Hip Replacement : Understand the procedure & possible complications.


Thankfully, the vast majority of total hip replacement procedures turn out as planned, with a successful outcome. Patients should know however, that there can never be a guaranty or implied warranty of results with any surgery.  Hip replacement surgery is a major procedure, involving placing metal implants in side of the femur bone and the pelvis hip socket. Patients will participate in an informed consent discussion, and the surgeon will explain a number of unlikely but possible complications that can occur with this surgery.  Complications can occur regardless of which direction the hip replacement is done, meaning both anterior and posterior hip replacements can result in problems.

Possible complications ( this list includes most but not all possible complications of hip replacement surgery!):

Infection– this is quite rare in anterior hip surgery, probably because there is little muscle necrosis and blood supply in this area is very good. A useful approximation of risk would be 1 in 200 cases will develop an early or “acute” deep infection. This would require another surgery to “wash the hip out” and start antibiotics. Most of the time it can be considered “bad luck” and no identifiable reason is found for an early infection. It is a known and accepted risk that this can occur. It is very disappointing to everyone when this happens, but inevitably one patient will end up with an unexpected but possible infection.

Dislocation-about 1 out of every 500 men will dislocate an anterior total hip replacement. This happens during an extreme motion such a bending way backwards or forwards soon after surgery. It takes 3 months for the hip ligaments to heal up and hold the hip in the joint during extreme motions. Women dislocate more frequently, about 1 in 100 women will pop out during a prohibited activity like shaving a leg, or cutting a toenail. The risk disappears after the ligaments have healed.women have different anatomy and smaller muscles then men, which allows the hip to lever out more easily.

Fractures- we are driving a wedge into soft bone in some cases, and a fracture of the femur can occur. Sometimes the tip of the implant or a rasp can break through the bone and cause a crack to propagate.  The anterior procedure may have slightly more fractures because the exposure is tighter.

Leg Length inequality- this is a common phenomenon in any hip replacement approach. Most often the difference is not large enough to be noticed.  Most patients will tolerate a 1 centimeter difference without any symptoms or concerns. Sometimes scoliosis ( curvature of the spine) will magnify a difference, and a small shoe lift Can be used to feel more equal. It is often necessary to relengthen a short leg so it does not dislocate from soft tissue laxity noted after the hip ligaments are opened. No matter how many times i tell my patients about this issue, some still are upset about it after surgery.

Bursitis and soft tissue pains.- some patients, possibly up to 5 percent develop trochanteric bursitis on the side of the hip, or psoas tendonitis on the front area of the hip.  Can be frustrating, but usually resolve over time. Stretching exercises and antiinflammatories will help.




Here is a link to another OFF SITE page listing possible complications of Total Hip Surgery.