5 Facts to Reassure You About Hip Replacement Rejection

1 – Don’t confuse organ rejection with replacement rejection

The term “rejection” is used by patients to describe both the rejection of a transplanted organ and the rejection of a hip replacement. But these are two medically and mechanically different situations.

Organ rejection: This is a reaction of the recipient body’s immune system against a transplanted organ, usually because it is perceived as foreign.

This can lead to dysfunction or failure of the transplanted organ (and potentially death) if not treated very quickly.

Replacement rejection : “rejection” is often used to describe the body’s reaction to a prosthesis or medical implant. Unlike organ rejection, this is not an immune response against a foreign object, but rather the body’s reaction to the presence of the prosthesis.

And this manifests itself as inflammation, which can be more severe depending on the individual. This inflammation leads to redness, swelling and pain in the hip area around the prosthesis.

On the contrary, inflammation is a sign that your body is adapting to your prosthesis. Inflammation releases substances into the body that help tissues damaged by the operation to heal.

Even in the event of a major inflammatory reaction, it is extremely rare for the hip prosthesis to have to be removed or replaced.

When a surgeon decides to remove a prosthesis, it is most often in the case of loosening (the replacement is no longer in place), wear, infection or allergy to metals.

2 – It is rare to have to change or remove a replacement

Numerous studies have been carried out to monitor people’s progress in the days, months and years following hip surgery.

Researchers note the frequency with which people need to be operated on again because of a problem with their prosthesis. This is referred toas “replacement revision“, “replacement change” or “replacement revision”.

This hip replacement revision rate is estimated at 8% at 10 years (Karachalios 2018). This means that out of 100 people operated on with a total hip replacement, 8 of them will need a new hip operation within 10 years.

In a sample of 535 patients in the United States, the most frequent reasons for repeat hip surgery were as follows (Kelmer 2021):

• mechanical failure (37%) [see my article: loosening after hip replacement].
• metallosis (21%): when a metal joint prosthesis is in place, friction between metal surfaces can cause the prosthesis to wear, releasing metal particles into the surrounding tissue. This can trigger an inflammatory reaction, leading to long-term problems(several years);
• dislocation or instability (15%) [see my article: dislocation after hip replacement],
• fracture around the prosthesis, often following a fall (10%),
• infection (10%),
• hematoma or poor wound healing (3%),
• pain or unexplained reason (4%).

As you can see, “rejection” of the prosthesis is not listed. Prosthesis revision is sometimes necessary, but this is linked to phenomena that can be described fairly well.

See also: How long does a hip prosthesis last?

3 – In the rare cases where the replacement needs to be replaced, this is on average 8 years after the operation.

In the study I mentioned earlier, the research team also looked at how long it took to change the hip replacement in cases where a problem occurred:

• on average, the replacement was replaced after 8 years;
• less than1 in 3 patients had their prosthesis replaced within 2 years of the first operation.

Conclusion: not only is it uncommon for a hip replacement to require revision (less than 1 in 10 cases), but of these 1 in 10 people, only 1/3 need to have their prosthesis revised within 2 years of their first hip operation.

Source: Kelmer 2021

4 – Pain and swelling are not sufficient symptoms to diagnose “rejection”.

Pain after hip surgery is extremely frequent (not to say systematic) .

Most people need at least a few days’ supply of painkillers of varying strengths. Some will need several weeks of these drugs, even if they don’t like to use them in the first place.

These pains are often associated with swelling and edema of the thigh around the scar, which can also extend down into the knee, leg and foot.

These symptoms are not signs of rejection of your prosthesis.

These are signs of inflammation, which is completely normal after an operation. To fit the prosthesis, your surgeon had to open up and damage tissue.

In order for them to heal naturally, your body reacts with inflammation.

If these pains and swelling worry you, you can of course discuss them with your GP, physiotherapist or surgeon. They will be able to reassure you.

Rarely do these symptoms alone require further tests (blood tests, X-rays) to ensure that all is well, as they are fairly standard and not a sign of prosthesis rejection.

It’s other symptoms , such as pus coming out of the wound, fever, or pain that prevents walking and causes a lot of pain several months after the operation, that (sometimes) require further investigation.

5 – Your attending physician or physiotherapist can reassure you if your surgeon is unavailable.

I know we sometimes feel awkward about reaching out to our surgeon when we’re worried after surgery.

However, you can always call your secretary’s office: the professionals are used to dealing with this type of concern and will be able to tell you what you can do (make an appointment with the surgeon, make an appointment with your GP, or wait for the follow-up x-ray).

If you are unable to contact your surgeon, or if you prefer to seek advice from someone else, you can turn to your GP, physiotherapist or nurse.

These 3 healthcare professionals are familiar with the after-effects of hip replacements. If you have any questions, please feel free to ask them!

And of course, in the event of any sign that might not be typical of the normal evolution of a hip prosthesis, these professionals will know what to do!

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I hope I’ve managed to answer a few of your questions! I’ll be happy to comment on the article if necessary!

If you feel the need to learn more about the recovery period after a hip replacement, I wrote this guide in eBook format:

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You may also be interested in these articles

• Pain relief after hip replacement
• Normal walking after hip replacement: how long does it take?

📚 SOURCES

Kelmer G, Stone AH, Turcotte J, King PJ. Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure. J Am Acad Orthop Surg. 2021 Jan 15;29(2):78-87. doi: 10.5435/JAAOS-D-19-00860. PMID: 32404682.

Karachalios T, Komnos G, Koutalos A. Total hip arthroplasty: Survival and modes of failure. EFORT Open Rev. 2018 May 21;3(5):232-239. doi: 10.1302/2058-5241.3.170068. PMID: 29951261; PMCID: PMC5994632.