Potential Adverse Events following
Total Joint Replacement Surgery

Please remember there are risks associated with any surgery and the likelihood that any of these events would occur and negatively impact the long-term outcome of your surgery are small. Total Joint Replacement is one of the most successful orthopaedic procedures performed today and can significantly improve your overall quality of life and your health.

• Minor superficial infection can occur involving the tissues and skin around the surgical incision. This type of infection will require antibiotics, close observation and occasionally special cleaning of the involved area.
  
• Deep infections are more serious and may involve the deep tissues inside the new joint and the bone. This type of infection may require additional surgery to clean the joint and the surrounding area and may also necessitate the removal of the implant and reinsertion of a new implant at a later date.

Bleeding
Some amount of bleeding and blood loss is expected during and after surgery. A few patients may require a transfusion after surgery and in rare instances may have to be taken back to surgery if bleeding continues. In addition to new surgical techniques, there are steps that are taken before surgery to help reduce the amount of blood lost. For example, you will be instructed to stop all blood thinning medication one week prior to surgery and will begin iron supplementation to help regenerate red blood cells after surgery. Your blood count will also be monitored daily while you are in the hospital.

Blood Clots
Blood clots, also called deep vein thrombosis or “DVT”, can develop in the legs following surgery and can travel to the lungs resulting in a serious problem called a pulmonary embolism, or “PE”. Both are significant cause for concern and special steps are taken to prevent this from happening. You will be placed on a blood thinning medication for several weeks after surgery and instructed on exercises to help promote blood flow while in bed. However, the most important preventative measures are mobility and ambulation!

Pneumonia
Another potential problem is lung congestion that can develop and can at times cause pneumonia. A small device called an Incentive Spirometer will be given to you after surgery which will help you to exercise your lungs. Coughing and deep breathing are also helpful in preventing this problem and again mobility and ambulation are the most important preventative measures.

Nerve Injury or Blood Vessel Injury
The skin surrounding the incision for hip and knee replacements can be numb for several months after surgery, this is normal and should improve over time, but can be permanent. In rare instances there can be damage to nerves or blood vessels that can lead to weakness, loss of sensation or hypersensitivity of the leg. These symptoms can completely resolve with time, but sometimes only partially . However, some individuals may never have complete resolution of symptoms and can be left with permanent numbness, weakness or pain.

Fractures
The implant must fit correctly and tightly in the bone. There are necessary cuts and preparations to the bone that have to be made. At times this may cause the bone to crack or break. It may be necessary to repair this fracture during surgery by using screws, cement, or wires. Some fractures may impact the recovery process by limiting the amount of weight that you can put on your leg and the amount of therapy after surgery.

Malfunction of Prosthesis
Loosening may occur as a result of “wear and tear” over the course of time, although an implant usually lasts 15+ years for both hips and knees in approximately 75% of patients. Additional surgery may be required if loosening becomes a problem (called a revision). Sometimes it is not necessary to replace the entire implant, but only certain components.
Dislocation, most commonly seen after hip replacement, when the joint “pops” out of place and is usually a result of extreme positions of the leg, muscle weakness or inadequate healing. You will be given instructions on steps that can be taken to prevent this from happening.

Stiffness
The lack of motion may occur after total knee replacement as a result of the buildup of scar tissue. Mobility, stretching, and aggressive physical therapy are important to prevent this problem. If stiffness persists a manipulation of the knee under anesthesia may be necessary to break up the scar tissue.

Leg Length Discrepancy
Some patients may feel as if their legs are different lengths after surgery. This may also be present before or after surgery due to conditions such as arthritis in other joints, spinal stenosis, and tightening of ligaments and tendons because patients are unable to straighten the hip or knee. At times, due to findings at surgery, we must lengthen the leg purposefully in order to tighten up the muscles which help hold the joint in place and minimize the chance for dislocations. It’s much better to have a slightly longer leg than to develop recurrent dislocations. It may take several months to readjust and feel balanced out, although patients may not even notice a difference. Treatment usually consists of using a lift that goes inside the shoe, like an over the counter Dr. Scholl’s heel insert. However, this need for a lift is based strictly on how you feel and patient comfort.

Additional Medical Problems
Several factors such as existing medical conditions, stress placed on the body during and after surgery and medications , may lead to other complications such as chest pain, heart attack, palpitations, kidney problems, nausea and vomiting, and constipation. Any pre-existing medical conditions are monitored closely and every effort is made to prevent these problems from occurring. However, if any of these problems do occur, a specialist will be consulted to ensure proper treatment. Prior to your surgical procedure you will be evaluated by having a physical exam, blood work, chest x-ray, and cardiogram and depending on existing medical problems you may need special clearance from your primary care physician or at times even a specialist ( for example, a cardiologist). Results of all testing and any additional information given by your primary care physician or specialist are reviewed before surgery.

Death
As with any surgery, routine or not, death is always a consideration. However your specific risk is dependent on any associated health problems and your own general medical condition.