Diagnosing Total Joint Implant Complications

Though the risk of a complication after joint implant surgery is small, it can occur. Surgeons at NYU Langone Orthopedic Hospital and NYU Langone Orthopedic Center have the expertise to recognize the signs and symptoms of any problem. Your doctor may diagnose a complication during a follow-up exam, which is typically scheduled 7 to 14 days after you are discharged from the hospital.

However, if you feel or see something unusual—even weeks or years later—our experts recommend that you contact your surgeon as soon as possible. Often, he or she can help you resolve the complication without needing a trip to the emergency room. If you do require immediate care, our experts are available 24 hours a day, 7 days a week to help you.

Joint Implant Infection

If a joint implant becomes infected, you may experience pain and notice fluid that drains from the surgical site. Other classic signs and symptoms of infection include swelling, redness, and fever, in which you have a temperature above 100 degrees. You may also notice sweating, chills, headache, and the sudden onset of fatigue. And you may have increased difficulty moving or putting weight on the affected joint.

Any one of these symptoms requires immediate evaluation by a doctor, who can conduct one or more of the following tests to confirm the presence of an infection.

Blood Test

Your doctor draws a small amount of blood from a vein in your arm, which is sent to a laboratory for testing. A pathologist, a doctor who studies diseases under a microscope, measures the number of white blood cells in your blood. An elevated level suggests an infection. The results of the blood test are usually available in a few days.

Arthrocentesis

In arthrocentesis, doctors remove a small amount of fluid from the joint using a syringe. They send the fluid to a laboratory, where it is tested for bacteria and checked for the number of white blood cells. An elevated white blood cell count may indicate an infection.

To perform arthrocentesis, a doctor first injects a small amount of local anesthetic to numb the skin, then carefully guides a needle into the joint space, where fluid has accumulated. The doctor removes fluid through the needle. Results are typically available in two days, at which time your doctor calls you or meets with you to discuss the results.

MRI Scan

An MRI scan uses magnetic fields and radio waves to create computerized, three-dimensional images of structures in the body. The test can reveal inflammation in the soft tissues surrounding the joint implant, which may suggest an infection.

Blood Clots

There are several warning signs that a blood clot may have developed in a blood vessel. In the leg, a blood clot is called deep vein thrombosis, and it may cause swelling in any part of the calf or thigh; pain or tenderness in the legs, especially when standing or walking; tenderness along a vein, especially near the thigh; and skin that is warm to the touch, red, pale, or discolored.

To diagnose deep vein thrombosis, doctors may use imaging tests, such as ultrasound, to assess blood flow throughout your body and identify a blockage.

A blood clot in the leg may quickly become more serious if it dislodges from a vein, travels to the lungs, and obstructs a blood vessel there. This is called a pulmonary embolism, and it requires immediate care.

Symptoms include coughing up blood; a sharp pain in the lungs or chest; and difficulty breathing, which may cause lightheadedness. To diagnose a pulmonary embolism, doctors may use tests to evaluate the level of oxygen in the blood, measure the electrical activity of your heart, or visualize the veins and lungs using imaging technologies, such as a CT scan.

If you are diagnosed with a blood clot, our orthopedists can refer you to vascular experts at NYU Langone’s Venous Thromboembolic Center (VTEC) for specialized care.

Joint Dislocation

If you experience a sharp pain in and around the joint implant, numbness or tingling in your extremities, and difficulty moving the affected joint, it may have dislocated. This is most common in the hip but can occur in the knee as well.

In a hip dislocation, the ball-shaped component of the joint implant separates from its normal position in the prosthetic hip socket.

If the knee joint dislocates, the prosthetic pieces at the bottom end of the thigh bone separate from the top end of the leg bone.

A dislocated hip or knee requires emergency care. Doctors confirm that a joint is dislocated by evaluating its appearance and range of motion during a physical exam, and by using X-rays to take images of the joint components.

Joint Implant Loosening

Joint implant loosening typically occurs 10 to 20 years or more after surgery. In some instances, friction between the parts of the implant wears away the joint surfaces, creating tiny particles. The body attempts to destroy the particles, and in the process, it may weaken the bond that keeps the implant attached to the bone. Over time, the implant becomes loose and unstable.

Symptoms of loosening include increasing joint pain, stiffness, and a feeling of instability in the affected joint—especially when standing or walking. If the implant moves significantly out of place, you may also notice swelling around the joint or a slight protrusion through the skin. If you experience these symptoms, a doctor can recommend the appropriate imaging tests to determine whether a corrective procedure is necessary.

Neurovascular Injury

Neurovascular injury as a result of implant surgery is uncommon, but nerves and veins are located near every joint in the body and may become compressed or damaged during a procedure. Often, these problems resolve on their own within weeks or months of surgery and don’t require intervention.

Symptoms include tingling or numbness in the area surrounding the implant. If symptoms get worse, you should see a doctor.

MRI Scan

An MRI scan can reveal signs of injury in nerves and blood vessels that may have been damaged as a result of joint implant surgery.

Electromyogram

If you feel tingling or numbness in the area surrounding the joint implant, an electromyogram can reveal whether any nerve damage occurred. An electromyogram measures the electrical impulses transmitted along nerves, nerve roots, and muscle tissue. This test helps doctors determine if there is any nerve damage.

During an electromyogram, a doctor inserts small, thin needles, called electrodes, into muscles that correspond to specific nerves. He or she then asks you to move these muscles one at a time. The signals recorded when each muscle contracts can show the doctor which nerves are affected and whether a nerve injury has caused muscle damage.

This test can be administered in a doctor’s office. Although some people feel uncomfortable with the needles, the test is relatively painless. It usually takes about 15 to 30 minutes to complete.

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