If you or a loved one suffers from a hip problem that may require surgery, it is important to learn the facts and risks associated with artificial hip replacements before they have it done.

Unfortunately, not everyone has a perfect result. 

There are a number of risk factors that impact hip replacement failure:

• Gender
• Age
• Obesity
• Other medical conditions, such as rheumatoid arthritis diabetes, liver disease, heart disease, HIV, and cancer

Although people with the above risks tend to have greater replacement failure , no one who undergoes this procedure is completely immune to its risks. So, let’s look at the top 4 problems with hip replacements.

Types of Hip Replacements

Metal and Plastic Implants

These are the most common types of implants used for hip replacements. Both the ball and the socket of the hip joint are replaced with a metal implant, typically titanium or stainless steel. A plastic spacer is placed in between the ball and socket, which is made of polyethylene. 

The implant is secured to the bone by either press-fit or cemented into place. In the press-fit method, the implant is fit snugly into the bone, and new bone forms around the implant to secure it in position. When an implant is cemented, a special bone cement is used to secure the prosthesis in position.

Metal-on-Metal Implants

Metal-on-metal implants use similar materials, but there is no plastic spacer inserted between the ball and socket. Metal-on-metal implants became very popular because they were found to have very good wear characteristics in the lab.  However, despite the low wear rates, there were problems with the metal-on-metal implants.

Ceramic Implants

These are becoming more popular for hip replacements. Ceramic hip replacement implants also use metal parts that fit within the bone, but the bearing surface (the ball and the socket) can be made of the ceramic material.  Ceramic hip implants are designed to be the most scratch resistant and smoother which means that wear better than all of the hip replacement implants. 

Top 4 Problems With Hip Replacements

1. Metal-On-Metal Hip Replacement Implants Have the Highest Complication Rates 

The frequency of problems occurring with hip replacements is associated with the type of material the implant is made from.

All metal joints have double the complications of ceramic hip replacements and nearly four times the number of implants that use a metal ball and a plastic socket. In particular, all metal hip replacements with larger heads, the portion of the hip that fits into the socket, have the highest failure rates. These were originally intended to provide a greater level of stability in younger, more active people in need of hip replacement surgery.

Once a patient begins to have problems with a hip replacement, a more complicated revision surgery may be required.

Unfortunately, this surgery has an even higher complication rate than the original surgery. In cases where the bone has deteriorated, bone grafts may be used to help rebuild enough damaged bone tissue to allow the replacement hip to be securely re-attached.

2. Movement of the Legs Causes the Implant to Release Particles

When the two components (the ball and the socket) of a hip implant rub together, a small percentage of those components are actually released and accumulate in the person’s tissues. While some people are more sensitive to them than others, these released particles have been known to create significant complications. Depending on the materials from which the hip implant has been created, different types of particles will be released into the body.

All metal hip implants tend to release small amounts of cobalt and titanium ions, leading to a condition known as metallosis. Because these ions can cause the surrounding tissue to become oxygen starved and eventually begin to die, pain, loosening of the implant, deterioration of nearby bone matter, and cysts may occur.

In severe cases, it can even lead to problems associated with the nervous system and brain where the metal ions have built up to a level that allows them to become distributed throughout the body.

Metal-on-plastic implants tend to release low levels of polyethylene particles which can lead to a condition known as osteolysis. This condition occurs as the body attempts to clean up and remove any foreign particles released from the implant and is responsible for approximately 75 percent of all problems associated with hip replacements.

As the body’s immune system attempts to remove and/or dissolve these particles, it triggers an autoimmune response where bones start reabsorbing their own cells. Over time, the implant is likely to completely fail as a result of the loosening of the prosthesis, which is unable to remain securely attached to less and less bone matter.

This is especially problematic for people who have replacements at a young age.

3. Mortality and Infection Are Less Common But Serious Complications 

Although mortality is not a common complication associated with hip replacements, occurring in only one percent of people during their original surgery, the rate jumps to 2.5 percent for those that are undergoing revision surgery. Perhaps not surprisingly, age was shown to be the largest determining factor in mortality from hip replacement surgery. The most common causes of death in older patients are circulatory and respiratory diseases.

Another less common, but very serious complication, is infection in the hip joint following surgery. When caught within four weeks of the procedure, a surgeon may be able to reopen the wound and inject antibiotics directly into the site. In more severe cases or when the infection has not been discovered quickly, the entire implant may need to be removed and re-implanted at a later time when the infection has completely healed.

Sadly, the most extreme cases of infection can lead to a complete amputation of the leg and hip joint, requiring the use of a prosthetic limb.

4. Recalls 

This is not the same as taking your car in to repair a faulty part. Imagine having to undergo major surgery again just to get the defective part out of you and put a safer model in!

Recalls happen and they typically happen long after the device has been approved by the FDA, years in many cases. Companies who manufacture the parts that are defective may not even declare a voluntary recall, they may choose to wait until the FDA orders them to recall their defective devices. Ultimately, this leaves you in the dark until the damage is done.

If the defective parts have caused any type of infection or bone fractures, you now have additional pain, discomfort and additional healing time to look forward to.

Other Risks

Once your hip is taken out, there is no putting it back. So, if your body rejects the implant, you will have major issues.

Do Your Homework Before Undergoing Hip Replacement Surgery

Because of the numerous problems associated with hip replacements, it is crucial that patients are aware of and understand the risks before making the decision to have hip surgery. If your doctor is pressing you to get the surgery and doesn’t explain the risks or alternatives, you should get a second opinion.

There are non-surgical alternatives, such as stem cell and platelet rich plasma therapy.  They have considerably less risks and the recovery is much less. But, if your doctor doesn’t do these treatments, be assured that they won’t be discussing them with you.

So, do your homework and make an informed decision.  Your long-term health may depend on it.