Complications in total hip replacement

THE PURPOSE of the present study was to present the most common treatment failures and complications associated with total hip replacement.

Between 1986 and 2002, 486 total hip replacements (THR) in 403 patients were performed at the Clinics of Orthopedic and Trauma Surgery (St. George University Hospital, Plovdiv). 315 (61.8%) of the patients underwent THR for coxarthrosis, 171 (35.1%)--for traumatic or pathologic subcapital femoral neck fractures. 312 (64.2%) of the patients were women and 174 (35.8%) were men. Right and left arthroplasties were carried out. Patients' age was in the range of 28 to 53 years (median age 59.6). Complications were diagnosed in 97 (19.9%). Late postoperative complications (53.6%) as aseptic loosening of the prosthetic components, superficial and deep hematogenous infections, prosthetic dislocations and heterotopic ossifications were predominant.

Complications were categorized as intraoperative, postoperative and late--a finding, consistent with the data in the literature. Among the intraoperative complications most common were malposition of the capsule (7 patients) and of the stem (4 patients) and longer stem (in 1 patient), but they caused no complaints. The postoperative complications consisted of hematomas and seromas wich were treated with early revision surgery. The main causes for late complications were postoperative ossification in 28 patients. Aseptic loosening of the prosthesis was seen in 11 patients. 8 of them complained of acetabular and 3 of thigh pain. Capsule dislocation was registered in 3 patients.

Complications in THR are not infrequent. Their avoidance is largely dependent on the skill and qualification of the team and the quality of hospital care. Adequate risk assessment and prophylaxis are essential in disease outcome.