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Hip Replacement Risks and Complications: Dr. Mayur Rabhadiya Explains

Understanding the Risks of Hip Replacement

Total hip replacement can provide substantial relief from pain and improve walking and independence in appropriately selected patients.

However, it is a major surgical procedure and carries potential risks.

Complications may occur:

  • During surgery

  • During the first few days

  • During the early recovery period

  • Several months later

  • Many years after the replacement

Possible complications include:

  • Infection

  • Blood clots

  • Pulmonary embolism

  • Dislocation

  • Fracture

  • Bleeding

  • Wound-healing problems

  • Nerve or blood-vessel injury

  • Leg-length difference

  • Persistent pain

  • Stiffness

  • Implant wear

  • Implant loosening

  • Medical or anaesthetic complications

  • Need for revision surgery

Dr. Mayur Rabhadiya discusses risk according to the individual patient’s medical health, anatomy, diagnosis, surgical complexity and expected benefit.

No surgical approach, implant or robotic system can eliminate every complication.

Patients seeking a broader surgical overview can first visit the page for a hip replacement surgeon in Mumbai.

Normal Recovery Symptoms and Possible Complications

Some discomfort and swelling are expected after surgery.

Common early recovery symptoms may include:

  • Incision soreness

  • Thigh or buttock discomfort

  • Bruising

  • Mild to moderate swelling

  • Temporary weakness

  • Tiredness

  • Reduced appetite

  • Difficulty sleeping

  • Temporary numbness around the scar

These symptoms should generally become more manageable over time.

Possible warning signs include:

  • Rapidly increasing pain

  • Persistent or increasing wound drainage

  • Spreading redness

  • Fever or chills

  • Sudden inability to bear weight

  • New deformity or shortening of the leg

  • Severe calf pain

  • Rapidly increasing leg swelling

  • Sudden breathlessness

  • Chest pain

  • New weakness or loss of sensation

The overall pattern matters. A patient whose pain and mobility are gradually improving is different from a patient whose symptoms suddenly deteriorate.

Infection After Hip Replacement

Infection may involve:

  • The skin and superficial wound

  • Deeper tissues

  • The artificial joint and surrounding bone

An infection may develop:

  • Soon after surgery

  • Several weeks or months later

  • Years after a previously successful replacement

Possible signs include:

  • Persistent fever

  • Chills

  • Increasing wound redness

  • Increasing warmth

  • Wound drainage

  • Recurrent wound breakdown

  • Increasing pain at rest and during activity

  • New stiffness

  • Deterioration in a previously well-functioning hip

The absence of fever does not completely exclude a deep infection.

Diagnosis may require:

  • Clinical examination

  • Blood tests

  • X-rays

  • Joint aspiration

  • Synovial-fluid analysis

  • Bacterial cultures

  • Tissue samples during surgery

A superficial wound problem may sometimes respond to local care and antibiotics. A deep implant infection commonly requires a more extensive treatment plan that may include surgery and targeted antibiotics.

Patients should not self-start leftover antibiotics because this may affect culture results and delay accurate diagnosis.

Reducing Infection Risk

Infection risk cannot be reduced to zero, but several measures may help.

Before surgery, preparation may include:

  • Diabetes optimisation

  • Treatment of active skin infection

  • Assessment of significant dental infection

  • Review of urinary symptoms

  • Smoking cessation

  • Nutrition assessment

  • Treatment of anaemia

  • Weight management where appropriate

  • Review of immunosuppressive medicines

  • Appropriate skin preparation

  • Antibiotics around the time of surgery

After surgery, patients should:

  • Keep the dressing and wound clean

  • Follow bathing instructions

  • Avoid applying unapproved products

  • Avoid scratching the incision

  • Report drainage or redness

  • Take antibiotics only as prescribed

  • Attend scheduled wound reviews

Patients should review the complete guide to preparing for hip replacement surgery.

Deep-Vein Thrombosis

Deep-vein thrombosis, or DVT, is a blood clot that develops in a deep vein, commonly in the calf, thigh or pelvis.

Possible symptoms include:

  • Calf pain unrelated to the incision

  • Calf tenderness

  • Increasing leg swelling

  • Redness or warmth

  • One leg becoming noticeably more swollen

Some blood clots cause few symptoms.

Blood-clot prevention may include:

  • Blood-thinning medicine

  • Early mobilisation

  • Ankle-pump exercises

  • Mechanical compression devices

  • Compression stockings in selected patients

  • Adequate hydration

  • Avoiding prolonged immobility

The medicine and duration should be selected according to the patient’s clotting and bleeding risks.

Patients should not stop blood-thinning medicine early because bruising or mild swelling develops without first obtaining medical advice.

Pulmonary Embolism

A pulmonary embolism occurs when part of a blood clot travels to the lungs.

Possible warning signs include:

  • Sudden shortness of breath

  • Sudden chest pain

  • Chest pain that worsens while breathing or coughing

  • Rapid heartbeat

  • Faintness

  • Coughing blood

  • Unexplained severe weakness

These symptoms require urgent medical assessment.

A pulmonary embolism should not be managed by waiting for a routine clinic appointment.

Hip Replacement Dislocation

Dislocation occurs when the artificial femoral head comes out of the socket.

The risk is generally greatest during the early recovery period while soft tissues are healing, but dislocation can also occur later.

Possible symptoms include:

  • Sudden severe hip or groin pain

  • Inability to stand

  • Inability to move the leg normally

  • A visibly shortened or rotated leg

  • A popping or slipping sensation followed by loss of function

Dislocation risk may be influenced by:

  • Component position

  • Surgical approach

  • Soft-tissue repair

  • Hip offset

  • Femoral-head size

  • Muscle weakness

  • Previous surgery

  • Spine and pelvic mechanics

  • Falls

  • Extreme movement combinations

A first dislocation may sometimes be treated by returning the hip to its socket without open surgery.

Repeated dislocation may require further investigation and revision surgery.

Can Dislocation Be Completely Prevented?

No technique can make a hip replacement completely dislocation-proof.

Robotic assistance may help the surgeon reproduce a planned component position, while conventional surgery uses templating, anatomical landmarks and intraoperative assessment. Neither method can eliminate instability caused by muscle weakness, soft-tissue damage, falls, spinal stiffness or inappropriate movement.

Patients may be advised to follow temporary precautions involving:

  • Deep bending

  • Crossing the legs

  • Twisting

  • Low seating

  • Specific sleeping positions

  • Certain combinations of movement

The precautions depend on the surgical approach, component stability and individual risk.

Generic precautions should not replace the instructions provided by the operating surgeon.

Fracture During or After Hip Replacement

A fracture may occur:

  • During implantation

  • During early recovery

  • After a fall

  • Years later around an implant

Risk may be affected by:

  • Osteoporosis

  • Poor bone quality

  • Severe deformity

  • Previous surgery

  • Cementless implant insertion

  • Implant loosening

  • Trauma

A small stable fracture recognised during surgery may sometimes be treated immediately with fixation or a change in implant.

A fracture occurring later around the replacement is called a periprosthetic fracture.

Treatment depends on:

  • Fracture location

  • Implant stability

  • Bone quality

  • Degree of displacement

  • Remaining bone stock

Some fractures can be fixed while retaining the implant. Others require fixation combined with revision of a loose component.

Sudden pain and inability to bear weight after a fall require urgent assessment.

Nerve Injury

Nerves around the hip may be stretched, compressed or injured during surgery.

Possible effects include:

  • Numbness

  • Tingling

  • Weakness

  • Foot drop

  • Burning or electric pain

  • Altered sensation around the thigh

Temporary numbness close to the incision is different from a major motor-nerve injury.

The likelihood of nerve injury may be influenced by:

  • Severe deformity

  • Previous surgery

  • Scar tissue

  • Significant limb-length correction

  • Complex revision surgery

  • Pre-existing neurological disease

Some nerve symptoms improve gradually, while others may persist.

New significant weakness or foot drop requires clinical assessment.

Blood-Vessel Injury and Bleeding

Major blood-vessel injury is uncommon but can be serious.

Bleeding during or after surgery may lead to:

  • Bruising

  • Swelling

  • Reduced haemoglobin

  • Dizziness

  • Fatigue

  • Need for transfusion

  • Rarely, further intervention

Bleeding risk may be affected by:

  • Blood-thinning medicines

  • Anaemia

  • Clotting disorders

  • Revision surgery

  • Complex anatomy

  • Vascular disease

Blood-conservation measures may include:

  • Careful surgical technique

  • Tranexamic acid where appropriate

  • Review of blood-thinning medicines

  • Treatment of preoperative anaemia

  • Postoperative monitoring

A blood transfusion is not required routinely, but it cannot be ruled out in every patient.

Wound-Healing Problems

Possible wound problems include:

  • Persistent drainage

  • Skin-edge separation

  • Blistering

  • Delayed healing

  • Superficial infection

  • Haematoma

  • Tissue breakdown

Risk may be higher with:

  • Diabetes

  • Smoking

  • Severe obesity

  • Poor nutrition

  • Steroid use

  • Poor circulation

  • Previous scars

  • Revision surgery

  • Significant swelling

Persistent wound drainage should be reported promptly because it may increase concern about deeper infection.

Patients should not repeatedly remove dressings or apply antiseptic, powder, herbal products or ointments unless instructed.

Leg-Length Difference

After hip replacement, one leg may feel longer or shorter.

Possible explanations include:

  • True change in limb length

  • Pelvic tilt

  • Long-standing hip contracture

  • Spinal curvature

  • Knee deformity

  • Muscle weakness

  • The body adapting to corrected hip position

The surgeon aims to restore suitable length while maintaining hip stability.

In some cases, a small length difference may be accepted because excessive shortening could increase instability.

Perceived inequality during early recovery may improve as:

  • Muscles strengthen

  • Pelvic posture adjusts

  • Hip contracture resolves

  • Walking becomes more symmetrical

Persistent clinically important inequality may require assessment. A shoe lift may help selected patients.

Perfect equality cannot be guaranteed by robotic or conventional surgery.

Persistent Pain After Hip Replacement

Many patients experience substantial pain relief, but a small proportion continue to have discomfort.

Possible causes include:

  • Infection

  • Implant loosening

  • Fracture

  • Instability

  • Iliopsoas irritation

  • Gluteal tendon disease

  • Trochanteric pain

  • Nerve irritation

  • Lumbar spine disease

  • Knee disease

  • Muscle weakness

  • Implant-related mechanical problems

  • Pain sensitisation

Pain during the first weeks is not equivalent to persistent long-term pain.

Evaluation may include:

  • Symptom history

  • Examination

  • Comparison of serial X-rays

  • Blood tests

  • Joint aspiration

  • CT or MRI in selected cases

Revision surgery should not be performed until the likely pain source has been identified.

Stiffness and Restricted Movement

Hip movement generally improves after replacement, but complete unrestricted movement cannot be guaranteed.

Persistent stiffness may relate to:

  • Severe preoperative stiffness

  • Scar formation

  • Muscle tightness

  • Pain

  • Poor rehabilitation

  • Component position

  • Spine or pelvic disease

  • Heterotopic ossification

Heterotopic ossification means that bone forms within soft tissues around the hip.

Small areas may cause no symptoms. More extensive formation may restrict movement.

Treatment depends on the severity and effect on function.

Patients should not force the hip into deep or painful positions in an attempt to regain movement rapidly.

Implant Loosening and Wear

Hip implants are exposed to repeated loading during daily activity.

Over time, the bearing surfaces may wear and the implant may loosen.

Loosening may cause:

  • Increasing groin pain

  • Thigh pain

  • Pain while walking

  • Reduced function

  • Implant migration on X-rays

  • Bone loss around the implant

Wear particles may stimulate bone loss around the components. This process is called osteolysis.

Implant wear and loosening often develop over years rather than during early recovery.

Regular review may be useful because bone loss can occasionally progress before severe pain develops.

Painful loosening or substantial bone loss may require revision hip replacement in Mumbai.

Medical and Anaesthetic Complications

Hip replacement can also be associated with complications not limited to the hip itself.

Possible medical complications include:

  • Heart attack

  • Stroke

  • Irregular heart rhythm

  • Lung complications

  • Urinary retention

  • Urinary infection

  • Kidney dysfunction

  • Delirium

  • Medication reaction

  • Nausea and vomiting

  • Constipation

  • Pressure injury

  • Worsening of an existing medical condition

Risk is influenced by:

  • Age

  • Frailty

  • Heart and lung disease

  • Diabetes

  • Kidney disease

  • Anaemia

  • Previous stroke

  • Sleep apnoea

  • Medicine use

  • Surgical complexity

Medical optimisation reduces avoidable risk but cannot eliminate every possible complication.

Falls During Recovery

A fall can cause:

  • Dislocation

  • Fracture

  • Wound injury

  • Head injury

  • Loss of confidence

  • Need for further surgery

Fall prevention may include:

  • Using the prescribed walker or stick

  • Removing loose rugs

  • Improving lighting

  • Using stair handrails

  • Avoiding slippery floors

  • Wearing supportive footwear

  • Standing slowly

  • Asking for assistance when needed

  • Avoiding sedating medicines beyond their prescribed use

Patients should not discontinue their walking aid simply because another patient stopped using one earlier.

The aid should be continued until walking and balance are safe.

Factors That May Increase Complication Risk

Risk may be increased by:

  • Poorly controlled diabetes

  • Active infection

  • Smoking or nicotine use

  • Severe obesity

  • Poor nutrition

  • Anaemia

  • Heart or lung disease

  • Kidney disease

  • Immunosuppressive medicines

  • Long-term steroid use

  • Previous hip surgery

  • Poor bone quality

  • Severe deformity

  • Previous blood clots

  • Frailty

  • Inadequate support at home

Having a risk factor does not mean that a complication will occur.

It means the patient may require:

  • Additional counselling

  • Medical optimisation

  • Modified surgical planning

  • More intensive monitoring

  • A different discharge pathway

Risk assessment should be individualised rather than based on one isolated number.

Does Robotic Surgery Remove Hip-Replacement Risks?

No.

Robotic-assisted hip replacement may provide computer-based planning, digital measurements and controlled guidance during selected steps. It does not eliminate infection, blood clots, dislocation, fracture, nerve injury, bleeding, wound problems or medical complications.

Conventional hip replacement also remains an established procedure and can achieve appropriate component placement using templating, anatomical landmarks and surgical assessment.

The overall complication risk is influenced by the complete clinical pathway, not by the presence or absence of a robot alone.

Read the detailed comparison of robotic versus conventional hip replacement.

Primary and Revision Surgery Risks

Primary hip replacement inserts an artificial hip for the first time, while revision surgery treats a problem involving an existing implant.

Revision surgery commonly carries greater complexity because it may require:

  • Implant removal

  • Scar-tissue management

  • Bone reconstruction

  • Infection treatment

  • Fracture fixation

  • Specialised implants

  • Longer operating time

The risk of infection, fracture, dislocation, blood loss and further revision may therefore be higher in complex revision procedures.

The individual risk depends on the reason for revision and the extent of reconstruction.

When Is Revision Surgery Required?

Revision surgery may be considered for:

  • Deep implant infection

  • Painful implant loosening

  • Recurrent dislocation

  • Periprosthetic fracture

  • Significant bearing wear

  • Progressive bone loss

  • Implant breakage

  • Severe mechanical failure

  • Persistent pain from a correctable implant-related cause

Not every abnormal X-ray or episode of pain requires revision.

The decision should consider:

  • Symptoms

  • Function

  • Implant stability

  • Infection investigations

  • Bone loss

  • Medical health

  • Expected benefit

  • Risk of continued observation

Warning Signs Requiring Prompt Assessment

Seek prompt medical attention for:

  • Persistent fever or chills

  • Increasing wound redness

  • Wound drainage

  • Rapidly increasing hip pain

  • Sudden inability to stand

  • Sudden shortening or rotation of the leg

  • Severe calf pain

  • Rapidly increasing leg swelling

  • New chest pain

  • Sudden breathlessness

  • Coughing blood

  • New foot weakness

  • A fall onto the operated hip

  • A popping event followed by severe pain

Suspected pulmonary embolism, dislocation, fracture or severe infection may require emergency assessment.

Frequently Asked Questions

Is hip replacement a high-risk operation?

It is a major operation with recognised risks, but many patients undergo it without a serious complication. Individual risk depends on health and surgical complexity.

What is the most serious complication?

Deep infection, pulmonary embolism, major fracture and serious medical complications can be significant. No single complication is the most likely for every patient.

How do I know whether pain after surgery is normal?

Expected postoperative soreness should gradually improve. Rapidly worsening pain, wound drainage, fever or sudden loss of walking ability requires assessment.

How do I recognise an infection?

Warning signs include persistent fever, chills, increasing redness, swelling, drainage and worsening pain at rest or during activity.

Can infection occur years later?

Yes. Deep implant infection may occasionally develop long after the original surgery.

What are the signs of a blood clot?

Possible signs include calf pain, tenderness, redness and new or increasing swelling.

What are the signs of pulmonary embolism?

Sudden breathlessness, chest pain, rapid heartbeat, faintness or coughing blood require urgent assessment.

How can blood clots be prevented?

Prevention may include blood-thinning medicine, early walking, ankle exercises, compression devices and avoiding prolonged immobility.

What does hip dislocation feel like?

It commonly causes sudden severe pain, inability to move or bear weight, and possible shortening or rotation of the leg.

Does one dislocation require revision surgery?

Not always. A first dislocation may sometimes be managed without open surgery after assessing the cause.

Can robotic surgery prevent dislocation?

No. It may assist component planning but cannot eliminate all causes of instability.

Can hip replacement cause nerve damage?

Yes, although major nerve injury is uncommon. Symptoms may include numbness, weakness, tingling or foot drop.

Why does one leg feel longer after surgery?

The cause may be a true length change, pelvic tilt, muscle weakness, spinal deformity or adaptation to corrected hip position.

Will a leg-length difference improve?

A perceived difference may improve as posture, strength and walking normalise. Persistent inequality should be assessed.

Why do some patients continue to have pain?

Possible causes include infection, loosening, tendons, nerves, the spine, muscle weakness or another joint condition.

Can a hip implant become loose?

Yes. Loosening may develop over time because of wear, bone loss, infection or fixation problems.

Does every complication require another operation?

No. Treatment depends on the complication, severity, implant stability and response to non-surgical management.

When should I go to an emergency department?

Seek emergency assessment for sudden breathlessness, chest pain, suspected dislocation, inability to bear weight after a fall or rapidly worsening severe symptoms.

About Dr. Mayur Rabhadiya

Dr. Mayur Rabhadiya is an Orthopedic & Joint Replacement Surgeon in Mumbai.

His qualifications include:

  • MBBS from LTMMC & GH, Sion Hospital

  • D’Ortho from KMC, Hubli

  • DNB Orthopedics from the National Board of Examinations, New Delhi

  • MNAMS Orthopedics

  • Fellowship in Robotic & Computer-Navigated Joint Replacement

His approach to hip replacement risk is patient-specific and transparent.

Patients are counselled about expected benefits, preventable risk factors, recognised complications, warning signs and the possibility that additional treatment may be required.

No implant, surgical approach or robotic platform is presented as eliminating all complications.

Last medically reviewed: June 2026.

Book a Hip Replacement Consultation or Postoperative Assessment

Patients considering hip replacement or experiencing unexpected symptoms after surgery can consult Dr. Mayur Rabhadiya at Ghatkopar East or Ghatkopar West, Mumbai.

Call +91 84249 03913 or +91 96113 30063.

Appointments can also be requested through the orthopedic doctor consultation page.

Seek emergency medical assessment rather than waiting for a clinic appointment when symptoms include sudden breathlessness, chest pain, severe pain with deformity, inability to bear weight or rapidly worsening illness.

Medical References

This patient-education page is informed by current guidance and educational material from:

  • American Academy of Orthopaedic Surgeons

  • National Institute for Health and Care Excellence

  • National Health Service

Medical Disclaimer

This information is intended for general patient education and does not replace examination, investigation or personalised advice from the treating surgeon.

Complication risk depends on the procedure, surgical complexity, medical health, infection risk, medicines, bone quality, rehabilitation and individual recovery. The operating surgeon’s postoperative instructions take priority over general online guidance.

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