Surgical Complications

Every operation has a risk of complications attached to it – there is no such thing as an operation without risk. There are general risks of surgery, which are common to most orthopaedic procedures and there are risks that may be specific to the particular operation required. This document will deal with the general risks and complications of surgery. Please refer to individual operation information sheets for complications related to specific procedures.

General Risks of Orthopaedic Surgery

Wound infection
Most frequently, wound infection occurs when the patient’s own skin germs find their way into the surgical wound. This complication is kept to a minimum by judicious use of antibiotics during (and sometimes after) surgery. More rarely, the patient may contract a “hospital acquired infection” with a particular germ, which may be more difficult to eradicate. Fortunately these latter infections are relatively uncommon in otherwise healthy patients undergoing elective surgery. Cigarette smoking, poorly controlled diabetes and the use of immunosuppressant drugs such as Prednisolone, Methotrexate, Immuran, Arava, Humira, Enbrel, and patients undergoing chemotherapy will increase the possibility or severity of infection or may predispose to infection.

Excessive bleeding to the point of requiring a blood transfusion is uncommon in orthopaedic surgery. Some procedures such as revision joint replacement or complex fracture management may increase this risk. A blood transfusion will only be given if absolutely necessary. Your risk of significant bleeding is reduced by varying the type of anaesthesia as well as by altering certain types of medications.

Nerve injury
This is an uncommon complication in general, however it may occur with any operation on the limbs, and can result in partial or complete loss of skin sensation and/or muscle power. While this is usually temporary or partial, in some cases it may be permanent, or may take many months to recover fully since the injured nerve must re-grow from the level of the spinal cord, and does so at a rate of approximately 1mm per day. Some procedures are more prone to nerve injury than others. It is very common to have some minor or partial loss of sensation around the surgical wound and this is not to be considered a complication of surgery per se, but normal for that operation.

Major blood vessel injury
Damage to a major blood vessel is extremely rare but can be very serious. If this does occur, the vessel will usually be repaired by a plastic or vascular surgeon. In exceedingly rare circumstances, it may even result in gangrene and the loss of a limb.

Deep Vein Thrombosis
Deep vein thrombosis (DVT) refers to blood clots that form in the deep veins of the leg. There are many factors that lead to DVT, most commonly immobility and poor flow of the blood back to the heart from these veins. In its own right a DVT is not a major complication and occurs relatively frequently after orthopaedic surgery. However, if a fragment of the blood clot breaks off and travels via the circulation into the lungs (known as a Pulmonary Embolus or “PE”) it can cause severe problems such as sudden chest pain, breathlessness, low oxygen levels in the blood stream and even potentially fatal cardiac arrest.

While a PE is rare, it is a serious enough complication to warrant significant consideration, as prevention of DVT and therefore in theory, prevention of PE, requires the use of either medications to thin the blood or mechanical means to encourage blood flow such as pneumatic foot or calf pumps. The pumps rapidly squeeze the slow-flowing blood from the calves back into the faster flowing main circulatory system to stop them from clotting.