Hip replacement and surgery complicationsApril 17, 2015 April 17, 2015
We see hip replacement complication questions very often. The lead question of course is why does the patient continue to have pain? One reason may be that the surgery did not address what was causing the pain. In so many cases, the surgery recommendation relied on radiographs – imaging studies – and scans (MRIs, et al.). However, researchers are telling us that simple hip radiographs alone are not sufficient to diagnose clinically significant hip osteoarthritis. Physical examination (hip internal rotation) was found to be more accurate.1 In other words, let the doctor’s examination be your guide to determining whether or not you need hip surgery, not the pictures of your hip.
Hip Replacement Complications
Pakistani physicians examined complication rates in patients following hip replacement surgery. What they found was:
- postoperative complications occurred in 39 patients (19.6%);
- dislocation being most common (6.5%),
- followed by wound infection in (2%),
- all of these patients required intervention.
Other minor complications which were managed conservatively included wound infection (2.5%), urinary tract infection (2.5%), dislocation (1%), pleural effusion and pneumonia (2%), deep venous thrombosis (0.5%) and myocardial infarction (0.5%). Finally pre-operative hip deformity and perioperative blood transfusion significantly influence the rates of complication after unilateral total hip replacement. (2)
Research in the British Medical Journal cited the alarmingly high number of failed hip replacements. Here is what the research says:
“Revision rates— (that is) how likely it is that a patient will need an operation to replace a prosthesis—for hip replacements are by far the highest overall for metal on metal (so called because the head and the lining of the cup are both made of metal) hip devices…the highest failure rates involved the now recalled articular surface replacement (ASR) total hip implant made by DePuy. Of those patients who received the device six years ago 29% have since had it replaced…” (3)
In another study – a warning to younger athletic patients
“A case-control study found that outcomes (measured by the Oxford hip score) for patients who had revision of hip resurfacing for adverse reaction to metal debris were significantly worse than for patients who had revisions for fractures or other reasons….We consider it important to diagnose adverse reactions to metal debris and consider revision surgery early to limit the extent of soft tissue destruction and osteolysis, especially as metal bearings are traditionally used in younger and more active patients.” (4)
We have successfully treated our patients and athletes and those with chronic hip pain with regenerative therapies like PRP (platelet rich plasma) and prolotherapy. With prolotherapy and PRP we can address the underlying cause of hip pain.
Furthermore with new regenerative breakthroughs like stem cell treatments, we can do more for patients who have an arthritic hip or labral tear, helping them avoid joint replacement and joint replacement complications.
1. Chong T1, Don DW, Kao MC, Wong D, Mitra R. The value of physical examination in the diagnosis of hip osteoarthritis. J Back Musculoskelet Rehabil. 2013 Jan 1;26(4):397-400. doi: 10.3233/BMR-130398.
2. Abbas K, Murtaza G, Umer M, Rashid H, Qadir I. Complications of total hip replacement. J Coll Physicians Surg Pak. 2012 Sep;22(9):575-8.
3. Revision rates for metal on metal hip joints are double that of other materials. BMJ 2011; 343 doi: 10.1136/bmj.d5977
4. Diagnosing and investigating adverse reactions in metal on metal hip implants.BMJ 2011; 343 doi: 10.1136/bmj.d7441 (Published 29 November 2011)