Complications of Hip Replacement Surgery

While hip replacement surgery is a safe and effective means of treating severe hip arthritis, complications and failure can occur. The failure rate of hip replacement in the United States is around one percent per year.

Factors associated with hip replacement failure include:

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

Lower age (between the ages of 65 and 74) is also seen to increase the risk of failure because the person will likely use the prostheses for more years than those who have this surgery later in life.

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. With advance planning, you may be able to reduce some of your modifiable risk factors by 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 unavoidable as deterioration of the surrounding bone may force a surgeon to remove additional bone in order to get a more solid fit with the replacement joint.

If your leg lengths are unequal, you can experience pain and muscle fatigue. When the difference is more than a few centimeters, the nerves can become stretched, leading to numbness and shooting pains.


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 post hip replacement dislocations occur as a result of a fall or trauma that causes the hip joint to be internally rotated and flexed (like being curled up in the fetal position).

This complication is becoming less common as the design and materials used in hip prostheses continue to improve. In addition, some 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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If a hip replacement becomes infected, it causes 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, since this bacteria lives on our skin.

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

Even with appropriate 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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A deep vein thrombosis (DVT) is a blood clot in the large veins of the legs. These clots can develop following major surgery, and they may travel to the lungs, leading to a pulmonary embolism (a blood clot in the lungs). Blockage of a blood vessel in the lungs can lead to severe respiratory distress, and can potentially be fatal.

To prevent these blood clots, your doctors may prescribe anti-clotting drugs to prevent platelets (blood-clotting cells) from sticking together. Additionally, devices like compression socks and squeezing boots can help keep the blood from pooling in the legs, which prevents DVTs. Walking is also an excellent means of preventing DVTs.

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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?