Hip replacement - Risks of hip replacement surgery

The most common complication of hip replacement is that something goes wrong with the joint, which occurs in around 1 in 10 cases.

Joint problems

Some common types of joint malfunctions are listed below.

Loosening of the joint

The most common problem that can arise as a result of a hip replacement is loosening of the joint. This can be caused by the shaft of the prosthesis becoming loose in the hollow of the thigh bone, or due to thinning of the bone around the implant.

Loosening of the joint can occur at any time, but it normally occurs 10-15 years after the original surgery was performed.

Signs that the joint has become loose include pain and feeling that the joint is unstable.

Another operation (revision surgery) may be necessary, although this cannot be performed in all patients.

Hip dislocation

In around 3% of cases the hip joint can come out of its socket. This is most likely to occur in the first few months after surgery when the hip is still healing.

Further surgery will be required to put the joint back into place.

Wear and tear

Another common complication of hip replacement surgery is wear and tear of the artificial sockets. Particles that have worn off the artificial joint surfaces can be absorbed by surrounding tissue, causing loosening of the joint.

If wear or loosening is noticed on X-ray, your surgeon may request regular X-rays. Depending on the severity of the problem, you may be advised to have further surgery.

There have been reports about metal-on-metal implants wearing sooner than expected and causing complications. The Medicines and Healthcare products Regulatory Agency (MHRA) advises that particular metal-on-metal implants should be checked anually. You can consult your doctor for further advice if you have any concerns about your hip replacement or do not know which type you have.

Read our metal-on-metal implant advice Q&A for more information.

Joint stiffening

The soft tissues can harden around the implant, causing reduced mobility. This is not usually painful and can be prevented using medication or radiation therapy (a quick and painless procedure during which controlled doses of radiation are directed at your hip joint).

Serious complications

Serious complications of a hip replacement are uncommon, occurring in fewer than one in a 100 cases.

These are described below.

Blood clots

There is a small risk of developing a blood clot in the first few weeks after surgery.

There are two main places a blood clot can develop:

• inside one of your legs – which is known as a deep vein thrombosis (DVT)
• inside your lungs – which is known as a pulmonary embolism

Symptoms of a DVT include:

• pain, swelling and tenderness in one of your legs (usually your calf)
• a heavy ache in the affected area
• warm skin in the area of the clot

Symptoms of a pulmonary embolism include:

• breathlessness, which may come on suddenly or gradually
• chest pain, which may be worse when you breathe in
• coughing

If you suspect that you have either of these types of blood clots you should seek immediate medical advice from your GP or the doctor in charge of your care. If this is not possible then call NHS 111 or your local out-of-hours service.

In order to reduce your risk of blood clots you may be given blood thinning medication such as warfarin, or asked to wear compression stockings.

Infection

There is always a small risk that some bacteria could work its way into the tissue around the artificial hip joint, triggering an infection.

Symptoms of an infection include:

• a high temperature (fever) of 38°C (100.4°F) or above
• shaking and chills
• redness and swelling at the site of the surgery
• a discharge of liquid from the site of the surgery
• hip pain that can persist even when resting

Seek immediate medical advice, as detailed above, if you think you may have an infection.