Post-operative complications and precautions taken to avoid them

Thromboses & Emboli (blood clots):
To prevent blood clots forming in the legs foot pumps are applied, early mobilisation (exercises & walking) is encouraged &, in most cases either Arixtra (fondaparinux sodium—a synthetic selective Factor Xa Inhibitor) or aspirin is given to reduce the risk of thrombosis. People at high risk of developing a clot will be treated with Warfarin.

Thrombosis in the lower calf veins is not considered to be a major medical problem. Thromboses that occur further up the leg can be dangerous and lead to pulmonary emboli (clot in the lungs). Pulmonary emboli can sometimes be fatal and if a proximal thrombosis is diagnosed you will have your blood thinned with anticoagulants. Do inform your GP if you experience acute chest pain or start coughing blood up in the early weeks after surgery.

Superficial Infection:
You will not be discharged unless the appearance of the wound is satisfactory. Inform the Hip Unit or Surgeon if you have any problems with healing of the wound in the weeks following your discharge from the hospital. At this stage the surgeon would normally prefer to check the wound him/herself rather than merely starting a course of antibiotics. If there is an indication that a deep-seated infection is present then a washout of the wound in theatre may be the appropriate treatment in this early post-operative phase. It may save the hip replacement from persistent deep infection.

Deep Infection:
A deep infection of the joint most often starts when bacteria gain access to the tissues at the time of surgery and great lengths are taken in theatre to reduce the risks of this happening. Operations are carried out in ultra-clean air and you will be given prophylactic antibiotics at the time of surgery. Occlusive clothing or “space-suits” are worn by the surgical team. Despite all the precautions taken infections can still occur. An early infection may sometimes be cured by washing the joint out and an extended course of antibiotics. However, depending on the type of infection and the microbe involved it is sometimes necessary to remove the new hip and then to attempt to replace another one at further operation after a period of intensive treatment with antibiotics.

An infection can occur at any stage in the life of a hip. The reason for this is that any infection in the body can circulate in the blood & settle on the surface of the implant. Once there it forms its own environment, or “bio-film”, & can thrive. Unfortunately, antibiotics cannot penetrate this film, although they may keep the symptoms under control. Usually the only way to eliminate later deep infections of this type is to remove the artificial implant as described above.

Leg length:
It is rarely possible to make the operated leg shorter & sometimes it is necessary to lengthen the leg in order to tighten any slack tissues & improve stability of the prosthetic hip joint. The Surgeons aim for equal length & in the vast majority of cases it is possible to achieve this. A noticeable leg length difference may, however, be inevitable. Small differences may not cause any problems but if the difference is significant it can be corrected by using a shoe insert or heal-raise on the opposite side.

Nerve Damage:
Very occasionally one of the nerves that goes past the hip can be damaged during the operation. This can cause a foot-drop or paralysis of other muscle groups in the leg. Although the nerve often recovers over a period of months the paralysis can persist.

Swelling of the leg:
This is to be expected, as it is a normal response to the operation. Patients are encouraged to continue leg exercises & to lie flat once or twice a day so that their feet are not dependent for long periods. Walking is also helpful but standing unnecessarily should be avoided. If the swelling is accompanied by tenderness in the calf or groin, a temperature or respiratory symptoms, you should ask a doctor to examine you.

Dislocation:
Dislocation of the ball from the socket of an artificial joint can occur. The joint is especially vulnerable in the first 8 weeks when the soft tissues are healing. Avoidance of the most common potential position of dislocation is useful: Do not bring the knee of your operated leg and the opposite shoulder towards each other.

If the joint does dislocate it needs to be reduced in the Accident & Emergency Department. A hip brace is usually prescribed for 6 weeks to allow the soft tissues to heal again. There is an increased chance, once a dislocation has occurred, of it happening again. Rarely further surgery may be required if the joint recurrently dislocates.

Ectopic bone or Heterotopic Ossification. (Extra bone formation):
The body may form new bone in the tissues around the hip in response to the trauma of the operation. This tends to occur only in the immediate recovery phase and may lead to long-term stiffness of the joint.

Urinary problems:
Depending on the type of anaesthetic used it may be necessary to introduce a catheter into the bladder. This is occasionally required in the post-operative period for other reasons. In men, especially if there were previous symptoms of an enlarged prostate, the advice of a Urologist my prove necessary.

Medical problems:
Complications of myocardial infarction, stroke, chest infection etc. can occur after hip replacement as with other forms of major surgery. These complications are rare and the anaesthetist will not allow the operation to proceed if it is felt that the risks are significantly higher than normal for any particular patient.

Aching in the joint, stiffness, limp etc
The operation of hip replacement requires a degree of soft tissue dissection and there are a group of patients who limp post-operatively. This is less common if a posterior approach to the hip has been used compared with some other types of approach. A very small proportion of patients, for whatever reason, remain less then 100% satisfied with their new hip joint.

Long-term survival of the Exeter Hip:
You have a 95% chance of still having the same hip in place & functioning well at 12-15 years after the operation. This is based on 30 years of experience with the Exeter Hip.