and intra-operative measures, it is not always possible, nor desirable, to seek equality in length of the lower limbs; indeed, a shortening of the operated side causes weakness of the gluteal muscles as well as instability of the prosthesis which can lead to dislocation.
In all cases, a pre-operative planning on specific shots taken at the clinic is carried out by Doctor PUCH, in order to get as close as possible to the original situation.
It is important to know that in cases of bilateral damage, a lengthening of the operated side will often be necessary because the adjustment of the prosthesis is not based on the opposite diseased hip. The balance will therefore be restored during the second operation.
Finally, the elongation is not a concern below 15mm because it is most often compensated by the pelvis, beyond that, compensation by heel or sole of half the elongation (e.g. 10 mm wedge for 20 mm elongation) can be used. In some cases, a surgical revision may be necessary.
Post-operative haematoma (blood bag)
It is rarely disturbing and exceptionally requires evacuation. It is most often a bruise, which is also common because the bone tissue of the hip bleeds easily, especially since anticoagulant treatment is systematically carried out after any hip prosthesis. It is therefore important to use an ice bladder on the operating area (the buttocks) regularly (for 20 minutes 4 to 5 times a day) and from the post-operative period up to sometimes 3 weeks.
Blood transfusion
In our experience, it is exceptional, but it may be necessary during or after surgery. Nowadays, blood products such as bone grafts undergo numerous and very rigorous tests to prevent the transmission of certain diseases such as AIDS or hepatitis.
Phlebitis
This is one or more clots that form in the veins of the lower limbs, these clots can migrate and cause a pulmonary embolism. The potential seriousness of pulmonary embolisms explains the importance given to the prevention of phlebitis. This prevention is essentially based on anticoagulant treatment and the post-operative prescription of support stockings. Thanks to the rapid rise in the 3 to 4 hours post-operatively, the mobility of the legs encouraged in bed and the rapid recovery, this complication has been reduced, but one must remain cautious because particular susceptibilities or family pathologies exist and phlebitis can occur despite anticoagulant treatment.
Much more rarely can we see intraoperative or quickly afterwards :
An intra operative fracture of the femur, which may require additional surgery.
Intra operative paralysis of the sciatic nerve, often due to traction during manipulation. It generally recovers in a few months. Exceptionally, a more severe damage can be observed, which may justify a specific apparatus or a new operation.
A little later :
Peri-articular ossifications. In the weeks following the operation, bone forms around the joint for an unknown reason and can cause stiffness; in some cases an operation has to be carried out.
A fracture of the femoral prosthesis is a rare complication, but it can occur. This can occur in the event of a very important overload of the implant (overweight, excessive and/or repeated physical activity...), sometimes associated with a defect of the metallurgical part.
A loosening of the prosthesis can occur in the medium or long term. That is to say that the prosthesis may hold less well in the bone and cause pain. There are several possible causes for this late loosening of the prosthesis :
They can be mechanical and linked to too violent and intensive physical activity.
They may be related to a reaction of the body to the wear debris of the prosthesis or to an infection of the prosthesis.