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Complications of total hip arthroplasty

Greg A Erens, MD
Section Editor
Daniel E Furst, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Most complications in total hip arthroplasty are infrequent and can be prevented or treated readily if anticipated and recognized. Complications associated with any major surgical procedure, including those related to anesthesia, comorbid medical conditions, medications, and allergic reactions, may also occur.

Potential complications known to occur during or following total hip arthroplasty will be reviewed here. The complications can be categorized as intraoperative or postoperative. The preoperative assessment, the alternatives to total hip arthroplasty, and an overview of the surgical procedure itself are presented separately. (See "Total hip arthroplasty".)


Fracture — The incidence of fracture during total hip arthroplasty ranges from 0.1 to 1 percent for cemented components and from 3 to 18 percent for uncemented components [1]. Most intraoperative fractures occur on the femoral side during stem insertion. Minor fractures may be left alone or treated with wires or cables. More extensive fractures may require more complex solutions including revision of components, bone grafting, and/or supplementary hardware (eg, plates and screws). Factors that increase the risk of fracture during primary arthroplasty include female sex, osteopenia, inflammatory arthropathies, and cementless stem fixation. The use of longer-stem cementless implants during revision surgery is an additional risk factor for fracture [2].

Nerve injury — The incidence of nerve injury in primary total hip arthroplasty ranges from 0 to 3 percent [3]. Injury to the sciatic nerve is most common, but the femoral, obturator, and superior gluteal nerves may also be injured. The peroneal division of the sciatic nerve is more susceptible to injury than the tibial division.

Risk factors — Risk factors for nerve injury include previous surgery, developmental dysplasia of the hip, lengthening of the extremity, obesity, and female sex.

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Literature review current through: Nov 2017. | This topic last updated: Oct 11, 2017.
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