What are the risks and complications associated with the implantation of a hip prosthesis?
The implantation of an artificial hip joint is considered a safe procedure, but complications can still occur.
In the large veins of the legs and pelvis, blood clots can form after such an operation (deep vein thrombosis DVT).
The risk of thrombosis can be reduced by prophylaxis started after surgery, taking blood thinners (anticoagulants) prescribed by the doctor for a few weeks after the procedure.
It is also recommended to wear circulatory compression support stockings.
Early active and passive mobilization after the procedure helps prevent the formation of blood clots.
A thrombus is dangerous when it detaches from the vein and gets into the lungs, which can cause a life-threatening pulmonary embolism.
Stiffness after surgery occurs due to a body reaction to the surgical incision in which a fibrous, inelastic scar tissue is formed. Muscles and connective tissue that attach to the hip retreat. The result is difficulty bending the hip, walking and climbing stairs.
For this reason, rehabilitation must be started as soon as possible after the operation, which must then be continued for at least 6 months.
Over time, the implants wear out, the average durability of artificial hip joints is about 20 years, but 30 years are also possible.
Hip dislocation is when the head of the femur emerges from the acetabulum.
There can be a variety of causes for this, often as a result of a fall or in patients suffering from Parkinson’s disease. There may also be more mundane triggers, such as sitting down on a low chair, especially within the first 3 months after surgery. For this reason, some rules of conduct must be observed.
Infection of the hip prosthesis
Hip replacement involves risks, like all other operations. A small percentage of patients may develop infection after surgery.
The hip can become infected in the wound or in the area of the prosthesis.
An infection can develop during hospitalization or after discharge, even after months and years.
The infections are caused by bacteria. Even though we have abundant bacteria in the gastrointestinal tract and on the skin, they are usually kept under control by the immune system. For example, when bacteria spread in the blood, the immune system reacts and kills the bacterial invaders.
But because the joint prostheses are made of metal and plastic, the immune system can hardly fight these bacteria.
Despite antibiotics and preventive treatments, patients with an infected hip replacement often need surgery to heal the infection.
The ways in which most bacteria enter the body are: wounds, dental surgery (for example, removal of a wisdom tooth), and injuries from other surgeries.
Some people carry an increased risk of developing an infection after a joint replacement.
Factors that increase the risk of infection include:
- Immune deficiency (e.g. HIV, lymphoma)
- Diabetes mellitus
- Peripheral vascular disease (poor blood circulation in the hands and feet)
- Immunosuppressive therapies (such as chemotherapy or cortisone treatment)
- Increase in pain and stiffness in a previously inconspicuous joint
- Overheating and redness in the wound area
- Wound drainage
- Fever, chills and night sweats
In some cases, only the skin or soft tissue in the joint area is infected, the infection does not spread deeply. This is called a “superficial infection.”
The doctor may prescribe oral or intravenous antibiotics.
If the infection is treated in time, there is a good chance of success with a superficial infection.
Infections that penetrate into the depth of the artificial joint almost always require surgical treatment.
Deep infections that are treated early (within a few days of their onset) can sometimes be treated by surgical joint lavage.
In the treatment, called debridement, the surgeon removes all contaminated soft tissue.
The implant is thoroughly cleaned and the plastic coating is replaced.
After the procedure, antibiotics are prescribed for about 6 weeks.
In general, the longer the infection persists, the more difficult it is to cure the patient without removing the implant.
The first stage of this treatment includes:
- Removal of the implant
- Irrigation of the joint and soft tissue
- Placement of a spacer with antibiotics
At home, the following arrangements can be made:
- The chair must be at least 50 cm high so that the hip is not bent further than 90°; Armrests can help shift the weight to the arms, which relieves the lower extremities. When standing up, the body weight must be shifted to the healthy leg, with the operated leg stretched forward.
- The bed must be at least 50 cm high, always move and load the healthy leg first when going to bed and getting up.
- Sexual intercourse can be resumed as soon as the condition permits, but it is necessary to take the supine position.
- Wait 1.5 – 2 months to shower; in the meantime, washing is done piece by piece, an assistant takes care of legs and feet.
- The toilet bowl must be raised in the first two months after surgery and armrests must be mounted to assist the patient in sitting down.
- Clothes and other everyday objects should be stored above hip height, then the patient does not have to bend over.
- Use heelless shoes without laces.
- Socks and underpants should be put on with the help of a shoehorn or other appropriate aid to avoid bending over.
- In the car, the seat must be positioned as far back as possible and with a fairly inclined backrest; When boarding, first sit on the healthy side of the buttocks, then slide backwards as far as possible, keep the operated leg stretched and carefully push it into the interior.
- Driving yourself should be avoided until 1.5-2 months after implantation.
How long does an artificial hip joint last?
Most patients know that hip prostheses can wear out over time.
Unfortunately, an artificial hip joint is not as resistant as a natural hip.
Hip prostheses are made of metal and plastic – materials that wear out over time, just like car tires.
Hip prostheses are made of special fabrics that have been developed for the longest possible durability, but not for eternity.
Scientific studies certify artificial hip joints a lifetime of more than 20 years. There are hundreds of different studies on this topic, but they focus differently on prosthesis shapes, age and state of health of patients.
A data-rich analysis has proven that 15 years after implantation, hip prosthesis works well in 80% of younger patients (under 65 years of age) and 94% of older patients (over 65 years of age).
A hip prosthesis can last for decades in some patients, while in others the implant has to be replaced after just a few years.
The second procedure is a major operation and has worse results than the first.
Scientific studies show that only 2% of surgical reimplantations of the hip joint required further surgery within 5 years.
The following factors seem to influence the longevity of an artificial hip joint:
- Age: in younger patients, the hip joint prosthesis lasts much longer; in addition, younger people tend to lead more active lives.
In any case, patients undergoing hip implantation at the age of 50 or earlier should expect that a new prosthesis will be necessary during their lifetime.
- Activities: various activities can put excessive strain on the prosthesis and, even if they do not cause direct pain, can be the cause of premature wear.
- Weight: the weight of the patient has a certain influence, because it increases the pressure on the new joint.
- Complications: for example, if surgical procedures are performed (including dental implants), taking antibiotics may be necessary to avoid bacterial infection of the hip.
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