Complications of Hip Replacement Surgery

While hip replacement surgery is a safe and effective means of treating severe hip arthritis, not everyone who undergoes the surgery has a perfect result. Failures do occur and often require revision surgery to correct the problem and/or treat the underlying condition. Current research suggests that the failure rate in the U.S. hovers around one percent per year, a strikingly low number.

A number of factors are closely associated with hip replacement failure:

  • Obesity
  • Multiple co-existing medical conditions, including rheumatoid arthritis diabetes, liver disease, heart disease, HIV, and cancer
  • Uncemented prostheses

Lower age (meaning between the ages of 65 and 74) is also seen to increase risk simply because the person has used the prostheses for far longer.

The good news is that the vast majority of people find significant pain relief and improvement in mobility after receiving a hip replacement. So speak with your doctor to identify your specific risks prior to surgery. By doing so, you may be able to address some of the modifiable risk factors for losing weight, exercising, and quitting smoking.


Unequal Leg Length

leg length
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After hip replacement surgery, some people may find their leg length has changed. This is sometimes avoidable as deterioration of the surrounding bone may force a surgeon to remove additional bone matter in order to get a more solid fit with the replacement joint.

When leg lengths are unequal, people can experience increased pain and muscle fatigue. When the difference is more than a few centimeters, the nerves can become so stretched that numbness and shooting pains can develop.


Joint Dislocation

x ray of a dislocated hip

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Dislocation of a hip replacement occurs when the ball becomes dislodged from the socket. Most of these occur as a result of a fall or trauma where the hip joint is internally hyperextended (yanked inward).

Fortunately, this complication has become less common in recent years as the design and materials used in hip prostheses continue to improve. In addition, many surgeons are advocating for the use of anterior hip replacement surgery (approached from the front of the hip joint) to maintain the ligament structure that holds the joint together.


Joint Infections

scalpel hand surgery
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Infection of a hip replacement is a serious problem. While the best efforts are made to avoid infection during an operation, accidental exposure to bacteria (such as Staphylococcus aureus) does sometimes occur.

Infections of this sort need to be treated aggressively. If the infection involves the replaced hip, revision surgery is almost always required.

Even with aggressive treatment, multiple surgeries and prolonged antibiotic therapy are often required to fully eradicate an infected hip replacement.


Formation of Blood Clots

blood clot
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Blood clots (thrombi) can sometimes develop in the large veins of the legs following major surgery and may lead to a serious medical condition known as a pulmonary embolism. An embolism occurs when the blood clot causes the blockage of an artery in the lungs.

To prevent this from happening, doctors will typically prescribe anti-clotting drugs to prevent platelets from sticking together excessively. Additionally, mechanical devices like compression socks and squeezing boots can keep the blood from pooling in the legs. Walking is also an excellent means of preventing the development of blood clots (thrombosis).

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  1. Wright, E.; Katz, J.; Baron, J. et al. "Risk factors for revision of primary total hip replacement: Results from a national case-control study." Arthritis Care Res. 2012; 64(12):1879-1885. doi:10.1002/acr.21760

  2. Centers for Disease Control and Prevention. What is Venous Thromboembolism?