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AFTER TOTAL JOINT SURGERY

It is important to understand that there are risks associated with any major surgical procedure and total joint replacement is no exception. Although the occurrence of these complications is low in number, each patient needs to be informed of these possible risks prior to surgery. In all cases discussion between the patient and the treating physician is imperative to put possible complications into proper perspective for a specific patient.

Death

The risk of death is present in any major procedure requiring anesthesia and blood transfusion. The risk of death in a patient undergoing a total joint replacement is 1 in 750 - 1,000 cases. The specific risk for each individual is dependent on their general medical condition, their age, and the difficulty of the surgical procedure performed. There are other risks involved with total joint replacement which are somewhat larger than the risk of death.

Infection

A major potential risk with total joint replacement is the risk of infection. When a patient undergoes total joint replacement, they are started on intravenous antibiotic therapy to reduce the chance of infection. In our experience, and across the country, the risk of infection is approximately 2% or less. This means that 1 case in 200 has the potential for infection. Infection in the post operative course in most patients is treatable. It may simply require longer hospitalization, treatment with antibiotics for a longer period than normal, opening the joint and draining it, or in some instances removing the artificial components in order to cure the infection before implanting another artificial joint. In extreme cases where infection cannot be treated successfully, a patient may need to have the artificial joint removed permanently and have the joint fused.

Loosening

Loosening of a prosthesis is another potential risk in total joint surgery. Loosening may occur in any one individual component or occur in all the components. The occurrence of loosening in a total joint replacement is approximately 1% per year in our experience. Loosening of a prosthesis is not usually a sudden occurrence, but a gradual process, characterized by increasing discomfort. In most instances, if a prosthesis becomes loosened, it can be corrected by another surgical procedure.

Thrombosis

The occurrence of a blood clot or thrombosis after total joint replacement is another potential risk. Because patients are mobile very early in the postoperative period, this is a complication that is seen much less frequently now than in the past. In addition to early mobility, patients are treated with pulsatile stockings, (to prevent the stasis of blood in the lower extremities) and low doses of aspirin or other anticoagulation medications to reduce the risk of forming a thrombosis. If a patient is diagnosed with a blood clot, treatment with intravenous heparin and oral coumadin is initiated. As a result, patients may need to be hospitalized slightly longer, but recuperation remains normal overall.

While these complications may occur after any total joint surgery, both hip and knee joint replacement have unique problems which may occur.

Loss of Motion

In the case of total knee surgery, a decrease in motion after total joint (Knee) replacement may require a manipulation to help break the adhesions formed in the postoperative period. If this were to occur, the patient is given a small amount of general anesthesia and while asleep, the knee is passively bent for them. In most cases, this is performed on an outpatient basis, with the patient starting physical therapy within 48 hours from the time of the procedure.

Dislocation

In total hip replacement surgery, there is about a 1% chance that the hip will (Hip) dislocate in the immediate post-op period. This may occur because of an inadvertent movement in which the ball part of the prosthesis becomes dislodged from the socket. In the vast majority of these cases, this can be treated by manipulation and does not require another surgical procedure, though use of a small anesthetic may be necessary. If unsuccessful in relocating the prosthesis, a second open surgical procedure may be necessary to correct the situation.

Medical

Medical risks after total joint surgery are of course varied, and range from minor to more serious complications. These may include complications involving the cardiovascular respiratory, gastrointestinal, or genitourinary systems or any system in the body. Each occurrence of a medical complication is addressed as it occurs and will vary for the individual patient.

While total joint surgery or any type of orthopaedic surgery does involve certain risks, it is safe to say that most of these risks are encountered in any major surgical procedure. Careful pre-surgical screening, superior surgical technique, and conscientious post-operative management are the cornerstones to minimizing not only the occurrence of any complications, but certainly the outcome of these risks as well. It is our policy to adhere to these criteria whenever a patient undergoes any operative procedure, and in doing so, keeping these risks to a minimum.

 
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