Complications After Surgery

Most people undergo surgery with out any problems and experience the good result they expect. Complications are rare but they can occur and that possibility cannot be ignored.

Rarely is a surgical complication "orthopedic" in nature. In other words, the most common problems are medical in nature involving the heart, lungs, abdomen or vascular system. General anesthesia is stressful on the body. Heart problems can develop during anesthesia. After surgery, the lungs are the most common cause of problems (poor ventilation called "atelectasis" or even pneumonia.) The blood veins can be the source of blood clots (deep venous thrombosis or DVT). A blood clot which breaks off and lodges in the lung (pulmonary embolus or PE) is particularly dangerous, even potentially fatal. Bleeding ulcers in the stomach can develop or be reactivated by the stress of surgery. For the men with enlarging prostates, urinating after surgery can sometimes be a problem.

A thorough physical examination prior to surgery will help avoid problems. Management of these medical problems (should they occur) is an important role of your medical physician or the hospital "hospitalist."

With regards to blood clots, surgeons prevent blood clots by many techniques including the use of elastic stockings, early knee motion, leg or foot pumps and early activity. Chemical prevention is also used. Often times, aspirin 325 mg (1 standard adult aspirin) taken twice daily is sufficient. Patients with a higher risk of developing a blood clot are often placed on a formal prescription blood thinner.

Complications related to the orthopedic procedure include infection, nerve damage, and blood vessel damage. Again, while potentially serious, these are all very rare

Infection after joint replacement is serious. If caught within the first 3 weeks the artificial joint components can be preserved. If infection develops later, it may be necessary to temporarily remove the artificial components, clear the infection with antibiotics and then perform a second surgery to replace the components. Surgeons take great care to prevent infection including operating in specialized rooms with highly filtered air, using antibiotics, and wearing “space suites” which add to the sterility of the operating environment.

Damage to a nerve or blood vessel is exceedingly rare but if it were to occur surgical repair would be necessary. The most commonly damaged nerve after knee replacement is the peroneal nerve, a nerve which goes to the muscles that pull your foot up. If this nerve were permanently damaged, it would be necessary to wear a plastic shell half-brace that runs down the back of your calf and into your shoe.

Finally, equipment problems can occur — an instrument can break or not function properly. A bone can break, a ligament can tear. While these problems can all be solved or repaired, they may change how you recover from the surgery.

Long term, if you have received an implant (joint replacement) this can be expected to wear out. This is not really a complication since it will always occur, but I include it here because is does represent a problem to be solved when it does happen.

Fortunately all of these medical and orthopedic problems are rare and orthopedic surgeons use many strategies to prevent them from occurring. People undergoing knee surgery tend to be healthy and active which minimizes the risk of complications.