If you have a cemented hip or knee, we need to evaluate the integrity of the cement. With time and stress, cement may crack. You probably would be unaware of this happening because it usually takes more than ten years to occur. The incidence is greater the longer the joint is in use. Seeing a crack in cement does not necessarily mean you need another surgery, but it does mean we need to follow things more closely. Why? Two things could happen. Your hip or knee could become loose and this might lead to pain. Or, the cracked cement could cause a reaction in the bone, called osteolysis, which may cause the bone to thin out. Orthopedists are constantly learning more about how to deal with both of these problems. The sooner we know about potential problems, the better chance of avoiding problems that are more serious.

If you have a plastic liner in your hip or knee, it may wear out. Little wear particles may get in the bone and cause osteolysis, causing the bone to thin out. Replacing a worn liner early can keep this from happening.

X-rays will be taken at your follow-up visits, which will help detect these potential problems. New X-rays will be compared with your older films to make these determinations.

You should generally follow up for postoperative visits as scheduled by your surgeon, annually for repeat x-rays, and any time you have mild pain for more than a week, moderate or severe pain that requires medication, or if you notice signs or symptoms of infection.

Possible Complications

Tell your orthopedic surgeon about any medical conditions that might affect the surgery. Joint replacement surgery is successful in more than 9 out of 10 people. When complications occur, most are successfully treated.

The surgeons and staff at Western Reserve Hospital do everything possible to prevent any complications, but at times, they may occur. Complications can include the following.

Infection:

Infection may occur in the incision or deep around the prosthesis. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Any infection in your body can spread to your joint replacement.

Blood clots:

Blood clots result from several factors, including your decreased mobility causing sluggish movement of the blood through your leg veins. Blood clots may be suspected if pain and swelling develop in your calf or thigh. If this occurs, your orthopedic surgeon may consider tests to evaluate the veins of your leg. Several measures may be used to reduce the possibility of blood clots, including:

  • Blood-thinning medications.
  • Compression stockings.
  • Exercises to increase blood flow in the leg muscles.

Despite the use of these preventive measures, blood clots may still occur. If you develop swelling, redness, heat, or pain in your leg following discharge from the hospital, you should contact your orthopedic surgeon immediately. Blood clots in the leg can travel to the lung, and this can be lethal.

Dislocation:

Occasionally, after total hip replacement, the ball can be dislodged from the socket. In most cases, the hip can be relocated without surgery. A brace may be worn for a period of time if a dislocation occurs. Most commonly, dislocations occur after complex revision surgery.

Nerve injury:

Nerves in the vicinity of the total joint replacement may be damaged during surgery, although this type of injury is infrequent. This is more likely to occur when the surgery involves correction of major joint deformity or lengthening of a shortened limb due to an arthritic deformity. Over time, these nerve injuries often improve and may completely recover.

Failure to heal:

Patients with chronic disease, such as diabetics, autoimmune disorders, malnourishment, complications from smoking, and other systemic diseases may be slow to heal or not heal at all. Failure to heal may result in continued pain or subsequent surgeries.

Blood vessel, tendon, ligament, skin or soft tissue damage:

All of these structures must be moved out of the way to perform orthopedic surgery. In rare cases, scarring and damage may occur.

Hematoma or seroma:

A pocket of fluid can develop under the closed incision. This collection of fluid can give a hardness to the skin over this area. As the surgical incision heals, the body reabsorbs this fluid most of the time and the area softens. Occasionally, this fluid finds an opening in the incision and drains out. Hematomas drain dark maroon colored fluid and seromas drain a clear yellowish fluid. If a hematoma happens to drain while you are still on medication to prevent blood clots, the initial darkish fluid may be followed by bright red bleeding. If the drainage continues, notify your surgeon.

Loss of a limb or death:

This rarely occurs, and we assure you that the staff at WRH does everything possible to ensure you have a safe and uneventful surgical experience.