Understanding Surgical Risks

All surgical procedures carry some degree of risk. Understanding potential complications allows you to make fully informed decisions about your treatment. This video explains risks associated with orthopaedic surgery, and the steps I take to minimise them. Blood clots in the leg veins, known as deep vein thrombosis, and blood clots in the lungs, called pulmonary embolism, are potential risks. The risk of a fatal embolism is less than 0.5%. We reduce your risk through early mobilization; adequate hydration; antithrombotic stockings; calf pump use; and blood-thinning medication. Signs to look out for are pain and swelling of the calf, chest pain, shortness of breath or coughing up blood. In such cases, call 999 as immediate medical attention should be sought. Infection is a risk with any surgical procedure, but currently stands at less than 1% with my treatment regime. Surgery is performed under strictly regulated sterile conditions, and antibiotics are given just prior to surgery. Occasionally further antibiotics are required after surgery. Subsequent infection may require further antibiotic treatment or additional surgery. Dislocation can occur with hip replacement surgery, particularly in the first three months. Following advice regarding specific movement precautions, should prevent this. Nerve and blood vessel damage can occur during surgery - though this is uncommon. Numbness around surgical scars, particularly following knee surgery is common, which may or may not be permanent. Movement is not usually affected. Significant nerve injury resulting in lack of joint movement, or weakness in the limb or artery damage are rare. Use of splints, or further surgery may also be required. Fracture of bone around the implant can occur during or after surgery. The risk is higher in patients with osteoporosis, use of uncemented implants or those undergoing revision surgery. If spotted during surgery, appropriate treatment will be carried out prior to closing the wound. Small stable fractures may heal with protected weight-bearing and physiotherapy. Unstable fractures will likely require additional surgery. Leg length discrepancy can occur after hip replacement surgery - particularly following revision surgery. Your operated leg may appear slightly shorter or longer, which may give rise to a temporary limp. Most patients adjust naturally, but occasionally, a shoe raise is needed. If a limp continues we will check for other issues like muscle weakness, spinal problems, or nerve injury. Loosening of the implant can occur over time, particularly those fixed with cement. Hip and knee implants are designed to last fifteen years or more, but problems may occasionally occur earlier, particularly in the presence of infection or trauma. If loosening causes pain, instability or risk of an impending fracture, revision surgery may become necessary. Stiffness of a joint can develop after surgery, particularly if range of motion is restricted pre-operatively. Hence the importance of regular physiotherapy exercises prior to surgery. Adhering to your prescribed rehabilitation programme is essential for achieving optimal range of movement. If exercises fail to achieve adequate movement, joint manipulation or further surgery to remove scar tissue may be required. General anaesthetic risks are: chest infection; urinary problems; and very rarely, serious complications affecting the heart or lungs. Your anaesthetist will assess your individual risk factors during pre-assessment, and discuss the need for optimization and safest anaesthetic approach. While risks do exist, the vast majority of patients experience successful outcomes with significant clinical improvements. During your consultation, I will discuss how these risks apply to your individual circumstances.