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Risks of hip and knee replacement

All surgeries have risks for complications. Knowing what these risks are and how they apply to you is part of deciding whether or not to have surgery.

You can help lower your chances of risks from surgery by planning ahead.

  • Choose a doctor and a hospital that provide high-quality care.
  • Talk with your health care provider long before your surgery.
  • Find out what you can do to help prevent problems during and after surgery.

Risks That may Occur With any Surgery

All types of surgery involve risks. Some of these include:

  • Breathing problems after surgery. These are more common if you've had general anesthesia and a breathing tube.
  • Heart attack or stroke during or after surgery.
  • Infection in the joint, lungs (pneumonia), or urinary tract.
  • Poor wound healing. This is more likely for people who are not healthy before surgery, who smoke or have diabetes, or who take medicines that weaken their immune systems.
  • An allergic reaction to a medicine that you received. This is rare, but some of these reactions may be life threatening.
  • Falls in the hospital. Falls can be a major problem. Many things can lead to a fall, including loose gowns, slippery floors, medicines that make you sleepy, pain, unfamiliar surroundings, weakness after surgery, or moving around with a lot of tubes attached to your body.

Bleeding

It is normal to lose blood during and after hip or knee replacement surgery. Some people need a blood transfusion during surgery or during their recovery period in the hospital. You are less likely to need a transfusion if your red blood count is high enough before surgery. Some surgeries require you to donate blood before surgery. You should ask your provider about whether there is a need for that.

Much of the bleeding during surgery comes from the bone that has been cut. A bruise may occur if blood collects around the new joint or under the skin after surgery.

Blood Clots

Your chances of having a blood clot form are higher during and soon after hip or knee replacement surgery. Sitting or lying down for long periods of time during and after surgery will make your blood move more slowly through your body. This increases your risk of a blood clot.

Two types of blood clots are:

  • Deep vein thrombosis (DVT). These are blood clots that may form in your leg veins after surgery.
  • Pulmonary embolism. These are blood clots that may travel up to your lungs and cause serious breathing and health problems.

To lower your risk of blood clots:

  • You may receive blood thinners before and after surgery.
  • You might wear compression stockings on your legs to improve blood flow after surgery.
  • You will be encouraged to do exercises while in bed and get out of bed and walk in the halls to improve blood flow.

Possible Problems With Your new Joint

Some problems that may occur after hip or knee replacement surgery include:

  • Infection in your new joint. If this occurs, your new joint may need to be removed to clear the infection. This problem is more likely in people who have diabetes or a weakened immune system. After surgery, and often before surgery, you will learn what you can do to prevent infections in your new joint.
  • Dislocation of your new joint. This is rare. It most often occurs if you return to activities before you are ready. This can cause sudden pain and inability to walk. You should call your provider if this happens. It is likely that you will need to go to the emergency room or return to the hospital. You may need a revision surgery if this happens repeatedly.
  • Loosening of your new joint over time. This can cause pain, and sometimes another surgery is needed to fix the problem.
  • Wear and tear of the moving parts of your new joint over time. Small pieces may break off and damage the bone. This may require another operation to replace the moving parts and repair the bone.
  • An allergic reaction to the metal parts in some artificial joints. This is very rare.

Other Risks

Other problems from hip or knee replacement surgery can occur. Although they are rare, such problems include:

  • Not enough pain relief. Joint replacement surgery relieves the pain and stiffness of arthritis for most people. Some people may still have some symptoms of arthritis. For most people, surgery usually provides a significant relief of symptoms.
  • A longer or shorter leg. Because bone is cut away and a new knee implant is inserted, your leg with the new joint may be longer or shorter than your other leg. This difference is usually about 1/4 of an inch (0.5 centimeters). It rarely causes any problems or symptoms.

References

Edwards PK, Mears SC, Lowry Barnes C. Preoperative education for hip and knee replacement: never stop learning. Curr Rev Musculoskelet Med. 2017;10(3):356-364. PMID: 28647838 pubmed.ncbi.nlm.nih.gov/28647838/.

Ferguson RJ, Palmer AJ, Taylor A, Porter ML, Malchau H, Glyn-Jones S. Hip replacement. Lancet. 2018;392(10158):1662-1671. PMID: 30496081 pubmed.ncbi.nlm.nih.gov/30496081/.

Harkess JW, Crockarell JR. Arthroplasty of the hip. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 3.

Mihalko WM. Arthroplasty of the knee. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 7.

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  • Hip joint replacement

    Hip joint replacement

    Animation

  •  

    Hip joint replacement - Animation

    Your hip is hurting so bad, you can't sleep. It's hard to bathe, to clean, make it to the mailbox or shop at the mall. You may have severe arthritis in your hip, and there's a good chance you need a hip replacement. Hip replacements are usually done in people age 60 and older. If you need one, you probably have severe arthritis that limits your daily life, or perhaps have a hip fracture. Your hip joint is made up of two parts, the hip socket and the upper end of the thigh bone. One or both parts may be replaced during surgery. Your new hip will probably have a socket made of strong metal, a liner that fits inside the socket, usually plastic, a metal or ceramic ball to replace the round head of your thigh bone, and a metal stem attached to the thigh bone to make your joint more stable. So, how is the hip replacement procedure done? Well you won't not feel any pain during surgery because you will have medicine to make you fall asleep. The surgeon will cut and remove the head of your thigh bone and clean out your hip socket, removing cartilage and damaged or arthritic bone. The surgeon will put the new hip socket in place, insert the metal stem into your thigh bone, and place the ball for a new joint. Cement will probably hold the new joint in place. The surgery can take several hours. After the surgery, you will probably stay in the hospital for three to five days. As soon as the first day after surgery, you will be asked to start moving and walking around with a walker, crutches, or a cane. You will need physical therapy to strengthen your new joint for up to several weeks after your operation. Some people need a short stay in a rehabilitation center after they leave the hospital. At the rehab center, you will learn how to safely do your daily activities on your own. Your new hip should allow you to resume your daily activities once you've learned to move around on your own. In the long run, over 20 years or so, the joint may need to be placed again. But, in the short run, most or all of your pain should go away. The stiffness should go away. Your doctor should be able to monitor any problems and you should enjoy your new joint.

  • Hip joint replacement

    Hip joint replacement

    Animation

  •  

    Hip joint replacement - Animation

    Your hip is hurting so bad, you can't sleep. It's hard to bathe, to clean, make it to the mailbox or shop at the mall. You may have severe arthritis in your hip, and there's a good chance you need a hip replacement. Hip replacements are usually done in people age 60 and older. If you need one, you probably have severe arthritis that limits your daily life, or perhaps have a hip fracture. Your hip joint is made up of two parts, the hip socket and the upper end of the thigh bone. One or both parts may be replaced during surgery. Your new hip will probably have a socket made of strong metal, a liner that fits inside the socket, usually plastic, a metal or ceramic ball to replace the round head of your thigh bone, and a metal stem attached to the thigh bone to make your joint more stable. So, how is the hip replacement procedure done? Well you won't not feel any pain during surgery because you will have medicine to make you fall asleep. The surgeon will cut and remove the head of your thigh bone and clean out your hip socket, removing cartilage and damaged or arthritic bone. The surgeon will put the new hip socket in place, insert the metal stem into your thigh bone, and place the ball for a new joint. Cement will probably hold the new joint in place. The surgery can take several hours. After the surgery, you will probably stay in the hospital for three to five days. As soon as the first day after surgery, you will be asked to start moving and walking around with a walker, crutches, or a cane. You will need physical therapy to strengthen your new joint for up to several weeks after your operation. Some people need a short stay in a rehabilitation center after they leave the hospital. At the rehab center, you will learn how to safely do your daily activities on your own. Your new hip should allow you to resume your daily activities once you've learned to move around on your own. In the long run, over 20 years or so, the joint may need to be placed again. But, in the short run, most or all of your pain should go away. The stiffness should go away. Your doctor should be able to monitor any problems and you should enjoy your new joint.

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    Review Date: 7/28/2021

    Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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