What can go wrong with hip replacement?
Some patients may suffer from:
- Blood clots
- Change in leg length
- Dislocation
- Fractures
- Infection
- Loosening of the implant
- Nerve injury, resulting commonly in a ‘foot drop’.
- Metal-on-metal implants can cause reactions for some people (matallosis)
If complications occur, then it may not be too bad. If you have a change in leg length, that can often be easily corrected with a shoe raise if the difference is minimal. A minor wound infection may clear up in a short time and blood clots can resolve with medication.
However, for others, hip surgery going wrong can affect their lives very badly. You expect your ability to move around (‘mobilise’) to improve after joint replacement surgery. You also expect to be pain-free.
Am I at higher risk of things going wrong during hip surgery?
Generally, the risk of complications is around 3%. However, if you carry a combination of risk factors, then the complication rates can increase to around 20%.
The following make operations riskier:
- Older age
- Being overweight (obese)
- Diabetes
- Smoking
- Drug abuse
- Repeat hip surgery (revision)
- Any previous hip surgery
Is a complication of hip surgery negligent?
Various things can go wrong during the process of selecting and operating on patients. There are examples below where hip surgery claims are often made. You need to ask yourself the following questions if you are considering a claim:
Was I properly advised about the risks of my surgery?
If you have a combination of risk factors (as listed above) then your surgeon should have told you that. You should make a choice about having major surgery with your eyes wide open. If part of the problem is that you are very overweight, or smoking, you should be told about the increased risks. You should be encouraged to make lifestyle changes before your surgery takes place.
Combined risk factors make it more likely that you will suffer from serious infection problems. If you do suffer an infection that ends up on your implant, then antibiotics (even given intravenously in hospital) are often not enough. If so, you must have further surgery to take out the implant (this is called first-stage revision). You then must live without a hip joint for months before further surgery to put in a new joint (this is called second-stage revision). The second stage surgery cannot go ahead until doctors are absolutely satisfied that all infection has gone. Patients waiting for second stage hip revision cannot walk and often have to use a wheelchair.
Carrying various risk factors also increases the risk of blood clotting issues after surgery. Blood clots can be treated with medication. A serious clot though can mean lifetime complications. It can also mean you need to take medication for life. Blood clots can be life-threatening if one travels to the lungs or brain.
If you are diabetic, then you have a higher risk of suffering from foot drop, caused by nerve damage (known as neuropathy). For some diabetic patients, making changes to how they eat and exercise before surgery can reduce their risk. Improved medical management (drug therapy) can make sure the condition is under better control before surgery.
Were preoperative checks carried out properly?
If you have a pre-existing condition, then it may be that other doctors need to see you to confirm it is safe for surgery to go ahead.
For example:
- If you have a heart condition, you may need to see a cardiologist.
- For an arthritic type condition, you may be taking steroids. If so, your steroid use may need to be reduced before surgery to a safe level.
- A haematology clinic should carefully assess patients taking anti-clotting drugs, such as warfarin. This is to ensure your blood levels are safe. Otherwise, you can carry increased risks of bleeding during or after your surgery takes place. If you do have increased bleeding risks, it’s very important that the haematology clinic lets the surgeons know. In this way, nurses and doctors monitoring you during and after surgery can take extra care in observing you for bleeding issues.
Was my surgeon negligent?
We set out below some examples of where surgeons have found themselves facing hip surgery claims. This list does not cover everything. Please do speak to us if you think something else has happened during surgery and you need advice.
Being awake during surgery
If you find that you are in pain during your surgery, when you should be asleep, that is generally negligent. However, it won’t be your surgeon that is responsible. There is another doctor who puts you to sleep for the surgery (this type of doctor is called an anaesthetist). The anaesthetist stays with you during the surgery. They are meant to give you enough anaesthetic, as well as a paralysing agent, to ensure that you both stay asleep, and do not move during the surgery. Unfortunately, we have had to investigate various cases where patients have not had enough of the medication to keep them asleep. This means they are unable to move or speak and suffer terrible pain during surgery.
Wrong size implant
Sometimes surgeons will not choose quite the most suitable size implant for you. In some circumstances, this can be negligent. There has recently been a trial in the UK where a claimant succeeded on the basis that they had already had a new hip on one side. The surgeon, inputting a new hip in on the other side, used a slightly bigger implant. The judge accepted the claimant’s medical expert’s opinion that this was the wrong decision and that the same size implant should have been used on both sides.
Broken bones during surgery
There is a stem attached to the hip implant. The stem has to be pushed deep into a bone in your thigh. A broken thigh bone can happen when the stem is being inserted. This can happen non-negligently. It can also happen because of lack of reasonable care taken by the operating surgeon.
Incorrectly placed implant
The implant has to sit in the hip socket correctly. Otherwise, it can irritate nearby structures.
In a recent UK trial, a Claimant had suffered a condition called iliopsos tendonitis. The judge found that a surgeon should have checked that the implant was deep enough into the socket. This is a simple check that only involves the surgeon running their finger around it.
The surgeon gave evidence that he had never received training to do this. His medical expert stated that there would be a ‘body of surgeons’ just like the defendant who had also never been trained to do this. On that basis, the defendant argued that the surgeon could not be considered negligent as there were plenty of others who were not doing the same checks. The judge was having none of this! Judgement was that it was not logical to fail to do a simple check and all surgeon should be doing it.
Dislocation of the hip can also occur if the implant is not placed well. Dislocation can lead to more surgery being needed and also to nerve injury.
Damaged nerves
Nerve damage is something that the surgeon should tell you is a risk of surgery. However, surgeons have to be extremely careful with nerves when operating. Hip surgery claims for foot drop do tend to be pursued as this condition is extremely distressing to live with.
Nerve damage is rare but is a devastating complication. There are higher risks of suffering from this complication if you are having a previous hip replacement repeated (a revision). In addition, if you’ve had any hip surgery previously. It’s very important that surgeons properly assess your anatomy before surgery and take precautions to ensure they do not injure nerves. There are very important nerves close to the hip joint such as the common peroneal nerve and tibial nerve.
This type of injury can occur due to compression because of poor positioning on the surgical table. Improper placement of surgical instruments (‘retractors’) can also cause nerve compression. Surgeons can cause stretching type injuries when manipulating the joint. If too much traction is applied, then this can lead to damage.
Direct trauma can be caused by surgical instruments, such as the scalpel, electrical instruments, screws et cetera. Bone cement is often used in hip replacement. This is used at a very high temperature and leakage of bone cement can cause injury to nerves. We have investigated various hip surgery claims where this happened.
Examples of awards in past cases
Over £500,000 compensation
For a teacher, in his 50s who, aged 46, consultant surgeon with pain in his hips. He suffered severe pain after surgery. It emerged that the hip replacements had been put in at the wrong angle. It was only five years after initial surgery that revision took place which was done by different Surgeon.
£430,000 compensation
A 74-year-old woman received £430,000 for the delay in correcting failed hip replacement surgery. The initial surgery was in 2006. Revision surgery only took place in 2011. She suffered an infection after the surgery. She had to undergo further medical procedures which included a knee replacement. Her mobility and activities were limited.
