WHAT ARE THE RISKS OF SURGERY?
All surgical procedures have risks. Despite pre-operative testing and optimization, utilizing less invasive surgical techniques, and novel pain and rehabilitation management, every joint replacement is still a major surgery. Although advances in technology and medical care have made the procedure very safe and effective, these risks do exist. The risks associated with a joint replacement surgery should be considered carefully before you decide to undergo surgery. We encourage you to discuss the potential risks with your surgical team, primary care provider, and your support system (such as family or friends). Additionally, we will work with you and your medical doctors to ensure you have the safest joint replacement journey possible. Overall, complications are rare and we will do our very best to avoid the most common risks which include:
Pain after surgery: These are artificial joints and unfortunately are not as good as the joints you were born with. It is normal to have MILD discomfort even after you have recovered completely from surgery, especially with more strenuous activities. Unfortunately, we can’t give you your 18 year old hip or knee back again. Our goal when performing a joint-replacement surgery is to give you a joint that will allow better function than your current arthritis bone-on-bone joint, and only after we have tried helping your pain without surgery.
Blood clots: blood clots can form in a leg vein and in your lungs after knee or hip replacement surgery and at times can even be fatal. Blood clots are more common in older patients, patients who are obese, patients with a history of blood clots, those with pulmonary disease, and patients with cancer. We will evaluate your risk for a blood clot and develop a preventative treatment plan for each patient, which will include a blood thinning medication after surgery for 4 weeks. Additionally, we recommend the use of compression socks after surgery for 4 weeks. In order to reduce the risk of blood clots, we recommend walking frequently after surgery.
Hematoma: Bleeding into the joint can occur either immediately after surgery or at a later time. This is accompanied by acute pain and swelling and is sometimes confused with infection.
Infection: infection can occur both in the early post-operative time period or even many years after a joint replacement. Despite doing everything in a sterile environment and giving you antibiotics at the time of surgery, infections still occur approximately 1-2% of the time. Most infections are caused by the billions of bacteria on that patient’s own skin. It is important to adhere to all the recommendations given by your surgeon and maintain good health before and after surgery to decrease the risk of infection. Patients who are diabetic, smokers, have autoimmune disease or other chronic health problems, are at higher risk of developing a post op infection. An infection can be treated successfully 75-80% of the time, but this usually requires one, and often two, surgeries along with long-term IV antibiotics to treat.
Drainage: A small amount of drainage is normal to notice after surgery, but larger drainage can sometimes require a return to the operating room to stop
Wound Healing: Sometimes the surgical incision heals slowly, particularly if you take corticosteroids or have a medical condition that affects the immune system, such as diabetes. Smoking can cause serious complications, which is why we ask you to stop smoking prior to surgery. Talk with your surgical team or your primary care physician if you need help with smoking cessation.
Nerve, Blood Vessel, and Ligament Injuries: Damage to the surrounding structures including nerves, blood vessels and ligaments, are possible but extremely rare. More commonly there is numbness in the area of the incision which usually, but not always, resolves in 6-12 months. It is not uncommon to have some small residual numbness in one or more of the areas around your incision.
Limited Range of Motion: Within a day of surgery, you will begin exercises to help improve the flexibility of your knee. Your ability to bend your knee after surgery often depends on how far you could bend it before surgery. The motion before surgery can also affect the motion of your knee following recovery. If your knee is stiff before surgery, you should understand that regaining or improving your range of motion after surgery may be HARDER than other people’s recovery, and often is still limited by how tight the muscles/ligaments/tendons have gotten over years and years of arthritis. Even after physical therapy and an extended recovery period, some people are not able to bend their knee far enough to do normal activities such as reaching your feet to put on socks or tie your shoes.
Implants can fail: Your new joint replacement is a mechanical device. Sometimes the metal, cement, or plastic liner can get loose or your bone – particularly weaker, osteoporotic bone – can fail to grow into the metal sufficiently. While we hope that this does not occur for at least 15 years, it can happen before that, even in the first year or so. This can require a repeat surgery to fix.
Failure or Loosening of the Joint Replacement Components: loosening of a joint replacement is an associated risk that can occur many years after risk associated with joint replacement. Loosening may occur when tissue grows between the artificial joint and your bone, or if there is a failure of the implant to grow into the bone.
Fracture around the implants: A fracture around the implants (peri-prosthetic fracture), can occur after a trauma, fall or if there is weaking of the bone surrounding the implants. If this occurs, often surgery is required to replace the parts and reinforce the bone.
Medical or Anesthetic Complications: These can include heart attacks, strokes, pneumonia, kidney damage, or even death etc. These are VERY RARE. We have a medical provider check you out before surgery to make sure you are fully optimized and they think that it is safe for you to undergo surgery with us, but even then, bad things can happen with any surgery.
Patient Factors that increase risk include:
- Increased Body Weight, BMI >30 (Obesity), Diabetes, Stiffness before surgery, Skin Problems, Heart Problems, Kidney or Liver Disease, Previous Surgeries, Narcotic Use, Autoimmune conditions (ex: Rheumatoid arthritis), and smoking or nicotine use
All of the risks above happen rarely. But I want all of my patients to know ahead of time that this surgery is a big deal, and that even for the healthiest and fittest patients, things can go wrong. Again, despite all of the risks and potential complications, 80-90% of patients are happy they had their surgery done and consider their quality-of-life improved.
