Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.
Implant surgery for artificial hip or knee joints (known as internal endoprosthesis) is a serious intervention, which inevitably brings significant changes in the lifestyle of the patient. Just like any surgery, artificial joint implantation has some potential risks which, although rare, should not be overlooked.
Risks
Risks associated with hip replacement surgery may include:
• Blood clots
• Infection
• Fracture
• Dislocation
• Change in leg length
• Loosening
• Need for second hip replacement
The prosthetic hip joint may wear out eventually, so if you have hip replacement surgery when you're relatively young and active, you eventually may need a second hip replacement. However, new materials are making implants last longer, so a second replacement may not be needed for many years.
The complications and risks associated with hip joint replacement are generally divided into:
• Complications arising during operation: generally these are risks associated with the technical difficulty of the surgery. Such complications may be significant blood loss, damage or fracture of the bone, nerve damage or complications caused due to anesthesia.
• Complications arising in the early postoperative period (immediately after surgery) - thromboembolic complications and the risks associated with them, the shock that the body experiences from the operation itself, the external interference in the bone structure (sometimes) the concomitant severe preoperative condition of the patient, as well as decreased mobility and prolonged immobility can cause the formation of blood clots in blood vessels of the lower limbs and pelvis. Under certain conditions, these clots can break off and move along with bloodstream and cause dangerous clogging of the vessels that fill the lungs with blood.
This is a condition known as pulmonary embolism. Depending on the severity of complications, this condition may cause disturbances in cardiac and respiratory activity, respiratory failure, and shock and death. In order to minimize risks and avoid such complications are taken certain measures - medication, exercise and more.
Other potential complications in the early postoperative period are: thrombophlebitis and phlebothrombosis the veins of the lower limbs, pneumonia (lung inflammation), increased bleeding, infection of the surgical wound.
• Complications arising after surgery include infections of the artificial joint, loosening of the endoprosthesis (w/o infection), wear, tear, damage or breakage of any of the components of the internal prostheses, as well as dislocation of the joint.
A number of factors can determine a relatively high risk of infection. Such infections are often endogenous, caused by microorganisms living in the organism of the patient. The infection usually affects the bone around the prosthesis and causes loosening of prosthetic components, thereby compromising the function of the artificial joint.
Loosening of the prosthesis without infection is also fairly common. Processes osteolysis (bone breakdown) between the bone and the artificial joint or between the bone and bone cement fixture can lead to serious breaches of functions of the endoprosthetics joint. The artificial joint components make microscopic movements which, intensified over time and with osteolysis changes, can cause major damage to the bone, which sometimes reach up to large areas with missing, broken bone.
Wear of the components of the artificial joint is related to the duration of the 'life' used for their construction materials. The conditions in which the endoprosthesis works are also of great importance. Proper placement of the artificial joint is crucial to the longevity of the implant.
More serious and severe trauma such as a fall on the hip or limb twisting can also cause hip fracture around the prosthesis stem.
All these late complications of hip replacement surgery require immediate and specialized medical intervention.
In many cases dislocated artificial joint can be adjusted, but this can only be done by a specialist doctor in hospital under anesthetic.
In all other cases most often the patient may need a new operation.
Metal-on-metal artificial joint complications
Most artificial hip joints have a polished metal or ceramic ball that fits into a cup liner that's made of very hard plastic. Some types of prostheses use a metal cup liner, which may last longer but can cause other problems. Metal-on-metal prostheses are more likely to release metal ions into your bloodstream, which can cause inflammation and bone erosion. Because of these concerns, metal-on-metal prostheses are now rarely used.
People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, fracture, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.
Today, a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore, they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes.
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