Total Hip Replacement Complications

Original Editor - lucinda hampton

Top Contributors - Lucinda hampton, Rana Samy Algarhy, Kim Jackson and Vidya Acharya  

Introduction

Total hip replacements in experienced hands provide very effective outcomes, however one must be aware of the potential complications of the procedure. These can be divided into general and procedure specific, and may occur during the surgery, immediately after the surgery or after weeks, months, or years after the surgery.

Common Complications

The most common systemic complication is a deep vein thrombosis. Infection is the most dreaded complication. Leg length discrepancy is a common causes of patient dissatisfaction. Other complications include:

• Aseptic loosening: considered to be the most common indication for revision surgery
• Particle disease / histiocytic reaction / aggressive granulomatosis
• Fracture: periprosthetic fracture; cement fracture; stem fracture
• Dislocation (~5% of all replacements): dislocation of femoral head out of the cup: component dissociation: dislocation of the entire acetabular cup; dislocation of stem
• Heterotopic bone formation

• Reaction to metal: eg metal-on-metal pseudotumour, metallosis.
• Abductor muscle/tendon dysfunction e.g. tears
• Stress shielding
• Trochanteric bursitis
• Revision total hip arthroplasty
• General post-orthopaedic surgical complications eg haemorrhage, wound complications, deep vein thrombosis and pulmonary embolism, vascular injury, neurological deficit, death.

Gait abnormality after THR

Despite this great gain in functional ability and a subjective improvement in the ability of walking, gait sequences in patients undergoing THR improvement, but achieve abnormality. Many gait analysis studies have shown that gait sequences remain abnormal in the long term and are comparable to pre-operative gait. Range of motion was improved following THR, but in severe cases remained less than normal. It is important to note that hip flexion contractures, with loss of hip extension, have been shown up to 1 year after total hip replacement, and is probably due to a combination of factors, e.g. persistent muscle weakness, scar tissue formation and learned gait patterns though the exact cause is unknown.

Abductor insufficiency

A common clinical scenario that follows a direct lateral approach is abductor muscle insufficiency. It may result in weakness of the abductor muscles, a Trendelenburg gait or sign, poor gait mechanics, and pain in the peritrochanteric area. The insufficiency most likely stems from either irreversible tears at the time of Total hip replacement in up to 20% of patients, chronic degeneration of the gluteus medius tendon prior to surgery, or failure of the repaired tenotomy following a direct lateral approach.

Fracture

Intraoperative fractures can be a devastating complication that prolongs the length of the surgery, makes weight-bearing modifications during the postoperative mobilization difficult, and has a negative impact on the patient's outcome.

There is a dearth of research on the intraoperative fracture risk rate using the posterior and lateral direct approaches. Using a lateral approach, the researchers anticipated 4.0% of intraoperative greater trochanter fractures. The authors propose that increased soft tissue tension and subsequent avulsion during femoral preparation are the cause of the fractures, in line with reports that use the direct anterior approach. The risk of intraoperative fracture can be decreased by following a few key principles. Any surgical approach that involves leg manipulation can lower the fracture rate by examining the tension in the soft tissues both before and after the manipulation. Every surgeon should be proficient in soft tissue releases, such as the short external rotators for better femoral exposure with a direct anterior approach.

Dislocation after THR

Total hip replacement is a common, cost-effective, and almostly successful intervention for improving pain and disfunction associated with sever hip joint disease such as osteoarthritis., however high success rates, however, some replacements may fail. Common complications after primary total hip replacement include aseptic loosening, dislocation, prosthetic joint infection, fracture, and adverse reactions to particulate debris.

The incidence of dislocation has been reported to be from less than 1% up to 22%. More than half of dislocations occur in the first 3 months following primary total hip replacement. As the population ages and with growing volumes of primary total hip replacement procedures being done.

Dislocation can lead to severe pain, restriction of mobility, recurrent dislocation, and poor quality of life. The associated consequences of dislocation include repeated admissions to hospital and substantial financial cost to both the patient and the health-care system.

our results provide a detailed picture of the different causes of dislocation risk following primary total hip replacement. Most of the risk appears to be caused by patient-related factors (eg, sociodemographic characteristics, high body-mass index, and comorbidities), surgery-related factors (surgical approaches), and several implant-related factors.

Early recognition of these factors, along with careful planning before and after surgery, along with a multidisciplinary approach, might represent an implementable strategy by which to prevent or decrease dislocations among patients at high risk.

Nerve injury

The prevalence of nerve injuries during THA has been reported to be around 1%.39 There are various situations in which nerve injury can happen, such as direct trauma from dissection or implanting wires or acetabular screws; retraction; thermal injury from methylmethacyrlate; hematoma-induced compression; leg lengthening; and component positioning. Forty The sciatic, femoral, lateral femoral cutaneous, and superior gluteal nerves are among the nerves that are frequently injured.

Direct lateral approach to the hip can result in complications, such as a superior gluteal or femoral nerve palsy. The nerve has been found between the gluteus medius and minimus muscles close to the greater trochanter. 41 Studies that are both retrospective and prospective indicate that superior gluteal nerve injuries that result from direct lateral hip reconstruction procedures occur between 2.2% and 42.5% of the time. Abductor insufficiency and worse functional outcomes after total hip arthroplasty can result from this nerve palsy. Because of the nerve's course around the anterior superior iliac spine, 15%–80% of patients undergoing Total hip replacement through a direct anterior approach may experience neuropraxia of the lateral femoral cutaneous nerve. The majority of these neuropraxic injuries heal without causing any long-term problems. A potential complication that could result in this case is a postoperative neuroma.

When using the posterior technique, there is a higher chance of sciatic nerve damage. Sensory or motor impairments resolved on their own in the majority of individuals.

Overly rigid soft tissue retractors across the anterior side of the acetabulum for all procedures put the femoral nerve at risk. Femoral nerve palsies are associated with THA at a rate of 0.1% to 2.4%.