PQ Pilot PQ8 – Early Complications Questions (Pre-Course)

Hint

Periprosthetic fracture (RISK: <1%).

A rare complication of hip replacement surgery is when the femoral shaft fractures, or breaks, during the surgery. This will necessitate a change of the procedure. For instance, the surgeon may have to use a longer femoral prosthesis than planned. It may also be necessary to wrap cables around the femoral shaft, or perhaps use a fracture fixation plate to bolster the implant.

It is also possible to fracture the greater trochanter of the femur. This may be fixed with wires or screws.

The acetabular socket may be fractured on preparation of the pelvis. This may be fixed with metal plates and screws. A larger socket than planned may have to be used.

In all of these circumstances, the risk of infection is increased, so it will be necessary to take antibiotics for a prolonged period.  In addition, it is likely that you will be unable to fully weight bear for a period of approximately 6-8 weeks following discharge from hospital.

See video: 00:10 – 01:24

Hint

Anaemia (RISK: 10-30%).

In the week following surgery, you may lose blood volume due to bruising, bleeding, or “third-spacing”.

If the haemoglobin drops to a level below 8g/dL, or you have the symptoms of anaemia already described, you will most likely be offered a blood transfusion.

See video: 01:59 – 02:20

Hint

Nerve injury (RISK: <1%).

Depending on the surgical approach to the hip, it is possible to suffer nerve injury. This is usually temporary, due to bruising of the nerve, and should fully recover.

However, while this might take a matter of days, in exceptional circumstances it could take up to 2 years to fully recover.

See video: 03:21 – 05:47

Hint

Deep Venous Thrombosis (DVT)(RISK: 2-5%).

Blood clots usually occur in the veins of the calf approximately 5-10 days following surgery.

They are often self-limiting, and resolve with transient calf pain. Occasionally the pain is severe and persistent, and typically located in the calf. You may find it difficult to walk with the pain. The calf typically swells and can become very hard, or tense.

Occasionally, the skin on the calf can turn shiny and red.

The calf is usually very tense to touch. If you suspect that you have a DVT, you should contact your doctor immediately, or alternatively, attend the emergency department for review.

In the long term, you may suffer from a post-phlebitic limb, which may cause pain and swelling of the lower leg on an intermittent basis.

See video: 05:51 – 06:45

Hint

Pulmonary embolism (RISK: <1%).

Pulmonary embolism (PE) occurs when a clot (DVT) in the calf becomes mobile and travels to the pulmonary tree, preventing oxygenation of blood in the lungs.

While most PE are mild, rarely they can be severe, and even fatal. Symptoms include shortness of breath, chest pain, and confusion.

If any of these symptoms occur in the first few weeks post-surgery, it is important that you attend your local emergency department for review.

It will be necessary to take anti-coagulation medication for at least 6 months once the diagnosis is made.

See video: 06:45 – 07:28

Hint

Dislocation (RISK: <1%).

Dislocation of the joint usually occurs in the first 6 weeks following surgery, but can in fact at any time.

It may dislocate if you have not followed the rehabilitation protocol, or if you suffered a sudden fall or accident. In addition, it may be due to the deep muscle repair failing, which could possibly reflect infection, or from a part of the implant becoming loose.

Dislocation is more common following posterolateral approach to the hip, so you could discuss this with your surgeon pre-operatively as to the best approach.

You will feel a sudden sharp pain, and be unable to walk.

You will most likely need to be transferred by ambulance to your local emergency department.

There, it may be possible to reduce the joint under sedation, although in many circumstances, it is necessary to administer a general anaesthetic in order to reduce the joint.

Once reduced, your surgeon may decide to have a brace applied to the leg for a short period, in order to prevent re-dislocation.

It is occasionally necessary to perform a soft tissue repair of the muscles, as well as to replace or revise part of the implant.

See video: 07:29 – 08:45

Hint

Ileus (RISK: <1%).

It can sometimes be difficult for the bowel to function post-operatively, and you may become constipated.

You may feel bloated and uncomfortable. You will be administered laxatives in these circumstances, and occasionally suppositories and even an enema. In some instances the bowel may obstruct, or become blocked, and this risk is increased in circumstances where there is an imbalance of electrolytes, such as sodium.

It may be necessary to undergo a colonoscopy to get the bowel functioning normally.

See video: 09:32 – 10:07

Hint

Atelectasis (RISK: <1%).

Atelaectasis is more common following general anaesthesia. This is when the alveoli of the lungs fail to function properly, sometimes due to very shallow breathing.

This can then predispose to the development of pneumonia.

Usually the oxygen saturation is monitored, so intervention can be started prior to the development of complications.

See video: 11:57 – 13:02