Complications after Joint Replacement - Dubai Orthopedic Clinic

Complications after Joint Replacement can be divided into Immediate or Long term Complications.

Immediate Complications

complications that happen during the operation or in the first 2 weeks after the operation. It can be summarized as follows:

• Thrombosis/Blood clot - which occurs within the veins around the operated area or at a distance. This usually follows operations for hip and knee replacement and is less likely in upper limb joint replacement, like shoulder and elbow replacement. We give blood thinning medication and mechanical prophylaxis to prevent the thrombosis
• Infection – can be either immediately after surgery which manifests itself by continuous wound drainage and significant pain or may be delayed due to hematoma collection or instability in the joint. Patients who have diabetes and rheumatoid arthritis, liver or kidney disease are at higher risk of developing an infection after joint replacement. We follow the protocol of giving prophylactic antibiotics to reduce the chance of infection around the operation period. Most of the time, the infection can be treated with potent antibiotics, particularly for superficial wound infection, and sometimes infection can be deep-seated and requires revision of the metal prosthesis to recover the case.
• Nerve injury – can happen in a very rare case. This is usually due to direct injury at the time of the surgery and can be a result of increased tension on the nerve as a result of retracting during the surgery or as a result of instability or recurrent dislocation of the joint.
• Hematoma/ Blood Collection – This is another possible complication after the surgery due to uncontrolled bleeding from the vessel during the surgery. We put a drain during the operation to prevent hematoma or blood collection and this drain is usually removed after 24 hours providing there is no significant drainage. Hematoma can happen in a slightly delayed period due to infection which we called it secondary hematoma.
• The Surgical wound – Can be affected and complicated by superficial infection and drainage, or have delayed healing due to the lack of inflammatory process required for wound healing. This is particularly a problem for patients suffering from diabetes, immune disease, and patients who regularly take steroidal therapy

Long-Term Complication

• The main long-term complication would be Stiffness of replaced joint due to adhesions at the operation site and possibly due to pain related to loosening of the prosthesis and some instability. We follow a protocol for rehabilitation and physiotherapy to overcome this joint stiffness and maintain the muscle tone around the replaced joint.
• Joint Instability –This is still a significant complication after joint replacement as it affects the function significantly and causes disturbing pain. This is an unusual problem in experienced hands as we follow an anatomical approach in terms of the joint and restoring the normal anatomy with the new prosthesis and also taking care of the soft tissue around the replaced joint to minimize this possible risk which is approximately 1-3%.
• Progressive Loosening –This can be due to low-grade infection or unrelated to infection due to mechanical factors and poor bone stock. These complications have been reduced significantly with the advantage of the new materials used in joint replacement especially the methods of manufacturing polyethylene and hydroxyapatite coating of the prosthesis which encourage the bone in-growth over the prosthesis giving the extra stability and less chance of loosening.
• Joint dislocation – we spoke earlier about joint instability after replacement. Dislocation of the joint can happen when extreme instability is present and this is mainly due to either loosening of the prosthesis or some anatomical factors related to the position of the prosthesis or may be due to muscle imbalance around the joint. Again, this complication is very rare in experienced hands and it is always in the surgeon's mind when he is performing the operation to maintain the joint anatomy and perfect biomechanics to avoid any instability and dislocation.