10 – Complications of joint replacement and revision arthroplasty
57. Complications of joint replacements
- Complications of joint replacements are relatively rare
- THR has an expected survival of more than 15 years
- Complications rate is < 3%
- Satisfaction rate > 90%
- Intraoperative complications
- Fracture
- Nerve damage
- Vessel damage
- Bleeding
- Complications related to anaesthesia
- Early postoperative complications
- Infection
- Patients receive antibiotic prophylaxis, but the risk is not eliminated
- Dislocation
- DVT
- Patients receive anticoagulation prophylaxis, but the risk is not eliminated
- Infection
- Late complications
- Particle disease (= particulum disease)
- Friction between the prosthetic femoral head and the polyethylene liner causes polyethylene particles to come off
- These particles increase osteoclastic activity, loosening the prosthesis
- This is visible as osteolytic lesions around the prosthesis
- The more active the patient, the higher risk for particle disease
- Prevention
- Use different surfaces
- Ceramic surfaces create less friction than metal surfaces, but are more expensive
- Keep normal bodyweight
- Use different surfaces
- Particle disease (= particulum disease)
- Revision arthroplasty (= revision surgery)
- Removing the old prosthesis and replacing it with a new
- Done if the implant is weary or loosening, most commonly due to particle disease
- Younger patients who get joint replacement may “outlive” their replacement and may therefore need a revision