Potential Complications and How to Help Prevent Them
Despite the success of total joint replacement, there is a slight risk of developing complications. These complications can develop because of health problems, the anesthesia or the surgical procedure itself.
Possible local Complications include: surgical site infection, damage to blood vessels and nerves, blood loss possibly requiring blood transfusion, bone or implant fracture, increased bone formation around the joint, dislocation of the joint, altered limb length, early wear of the prosthesis, and persistent or increasedpain and stiffness in the joint that was replaced. These complications may require additional surgery to improve one’s functioning.
General Medical Complications include: the risk of developing a deep venous thrombosis, pulmonary embolism, heart attack, stroke and even death.
Although the likelihood of such complications occurring is low, your surgical team will make every effort to minimize the risk as much as possible. Your surgeon, anesthesiologist and medical internist will discuss these issues with you before surgery. Please make sure all your questions are addressed when you meet with your surgical team.
Infection is a possible complication of any surgery. The risk is reduced through careful surgical technique and the use of antibiotics before and after your surgery. Bacteria can travel through your bloodstream from infection elsewhere in your body to your new joint, i.e. from your throat, teeth, skin or urine. This is why it is important to have all infections assessed and treated before your surgery, as well as after surgery to protect your new joint.
Despite protective measures, there is still a chance of developing an infection but this is less than 2%. Normally these are superficial wound infections that are resolved with a course of antibiotics. Occasionally serious infections occur that require further hospitalization and treatment. Sometimes they necessitate removal of the hip replacement for a period of time; antibiotics are administered via a drip for a few weeks, prior to re-implantation of another hip replacement.
Breathing problems such as pneumonia can occur after surgery. It is important to do several deep-breathing and coughing exercises every half hour when awake the first few days after surgery. This helps provide oxygen to your lungs and keeps your airways clear. Sitting up, getting out of bed as soon as possible and being active also helps prevent breathing problems.
Cardiovascular complications (heart problems) can occur due to the stress of surgery. Surgery puts an additional workload on the heart. In patients with known heart disease, this can increase the risk for abnormal heart beats, chest pain or very rarely, heart attack. These complications can also happen in patients with no known heart problems. This is why it is important to have a thorough health assessment before your surgery.
Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis (DVT) are blood clots which can develop in the deep veins of your legs. This is often associated with lack of movement, and therefore early activity is encouraged. It is important to move your ankles up and down several times an hour after surgery. This is called “ankle pumping”. You are also encouraged to tighten and release the muscles in your legs. These exercises promote good circulation. Anticoagulants (blood thinners) will also be used to prevent blood clots. They are given in either the form of a pill or through a needle .
Pulmonary Embolism can occur when blood clots from the deep veins in the legs or pelvis break off, travel up to the lung and lodge there. If the clot is large enough, all circulation to the lungs may be cut off. This is a serious complication. Anticoagulants (blood thinners) are given after surgery to prevent clot formation. Ankle pumping and early activity will also help prevent this complication.
Urinary Problems, such as difficulty passing urine, can happen following any type of surgery. Sometimes a catheter (tube) is inserted into the bladder to drain the urine. The catheter can be left in place for a few days or removed immediately after the bladder has been emptied. Let your nurse know if you have problems passing urine. Following spinal anesthesia you may pass some urine without being aware of it. This is normal and can happen during the first few hours until the spinal anesthesia wears off.
Nausea is common after surgery. Medication may be given to settle your stomach, so let your nurse know if you are experiencing nausea. In order to minimize nausea, it is important to take your pain pills with food to protect your stomach.
Paralytic Ileus is a distention of the bowel with gas. This can happen when the bowels stop working properly. As a result, gas builds up and causes abdominal discomfort, distention and vomiting. To prevent this, early activity is important to stimulate your bowels to function normally.
Constipation is common and a potentially serious complication that can occur because of pain medication, reduced activity and dehydration. Constipation can lead to and aggravate other medical conditions. Stool softeners and mobility agents are given daily to help prevent constipation. If they are not effective, ask your nurse for a laxative or a suppository. Make sure you have a bowel movement the day before your surgery to help prevent problems after surgery. A high fiber diet, lots of fluids and being active are important to help promote regular bowel movements.
Allergic reactions can take place after surgery and vary from a mild rash to an intense reaction that can interfere with your breathing. Please let us know if you have any allergies. They will be documented in your medical record. We will also provide you with an allergy alert bracelet to be worn while you are in the hospital.
Skin Irritation and Bed Sores
Skin Irritation and bed sores are caused by pressure from lying in bed. It is important to change your position frequently while in bed and to get up as much as possible after surgery. The nurses and therapists will help you.
Confusion and Delirium
Confusion and Delirium can sometimes occur in older people after surgery. You may behave differently, and see or hear things that aren’t really there. This usually resolves in a few days, but can sometimes last for several weeks. Many things can contribute to this, such as the anesthetic, pain medication, lack of sleep, and alcohol withdrawal.
Stiffness- Sometimes the knee becomes stiff after surgery (1%) due to scar tissue forming inside the knee. If this happens the knee may require a manipulation under a second general anesthetic to help regain movement.
Pain- A small number of people after knee replacement surgery continue to experience some pain. Sometimes no obvious mechanical cause for the pain can be found. Research and studies conducted have shown that 10 – 15% of patients still have some ongoing pain and are not fully satisfied after their surgery. There isn’t any specific reason to explain why this is the case but the majority of this sub group of patients still feel that this post-operative pain is still better than their previous arthritic pain and doesn’t impede their function. An important point to note is that overall recovery and improvement following a Total Knee Replacement can sometimes take up to 1 years.
Treatment for this involves medical management of the pain, and specialist rehabilitation.
Tendon, Nerve or Blood Vessel Damage – Very rarely these structures can be injured during the operation. Normally they recover, but occasionally patients may experience extensive bruising or have difficulty moving their foot up and down.
Prosthesis Wear/ Loosening – Over time the components of the joint replacement can wear out or become loose. This normally leads to increasing pain and may require further surgery to install new components .
Leg length Discrepancy (in hip replacement surgery)- At the time of surgery, we try and get your leg lengths equal and as close to each other as possible. Sometimes this may not be possible and the operated leg may appear slightly shorter or longer than the other one. Normally this is not noticeable and doesn’t cause any problems with walking or gait but, rarely this may need addressing with an insole or a shoe raise.
Dislocation- The rate of this is about 1-3%. It is very important that you strictly follow the safety positions after your operation as advised by the physiotherapist to minimize the risk of dislocations. If your artificial joint does dislocate, you may need a further operation to re-locate it. If you have recurrent dislocations then you may need revision surgery.
Getting out of bed and walking as soon as you are able will help prevent many of these complications and allow for a smooth recovery.