Complications of total hip arthroplasty

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Complications of total hip arthroplasty are common and it is essential for the radiologist to be aware of them in the assessment of radiographs of total hip replacements. Complications are many and can occur at various time intervals following the initial surgery:

aseptic loosening: considered to be the most common indication for revision surgery ^1,2,4
infection of hip prostheses ^5,6
particle disease / histiocytic reaction / aggressive granulomatosis
fracture
dislocation (~5% of all replacements ⁴)
- dislocation of femoral head out of the cup: component dissociation
- dislocation of the entire acetabular cup
- dislocation of stem
malpositioning
- creep: can lead to protrusio acetabuli
- intrapelvic cup migration
- polyethylene wear eccentric position of the femoral head component within the acetabular component
heterotopic bone formation
reaction to metal
- metal-on-metal pseudotumour /
- aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL)
- metallosis
pseudobursae formation ²
abductor muscle/tendon dysfunction e.g. tears
stress shielding
trochanteric bursitis
revision total hip arthroplasty
general post-orthopaedic surgical complications
- haemorrhage
- wound complications e.g. dehiscence
- thromboembolism, i.e. deep vein thrombosis and pulmonary embolism
- vascular injury
- neurological deficit
- death

A standardised list of complications post total hip arthroplasty was developed by consensus by The Hip Society. This enables consistent standardised reporting of complications ⁸.

~~-<a title="Prosthetic hip infections" href="/articles/prosthetic-hip-infections-1">infection of hip prostheses</a> <sup>5,6</sup>~~
+<a href="/articles/prosthetic-hip-infections-1">infection of hip prostheses</a> <sup>5,6</sup>
~~-<li>creep: can lead to <a href="/articles/protrusio-acetabuli-1">protrusio acetabuli</a>~~
+<li>creep: can lead to <a href="/articles/acetabular-protrusion-1">protrusio acetabuli</a>
-<a href="/articles/metal-on-metal-pseudotumour">metal-on-metal pseudotumour</a> / <a href="/articles/aseptic-lymphocyte-dominant-vasculitis-associated-lesion-alval">aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL)</a>
~~-</li>~~
+<a href="/articles/reaction-to-metal">reaction to metal</a><ul>
+<li><a href="/articles/metal-on-metal-pseudotumour">metal-on-metal pseudotumour</a></li>
+<li>aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL)</li>
+</ul>
+</li>

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Complications of total hip arthroplasty

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