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What Are The Risks Of Hip Surgery?


Hip replacements have been highly successful for more than 30 years. Millions of people who have suffered from hip pain and arthritis have experienced relief through total hip replacement and restored mobility. Globally, hundreds of thousands of hip replacement procedures are performed each year. And because medicine is always developing new materials and procedures, the results continue to get better. The complication rate following total hip replacement is low. Serious complications, such as hip-joint infection, occur in approximately 1.0% of patients.1 Major medical complications, such as heart attack or stroke, occur even less frequently. (Of course, chronic illnesses may increase the potential for complications.)

Every surgical procedure has risks and benefits. Your individual results will depend on your personal circumstances, and recovery takes time. How long your hip replacement will last depends on many different factors, and everyone is unique. Only your doctor can discuss this aspect of surgery with you.

Each of the following reactions or complications can occur during and after surgery and may require medical attention (such as further surgery) and implant removal:

Implant dislocation and leg-length difference

The most common complications specific to hip replacement surgery include loosening or dislocation of the implant and a slight difference in leg length. Your healthcare team can discuss these with you.

Blood clots

Blood clots in the leg veins are a possible complication of hip replacement surgery. Your surgeon will outline a prevention program. This may include periodic elevation of your legs, lower-leg exercises to increase circulation, support stockings, and medication to thin your blood. 


Infection is a risk with any surgical procedure. According to a recent study, approximately 1.0% of patients get an infection in the first two years.1 When infection occurs after total hip replacement, it is most commonly caused by bacteria that enter the bloodstream during dental procedures, or from urinary tract, skin, or fingernail infections. Although uncommon, when these complications occur, they can delay full recovery. 

For the first two years after your hip replacement, your doctor may require you to take preventive antibiotics before dental or surgical procedures that could allow bacteria to enter your bloodstream. Generally, talk to your orthopedist and your dentist to see if you still need preventive antibiotics before other procedures.


The bone next to the hip implant may break down (called osteolysis) because of your body's reaction to particles that may be caused by:

  • Direct contact of the metal and plastic components
  • Contact between the hip components and the bone cement
  • Contact between the hip components and your natural bone particles that exist between the hip's moving parts, which can cause more particles or damage to the implant components

Implant fracture

Implant fracture has been reported following total hip replacement. This is typically caused by:

  • Patients with unrealistic performance expectations
  • Heavy and/or overweight patients
  • Physically active patients

To minimize the possibility for implant fracture, it is important to follow medical instructions and to avoid excessive or inappropriate activity. 

Other risks

  • Removal and/or replacement of the device system or its components may be necessary at some point in the future
  • Although rare, metal-allergy reactions from hip implants have been reported. Inform your doctor if you have any allergy symptoms
  • Dislocation can result from improper positioning of the implant components
  • Implant components can loosen or move due to improper cementing or shock from falls or collisions
  • Cardiovascular disorders associated with the use of bone cement include blood clots; decreased blood pressure; heart attack; and, in rare instances, death

When hip replacement surgery is not appropriate

Given the risks, your doctor may decide that hip replacement surgery is not appropriate if:

  • You have an infection or a history of infection
  • You don't have enough bone or the bone is not strong enough to support your new hip
  • You have injured nerves in your hip area
  • You have injured or nonfunctional hip muscles
  • Your hip is severely unstable
  • Your bones are not fully grown or developed
  • You have noticeable bone loss or a severe decrease in bone mass (osteoporosis)
  • Your hip joint has been previously fused and is stable, functional, and painless
  • You have rheumatoid arthritis and active/history of skin lesions (because of increased risk of infection)


  1. Elie Ghanem, Fereidoon M Jaberi and Javad Parvizi Am J Orthop (Belle Mead NJ) 36(10):520-5 (2007) PMID 18033562