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Complications of the Artificial Hip Joint - Medical Experts
Every operation is associated with a certain amount of blood loss. Normally, a healthy organism is able to compensate for a loss of about 1 liter of blood without major problems. After the procedure, regular blood tests will be carried out and, if necessary, iron-containing medication will be prescribed. With greater blood losses, which have become increasingly rare in the context of minimally invasive endoprosthetics, the cardiovascular system is severely impaired. If this reaches a critical limit, the transfer of foreign blood is also necessary in exceptional cases. This entails certain risks of intolerance, infection and the transmission of diseases. However, due to the legal provisions applicable in Germany for the selection of donors and the can tests, the risk of these disease transmissions is negligible.
Another very low risk is the severing of the skin. This interrupts the protective function of the skin. Bacteria from the environment and from the skin itself can enter the body. In order to kill these off immediately, each of the patients usually receives an antibiotic injected into the vein immediately before the procedure. In addition, all wound surfaces are permanently subjected to a high-pressure cleaner-like wound cleaning (jet lavage) during the operation.
Nevertheless, there is a residual risk that bacteria will adhere to the artificial hip joint. If the body's own defense mechanisms fail, this can lead to a very treatable, superficial wound healing disorder with prolongation of the wound secretion, or to a purulent inflammation of the joint. Ultimately, only a new operation with complete removal of the artificial joint parts can bring about healing. But this always means the loss of the joint.
It is important for the prosthesis wearer to know that an inflammation of the artificial hip joint, a so-called prosthesis infection, is possible long after the operation. Every intervention (e.g. tooth root extraction) and inflammation of the body (e.g. gall bladder, middle ear) can lead to the ingress of bacteria into the artificial hip joint and an associated artificial joint infection.
Injuries to nerves and vessels
An injury to accompanying tissue caused by the access route has already been described. This is kept very low in minimally invasive interventions. Nevertheless, with anatomical variants (bypass circuit, congenital malformation) it is possible that larger blood vessels and, very rarely, nerves are injured as a result of the surgical trauma. Since the nerve passes relatively close to the hip and knee joint, the swelling caused by the operation or the leg pull required during the operation can lead to a temporary loss of function of the muscles supplied by the nerve, e.g. B. come in the form of foot paralysis. These nerve lesions usually recover within a year.
The operation-related immobilization of the leg can lead to blood congestion in the leg veins (thrombosis). This is accompanied by painful swelling of the leg and can lead to permanent damage to the leg veins and skin (post-thrombotic syndrome with trophic dermatosis). Since the general use of heparin preparations and the early mobilization after minimally invasive interventions, the thrombosis rate has fallen very sharply. Nevertheless, theoretically every thrombosis can develop into a partial or complete blockage of the pulmonary blood flow (embolism) through washing away of small blood clots, which can still be fatal even today despite the most modern intensive medical care.
Leg axis and leg length changes
The installation of artificial joint parts, which also require a certain amount of space, can lead to changes in leg length, especially with hip prostheses. Particularly in difficult anatomical conditions with reconstruction of the hip center or a disease of the opposite side, the operated leg is lengthened. Side differences of 1 to 2 cm are not a problem and can be compensated for with shoe insoles, raised heels or later during the operation on the opposite side.
The leg length achieved depends on many factors and can only rarely be influenced by the surgeon. So the good function of the hip joint is more important than the same leg length. Since the joint partners of the artificial joint have no inherent stability, sufficient joint tension is necessary for good joint function. This can be varied by selecting different joint partner sizes, inlay thicknesses and head lengths. Only an artificial hip joint with good joint tension will later work without any problems. This means that good joint tension can only be achieved by slightly lengthening the leg.
After the procedure, you will be able to move your joint painlessly again. Nevertheless, it is and will remain an artificial hip joint. In contrast to the body's own joint, which can only "dislocate" with a very high force, it is much easier for an artificial joint to dislocate due to its mechanical properties. Such an event, which is very painful for you, can occur, especially with large fluctuations in movement such as very strong flexion or strong rotation in the joint. As a rule, an experienced orthopedist can straighten the joint in a brief anesthetic without surgery. In exceptional cases, however, an operative reduction is necessary. The probability of such a dislocation is extremely low in the Clinic for Orthopedics and Orthopedic Surgery due to the vast experience of the surgeons.
Ossification around the artificial hip joint
Some of the patients tend to develop ossifications around the artificial hip joint as part of the wound healing process. This can be so severe that the artificial hip joint becomes stiffer. However, scientific research and our own experience have shown that certain procedures can minimize this risk. We use jet lavage as standard during the operation. All patients receive prophylaxis using medication from the first day after the operation. Patients who are known to have such a tendency may be given perioperative radiation therapy.
Loosening of the prosthesis
Artificial hip joints can come loose. However, this is not due to the strength of the artificial hip joint, but often to the reduction in the load-bearing capacity of the bone surrounding the prosthesis. The prosthesis in the bone loosens and very seldom begins to hurt after many years without symptoms. Then it is time to replace the artificial hip joint, which usually means a greater surgical effort than the primary implantation. In addition, the patients are then significantly older than with the primary implantation, which is why the risk of surgery increases. The average durability of an artificial hip joint is given at 15 years.
Since endoprostheses are made of metal, everyone can generally have an allergic reaction. These intolerances can manifest themselves in pain and premature loosening of the artificial hip joint. Patients with a certain metal allergy in particular should inform their doctor about this at an early stage. Special, hypo-allergenic prosthetic materials are available for these patients. However, these sometimes have to be tested in advance of an operation, which takes some time.
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