Possible complications after joint replacement surgery.
Replacement of the hip and knee joints has a high success rate and is performed in a sterile environment while administering preventive antibiotics before and after surgery. As with any surgical procedure, there are risks of complications that may be caused by various factors such as anesthesia complications, infection, nerve damage, damage to blood vessels, and even pain that remains after the surgery and does not go away.
Complications associated with surgery
Joint stiffness – This complication most often occurs in knee replacement surgery, as a result of adhesions and scar tissue that forms after surgery. In the vast majority of cases, stiffness can be treated with aggressive physiotherapy, and if there is no improvement, manipulation under anesthesia may be considered when the patient is sedated and relaxed (full laxity), gently bending the knee to the maximum range.
Swelling of the leg after surgery – mainly in knee replacement surgery, sometimes only in the area of the knee, and sometimes throughout the entire leg. Over time, the swelling will go away on its own. Swelling is due to the increased blood flow to the operated limb, and difficulty in evacuating the blood back, resulting in the fluids coming into the tissues and causing swelling. You can help the limb by wearing pressure socks, and lifting the leg that has been operated on while lying down or when seated.
Numbness on the outer side of the knee – In knee replacement surgery, the surgical incision passes through the center of the knee and cuts a small nerve that gives sensation to the outer side of the knee (the nerve passes from the inside to the outside); this causes numbness on the outer side of the knee. Usually, sensation returns after a few months to a year; sometimes it does not return. Other than the feeling, it has no clinical significance.
Grinding and loosening of the implant – Over time, the components of the
implant, especially the plastic parts, may wear out and loosen. This condition causes pain and usually requires repeated surgery to replace the loose
components.
Difference in leg length (in hip replacement surgeries) – During surgery, an effort is made to maintain equal leg length. However, sometimes this cannot be done, and the operated leg is longer than the other leg (up to two centimeters). This condition is not noticeable and does not interfere with standing or walking and is usually resolved by means of a tread or creating a
special shoe fit for the purpose of comparing the length of the feet.
Chronic pain (knee replacement surgery in particular) – Various studies have shown that 10-15% of knee surgery patients suffer some pain after surgery, and are only partially satisfied with the results. The cause of the pain is not clear, but it is important to know that the complete recovery process after knee replacement surgery can take more than a year. Chronic pain can be treated in a pain and rehabilitation clinic, and sometimes when no improvement has been achieved, repeated surgery may be considered. It should be emphasized that if it is night pain, it will usually pass by itself within six weeks to three months, during which time it is possible to function normally and use pain medication.
Fractures – In knee and hip replacement surgery, the joint is shaped as anatomically as possible. On rare occasions, there is a risk of an intraoperative fracture (as a result of the work or an osteoporotic bone), or after surgery following a fall or injury. Treatment is usually surgical and includes placing a grip, plate/brace or other fixation. Sometimes the entire implant will need to be replaced by a special implant.
Dislocations – when the artificial joint goes out of place. The risk of this complication is less than 1%, and can be treated by putting the joint back into place. Causes: falling, incorrect placement of the implant. If this occurs during the first few weeks, we usually wait to allow scar tissue to form around the implant, which helps to hold it in place. If dislocation recurs, it will be necessary to repeat surgery to optimize placement of the implants.
Rare Local Complications
Damage to the nerve, blood vessels or tendon – the surgical area is surrounded by nerves, blood vessels, and tissues; during surgery, one or more of these may be damaged. The treatment depends on the injury, and if possible, this will be performed during surgery. Usually, even if there is a nerve injury, it goes away on its own.
Deep infection of the implant – a serious complication that requires thorough treatment, since most bacteria accumulate on the implant and are covered with a special substance (biofilm) that prevents the antibiotics from harming them. Treatment of the infection is carried out with the combination of intravenous antibiotics for a period of six weeks to six months.
Infection in the first few weeks after surgery – This appears as redness, fever,
and/or discharge; usually one or more rinses are performed in the operating
room with partial replacement of the modular implant components (those that
are not fixed). This treatment has an 80-90% success rate, depending on the
timing and the type of bacteria.
Long-term infection – This appears as pain, a local fever, with and without discharge, and requires thorough treatment that includes complete replacement of the implant in one or two stages. (The first stage is temporary implantation together with antibiotics, and the second stage takes place after a period of three months to six months.) Only after blood tests find that the infection has been suppressed, a repeat operation will be performed in which a new implant will be placed, during which the patient will receive intravenous antibiotics against the bacterium that was discovered.
General Complications
Respiratory problems – alectasis (collapse) of lung bronchi. It manifests as a decrease in pulmonary ventilation (decrease in oxygen saturation). In this case, it is very important to perform respiratory physiotherapy that includes breathing and coughing to increase the flow of oxidation and keep the airways open. It is also recommended that movement is increased after surgery: get out of bed, sit down, and make sure to move to prevent possible respiratory complications.
Deep Vein Thrombosis (DVT) – blood clots that develop in the leg veins as a result of slowing blood flow are disconnected and may reach the lungs. When a large blood clot reaches the lung, it can stop blood flow to part of it and cause serious respiratory complications. Therefore, after the operation, while lying in bed and at all waking hours it is very important to move the feet and ankles. In addition, it is recommended that you practice sitting and walking as early as possible after surgery to reduce the risk of this complication.
After surgery, anticoagulants (blood thinners) are taken for two to four weeks (Mycorphyrin, Aspirin, Elquist, Xerlato and so on) to prevent the formation of blood clots.
What is not recommended? Avoid smoking, taking birth control pills and taking hormonal suppressive medications that significantly increase the risk of blood clots.
Problems with urination – Difficulty or cessation of urination is common after any surgical procedure. Most often, in joint replacement surgeries, if this occurs, a temporary urinary catheter is inserted after surgery in order to prevent urine leakage and relieve the patient during these days.
Nausea – This is very common following anesthetic drugs; it usually goes away on its own within a day or two, and can be treated with anti-nausea pills.
Constipation – This may occur due to painkilling medications, most often morphine-containing medications, which cause slowing of stomach and intestinal movements. Constipation can be alleviated through drinking copious amounts of water, taking a high-fiber diet, and stool softener preparations.
Allergic reaction – after surgery, an allergic reaction may occur that could manifest as a slight rash and range to an acute allergic reaction and respiratory injury. Treatment is provided with antihistamines.
Pressure sores – These are formed as a result of prolonged immobilization, and usually appear in the heels and buttocks. Changing position and getting out of bed as often as possible will prevent this risk.
Confusion and delirium – This manifests as different behavior and disorders of vision and hearing. These phenomena often appear due to the taking of strong analgesics, anesthesia, lack of sleep and alcohol withdrawal. These symptoms will usually subside within a few days, but in some cases may persist for several weeks.
Rare Complications
Rare general complications:
As part of the preparation process for surgery, the anesthesiologist and
surgeon will discuss rare general complications with the patient, such as the
development of a blood clot in the legs (venous thrombosis), a blood clot in
the lung (embolism), a heart attack, a stroke and even death. At this stage it is
very important and desirable to ask questions, get acquainted with the
existing solutions and prepare accordingly, since although the chances of
these complications are relatively small, there is still a chance.
How can you reduce and even prevent the various complications of joint replacement surgery
Movement is very important for recovery, so it is important to get out of bed and walk as early as possible after surgery. Increase movement so that you can significantly reduce the risk of complications, prevent them, and recover quickly. The complications and risks are common to any medical procedure, the probability of the occurrence of rare complications is very low, and the possibilities are discussed with you in the preliminary meeting held with the anesthesiologist and the surgeon.
We are available for any questions or concerns.
