SYSTEMIC or GENERAL   COMPLICATIONS  AFTER  

TOTAL  JOINT  REPLACEMENT

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"I am scheduled to have a total hip at the end of June. After considerable research among people around me, my concerns are not the surgery or the recovery, I am concerned that I am doomed to a life full of inactivity and repeated surgeries. How frequently do such complications as hip dislocation, postoperative infection, and other complications occur after a total hip replacement? Is there any type of replacement that has fewer complications than others? ...."

• Total replacement of the hip and knee joint is Major Surgery causing considerable operation trauma. The stress on the body’s circulation system from this surgery is considerable. Moreover, these operations are commonly performed in aged patients, who are often suffering from systemic diseases of heart, lung, or urinary tract. Systemic complications common to any Major Surgery are therefore occurring also after total hip or knee operations.

The frequency of these complications varies in different reports.

• It is important to know that most of these systemic complications are preventable . A thorough preoperative examination and treatment of all conditions that may develop into a systemic postoperative complication will prevent the majority of these complications. (See more about it in the chapter on preoperative examination).

• The important systemic complications after a hip or knee replacement operation and their frequency are apparent in the Table.

Heart infarct

Myocardial infarction occurs as a postoperative complication mainly in aged patients with previous heart disease or high blood pressure. The risk for this complication is very high in patients who have had heart infarct within six months before the artificial joint operation. The prevention is by careful preoperative screening for diseases that predispose for this complication.

Disturbance of the stomach and bowels function

Upset stomach or temporary disturbance of bowel passage after major artificial joint replacement operation may occur in up to 1% of all operations. With standard treatment (no food by mouth, intravenous nutrition) this complication resolves within days without further problems.

Retention of urine

Retention of urine may occur both in male and female patients, more often after the spinal or epidural anesthesia. In a male patient the latent prostate obstruction may cause full-blown urine retention after operation. (If you have prostate problems, they should be dealt with before your total joint surgery.)

The treatment of urinary retention is by inserting an urinary bladder catheter to provide free passage for urine. Inserting the catheter after surgery is 1) painful, and 2) it may induce bacteria into the urinary system and cause a urinary tract infection. There is always an increased risk that these bacteria may spread into the recently operated artificial joint.

To prevent this situation, the surgeons insert routinely urinary catheters to all patients already during anesthesia, so that the insertion is pain-free. At the same time the newly operated artificial joint is covered by prophylactic antibiotics.

The catheters are usually removed on the second postoperative day, the removal is not painful.

Postoperative confusion

a mild form of postoperative confusion may occur after general anesthesia, more often in aged patients. Risk factors are high age, deficiency of B vitamins, and "intake of alcohol on regular basis". On the other hand, it is astonishing to see old patients, tormented by painful joints and in deep depression, to literally blossom up after a successful total joint surgery.

Mortality after total joint replacement operations

Total joint replacement is Major Surgery, and as with all Major Surgery there is a certain risk for deadly complications. If you are scared by all rumors, you should know that also the non-operative treatment of joint arthritis has its risks, some of them lethal. These risks are low compared with the risks for surgical treatment of joint disease, but they are present.

Statistics showed for example, that one out of every 1000 patients treated with NSAID developed bleeding gastric ulcer .Ten percent of patients with this complication died, a mortality rate of 1 / 10 000. For comparison, the thirty-day mortality rate after total hip surgery is nowadays 15 /10 000 (Parvizi,  2001).

The patients often wonder if they will make it through the operation. To allay your subconscious fears, here follow some optimistic facts about one unpleasant issue, the risk of death after an artificial joint operation.

• Most deaths occurring early after the total joint operations have been caused either by pulmonary embolus or by myocardial infarction in aged patients.

• Unanimous statistics demonstrate that the death rates after total joint operations have been steadily diminishing thanks to the introduction of new operation techniques and improved anesthesia care.

• The risk of death  has been 0,9 % in the 1970's a it has dropped to 0,1 % in the 1990's total hip and knee operations ( Sharrock NE 1995; Parvizi ,  2001).

• There is also another positive message: patients operated on with artificial hip and knee joints live longer then do the people in the general population. (Lie ,  2000) Five years after a total hip or knee operation, 89% of patients were still alive whereas only 81% of the people in the general population of equal age were still alive.

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