10 – Complications of joint replacement and revision arthroplasty

From greek.doctor

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
  • 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
  • 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