Total joint replacements are commonly performed at the knee, hip and shoulder. Less commonly other joints such as the elbows, wrists, ankles and fingers are replaced. Some of the complications which effect individuals who undergo any of these total joint replacements are discussed below. Because these are complicated and intricate surgeries, all surgeries are done under general anesthesia. The complications of general anesthesia will be common to all surgeries.
One of the most common problems with joint replacements are infections. Bacteria are usually well controlled by our immune system which often responds rapidly and attacks infecting bacteria. However, implanted materials used in joint replacement can allow infections to persist in the body. The immune system is unable to attack bacteria that live on these implants. These infections can become serious problems. If an infection in an implant goes untreated the problem can worsen and the bacteria gain such a foothold they become a systemic problem.
Bacteria cannot easily be eliminated from a joint replacement implant. Despite excellent antibiotics and preventative treatments of available to patients today these joint replacement infections often require the removal of the implanted joint in order to cure the infection. So, prevention becomes the best method of treatment for infections of total joint replacement.
At the time of surgery there are several measures which are taken by surgeons to minimize the risk of infection. Some of these steps are known to lower the risk of infection while others are thought to help but there is no current conclusive research which points to their efficacy. The first factor in prevention is usually antibiotics given before and after surgery. These medications are usually given via IV within one hour of the beginning of surgery and continued for a short period of time following the end of surgery.
Of course, use of strict sterile technique both during the surgery and of the implant are important measures to use during implant surgery. It is also important for the surgeon to be efficient in the operating room. By decreasing the time the joint is exposed they will also lower the risk of infection. This means that the surgeon should be effective in their implant pain procedure but also efficient. Limiting the number of operating room personnel who enter and leave the room is also believed to decrease the risk of infection.
Once this surgery has been finalized the risk of developing an infection from an outside source is reduced but there continues to be a risk of developing an infection from the bloodstream. Because of this, patients should take antibiotics before any invasive procedures such as dental work or colonoscopies. Research has shown that these procedures can cause a transient risk of bacteria entering the bloodstream during the specific time of the procedure and that antibiotics will help control and prevent infections.
Other complications, which are less common, include heart attack, heart or kidney failure, wound drainage, skin blisters, nerve or blood vessel injury or severe muscle spasms. The death rate after total joint replacement is a steady 2.2 percent. The risk of pulmonary embolism runs between 10 and 20 percent and the risk of pneumonia is around 1.4 percent.
Early discharge from the hospital is now standard practice after most total joint replacements. Researchers from Rothman Institute of Orthopedics are at looking at ways of predicting which patients may be at higher risk for complications after joint replacement and require longer hospitalization stays. In a retrospective study patient records were reviewed and complications were placed into two separate groups: systemic and local. Major systemic complications included things such as heart attack, blood clots, heart or kidney failure. Minor systemic complications included anemia, urinary tract infection, pneumonia or change in mental status.
Local complications were classified as nerve or blood vessel injury, bone fracture, wound drainage, infection, skin blisters or severe muscle spasms. Of the over 1300 patients who were evaluated one patient died and 6 percent had major complications. Most of the life-threatening complications happened in the first four days before discharge from the hospital. Researchers felt that some of these problems could be predicted based on the patient’s age, body mass index and overall health. However, the patients who ended up with life-threatening complications had no predictable risk factors.
Based on these results the researchers advise against current trends toward even shorter hospital stays. Patients who have minimally invasive operations are still at risk for the same major complications as with a standard joint replacements.
Standard hospital stays of three to six days for total joint replacement may not be lengthy enough for some of these complications to arise. For this reason patients and their families should be advised of the signs and symptoms they must be on the lookout for. Abdominal or chest pain and shortness of breath are common complaints after surgery which may be indications of more significant medical complications such as pulmonary embolism or gastritis. Other symptoms which patients should report are fever, cough, nausea, vomiting, back pain and problems with breathing or urination.
Early recognition of complications is important in a successful treatments and resolution of these issues. Prolonging the recognition and treatment of complications will be either life-threatening or will significantly delay the rehabilitation and return to normal activity following the total joint replacement.
(1) Journal of Bone and joint Surgery: TOtal Joint Arthroplasty
- National Institute of Arthritis and Musculoskeletal and Skin Diseases: Questions and Answers about Hip Replacement
- American Academy of Orthopedic Surgeons: Total HIp Replacement
- Ohio State University Medical Center: Possible Complications of Total Joint Replacement Surguries
- The American Journal of Orthopedics: Complications and Functional Outcomes after Total Hip Arthroscopy
- Journal of Arthroplasty: In Hospital Complications after Total Joint Arthroplasty
- University of California: Recovering from Hip Replacement Surgery