For joint replacement surgery to be successful, we need to identify risks and prevent complications. Total joint replacements have success rates of greater than 95 percent — relieving pain, improving function and allowing patients to keep an active lifestyle.
As with any major surgery, there are risks. Medical risks are primarily determined by the health of the patient undergoing surgery, not from the surgery itself. For example, pneumonia and heart problems (such as heart attack, irregular heart beat or heart failure) might occur due to the stress of surgery. There is also a risk of post-operative confusion, which is common in people over the age of 65. The confusion should clear in a few days unless it is related to other medical issues.
An internal medicine physician will examine you before your surgery to identify your personal health risk through a complete physical examination and a review of your medical history.
If the risks are too high, your surgeon will discuss with you your options, including whether to have the surgery. Your surgery could be postponed if additional testing needs to be done or until risks are brought under control.
Risks of joint replacement surgery:
Infection
- The risk of infection after surgery is less than 1/300. We do several things around the time of your surgery to reduce this risk as much as possible. One of the most important part of preventing infection is ensuring that you do not have any active bacterial infection in your body at the time of surgery. Please inform us of any concerns you have.
- Strategies for prevention:
- Weight management and weight loss if appropriate can reduce this risk. Fat cells heal less well that other tissues and can increase the risk of a wound complication and infection.
- If diabetic, good blood sugar control is critical to reduce this risk.
- If smoking cigarettes, cessation is important and reduces the risk of wound problems.
- Dental health is important. Obtain all dental work necessary prior to surgery. No routine dental work or cleanings for 4 months after surgery unless absolutely necessary. You will need to take an antibiotic pill 30 minutes prior to dental procedures (including cleanings) to protect your knee replacement indefinitely. You may call us for prescriptions as needed.
Fracture or Ligament Injury
- A fracture or ligament injury can occur while the bones are being prepared for the implants. These complications are very rare.
- If a fracture or ligament injury occurs during the procedure, it is typically fixed during the procedure and your final outcome will be similar. However, it may result in some early precautions to protect the bone while it is healing which could lengthen your recovery period.
Bleeding, Damage to Blood Vessels
- Damage to large blood vessels is very rare.
- The rate of blood transfusion very low unless you have a low blood count (Anemia) prior to surgery. This will be checked and addressed if needed during your pre-operative visit with the hospitalist.
Nerve Damage
- It is rare to have an injury to a major nerve that controls your muscles. However, such an injury can result in long term or permanment weakness in your legs.
- There are small nerves in your skin that cross the incision. Because of this you will have some skin numbness outside the skin incision. This improves as the nerves grow back.
Blood Clots
- This risk is present with any operation of the legs.
- These occur in the deep veins of the leg in fewer than five out of 100 patients (5 percent).
- May cause death in extremely rare cases if a blood clot travels from legs up to the lungs or forms in the lungs blocking flow to the heart (pulmonary embolus). Chest pain and shortness of breath can be symptoms of a pulmonary embolus which should be treated immediately.
Risks specific to hip replacement:
Dislocation, Leg Length Difference
- It is possible to dislocate a hip replacement. It is important to follow some precautions that the physical therapists will show you to reduce this risk during the first 2 months after surgery. After the tissues around your hip have fully healed, the risk of dislocation is very low and you can return to activities that requite more range of motion at the hip.
- Your arthritis has worn out the cartilage in your joint and has shortened your leg a little. You may or may not have noticed this as it typically happens gradually and you get used to it. During surgery, your leg length will be corrected as close as possible to your other leg. You may feel like its longer as this will be a sudden change. You will grow used to the change over time.
- At times, there is a need to lengthen the operated leg compared to the other leg in order to obtain better stability and muscle tension to prevent hip dislocation. The difference will not be greater than ½” and is rarely noticeable. In rare instances, a shoe lift may be needed on the other side to make up the difference.
Risks specific to knee replacement:
Stiffness
- The way your body heals is by making scar tissue. The newly operated knee will want to scar down. You must work hard to break up this scar tissue in the first few weeks after surgery. I expect that you will have at least 90 degrees of flexion by 2 weeks and between 110-125 degrees by 3 months. It is also very important to work on straightening your knee fully.
- The success of knee replacement surgery is dependent on your dedication to the rehabilitation program.
Clicking/Noise
- A knee replacement is made of metal and plastic. You may notice some noise from the knee replacement. This will improve as you gain strength and the amount of swelling in the joint is reduced. Some clicking may still be noticeable and is normal.
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Anesthesia & Pain Management