The risks, with approximate frequency
| Risk | Approximate frequency |
|---|---|
| Deep infection requiring further surgery | <1 in 100, lower with anterior approach |
| Dislocation | <1 in 100, lower with anterior approach |
| Blood clot, DVT or pulmonary embolism | ~1 in 100 symptomatic |
| Fracture during or after surgery | <1 in 100 |
| Nerve injury | <1 in 100 |
| Leg length difference needing a shoe raise | Uncommon |
| Persistent dissatisfaction despite a sound operation | <10% |
| Revision within 10 years | 5.5% |
| Revision within 20 years | 10.8% |
| Death within 30 days | Very rare |
What each of these actually is
Deep infection. One of the most serious common complications. It usually requires further surgery, sometimes including removal and later replacement of the implant, and a prolonged course of antibiotics. Superficial wound infections, which are more common and less serious, are separate and usually resolve with antibiotics alone. Risk is lower with the anterior approach.
Dislocation. The ball comes out of the socket, most often in the weeks after surgery before the surrounding tissues have healed and while precautions may still apply. It usually requires a procedure, sometimes under sedation without further surgery, to put the joint back. Risk is lower with the anterior approach, and varies with prior hip surgery and the muscle condition around the joint.
Blood clot. A clot can form in the leg (deep vein thrombosis) or travel to the lung (pulmonary embolism). This is why blood-thinning medication and early mobilisation are standard after surgery, both measures exist specifically to reduce this risk.
Fracture. The bone can crack during the operation, particularly when fitting an implant into bone that is thinner or more brittle than average, or afterwards from a fall. Risk is higher with osteoporosis and increases with age.
Nerve injury. A nerve near the hip can be stretched or bruised during surgery, most often producing numbness or weakness that improves over weeks to months. Permanent nerve injury is uncommon.
Leg length difference. Restoring equal leg length is planned before surgery and checked during it. Small differences of a few millimetres are common and usually unnoticed. A larger difference is uncommon and can be managed with a shoe raise if it occurs.
Bleeding requiring transfusion. Uncommon with current practice, including the routine use of medication that reduces surgical bleeding.
Wound healing problems. More likely with higher BMI, diabetes, smoking, or with the anterior approach given its position near the groin crease.
Heterotopic ossification. Bone occasionally forms in the soft tissue around the joint. Usually without symptoms; occasionally it limits movement.
Anaesthetic and medical complications. Cardiac, respiratory or other medical complications relate more to your general health than to the hip operation itself, and your anaesthetist will discuss these with you separately based on your individual health.
Postoperative delirium. A temporary state of confusion, more common in older patients, particularly after a general anaesthetic or in unfamiliar surroundings. It is distressing for families to witness and is rarely discussed beforehand. It usually resolves within days.
Death. Very rare. A complete account of risk should include it rather than omit it.
What increases your individual risk
Your own risk is not the average. Some factors can be changed before surgery; others cannot.
Can be modified
- Body weight
- Smoking status
- Diabetes control
- Anaemia
- Dental health, an active dental infection is a genuine infection risk and is usually addressed before surgery
- General fitness
Cannot be modified
- Age
- Prior hip surgery
- Inflammatory arthritis
- Immunosuppression
- Bone quality
This is not an abstract list. Getting some of these into better shape before surgery, where there is time to do so, genuinely changes your risk profile, and is covered in the preparation phase articles that follow.
Timing, if you are already considering an injection
If a hip replacement is likely within the next few months, this is worth raising before considering a corticosteroid injection into the joint. Professor Rodda will not perform a joint replacement within 3 months of a steroid injection into the joint.
Questions to ask
- Which of these risks apply particularly to me?
- Is there anything I can do beforehand to reduce my risk?
- What is your approach to reducing infection and clot risk?
- What would recovery from a complication actually involve, if one occurred?
- How is dissatisfaction assessed and followed up, if it occurs?
Common questions
How common is infection after hip replacement?
Deep infection requiring further surgery occurs in roughly 1 in 100 hip replacements. Superficial wound infections are more common and generally resolve with antibiotics alone. Risk is higher with diabetes, smoking, higher body weight and other factors that can, in part, be addressed before surgery.
What is the risk of dislocation after hip replacement?
Dislocation affects roughly 1 in 100 hip replacements, most often in the weeks after surgery. Risk varies by surgical approach and by factors specific to the individual, including prior hip surgery. It usually requires a procedure to put the joint back, though this does not always mean further surgery.
What is the most under-discussed risk of hip replacement?
Persistent dissatisfaction despite a technically sound operation and no identifiable complication affects a meaningfully higher proportion of people than the surgical complications typically discussed, commonly cited at around 1 in 10. It is rarely raised before surgery and is worth understanding as part of informed consent.
Can I reduce my own risk before surgery?
Yes, in part. Body weight, smoking status, diabetes control, anaemia and dental health can all be improved before surgery and each affects your individual risk profile. Age, prior surgery and some medical conditions cannot be changed, but knowing your individual risk factors allows a more accurate conversation about what applies to you specifically.
Is postoperative confusion normal after hip replacement?
Temporary confusion, known as postoperative delirium, is relatively common after surgery in older patients, particularly following a general anaesthetic or in unfamiliar surroundings. It is distressing to witness but usually resolves within days. It is rarely discussed beforehand despite being a recognised and common occurrence.
Common questions.
How common is infection after hip replacement?
Deep infection requiring further surgery occurs in roughly 1 in 100 hip replacements. Superficial wound infections are more common and generally resolve with antibiotics alone. Risk is higher with diabetes, smoking, higher body weight and other factors that can, in part, be addressed before surgery.
What is the risk of dislocation after hip replacement?
Dislocation affects roughly 1 in 100 hip replacements, most often in the weeks after surgery. Risk varies by surgical approach and by factors specific to the individual, including prior hip surgery. It usually requires a procedure to put the joint back, though this does not always mean further surgery.
What is the most under-discussed risk of hip replacement?
Persistent dissatisfaction despite a technically sound operation and no identifiable complication affects a meaningfully higher proportion of people than the surgical complications typically discussed, commonly cited at around 1 in 10. It is rarely raised before surgery and is worth understanding as part of informed consent.
Can I reduce my own risk before surgery?
Yes, in part. Body weight, smoking status, diabetes control, anaemia and dental health can all be improved before surgery and each affects your individual risk profile. Age, prior surgery and some medical conditions cannot be changed, but knowing your individual risk factors allows a more accurate conversation about what applies to you specifically.
Is postoperative confusion normal after hip replacement?
Temporary confusion, known as postoperative delirium, is relatively common after surgery in older patients, particularly following a general anaesthetic or in unfamiliar surroundings. It is distressing to witness but usually resolves within days. It is rarely discussed beforehand despite being a recognised and common occurrence.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.