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Updated: Apr 30 2023

THA Other Complications

Images length.jpg overhand with normal anteversion.jpg wear.jpg
  • Introduction
    • This topic includes
      • heterotopic ossification
      • squeaking
      • blood transfusion
    • Other THA Complication topics
      • periprosthetic infection
      • THA dislocation
      • Iliopsoas impingement 
      • periprosthetic fractures
      • THA pseudotumor 
      • aseptic loosening
      • limb length discrepancy
      • sciatic nerve palsy
      • THA trunnionosis 
      • Vascular injury and bleeding 
  • Heterotopic Ossification
    • Introduction
      • frequent radiographic complication but rarely results in functional limitations following hip replacement
      • mild cases with notable symptoms should undergo workup for other potential causes of pain
      • risk factors
        • prolonged surgical time
        • excessive soft tissue handling during procedure
        • hypertrophic osteoarthritis
        • male gender
        • ankylosing spondylitis 
        • history of prior heterotopic ossification at other sites
    • Treatment
      • surgical excision
        • indications
          • severe loss of motion
          • once heterotopic ossification is visible on radiographs, only surgical excision will eradicate
        • technique
          • must wait 6 months after initial procedure to allow for maturation and formation of capsule
          • perioperative prophylaxis with perioperative radiation or NSAIDs
    • Prophylaxis
      • classically oral indomethacin, although various NSAIDs have equivalent efficacy
      • radiation therapy
        • 600-800 cGy administered ideally within 24-48 hours following procedure
  • Squeaking
    • Defined as a high pitched audible sound occurring during hip movement
    • Incidence
      • ceramic-on-ceramic
        • 0.5-10%
      • metal-on-metal
        • 4-5%
      • incidence of revision because of squeaking is 0.5%
    • Risks
      • impingement
      • edge loading
      • component malposition
      • loss of fluid film lubrication
      • third body particles
      • thin, flexible (titanium) femoral stem
  • Postoperative Anemia
    • Low preoperative hemoglobin
      • is the best predictor of the need for a blood transfusion postoperatively
    • Prevention
      • TXA
    • Treatment
      • postoperative transfusion
        • indications
          • most centers have dropped to a hemoglobin of 7-8
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