What is a hip replacement?
Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.
Who should have hip replacement surgery?
People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or vascular necrosis, which is the death of bone caused by insufficient blood supply), injury, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people are typically less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.
Today, a person's overall health and activity level are more important than age in predicting the success of a hip replacement. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinsons disease or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. People who are at high risk for infections or who are in poor health are less likely to recover successfully. Therefore, they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occur tend to recover more easily and have better outcomes.
Why do people have hip replacement surgery?
For the majority of people who have hip replacement surgery, the procedure results in:
decreased pain
increased mobility
improvements in daily activities
improved quality of life
What are the alternatives to hip replacement?
Before considering a total hip replacement, the doctor may try other methods of treatment, such as exercise, walking aids, and medication. An exercise program can strengthen the muscles around the hip joint. Walking aids such as canes and walkers may alleviate some of the stress from painful, damaged hips and help you to avoid or delay surgery.
For hip pain without inflammation, doctors usually recommend the analgesic medication acetaminophen.
For hip pain with inflammation, treatment usually consists of no steroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen (Motrin, Advil). If you need to take NSAIDs on a long-term basis or at doses that are higher than those obtainable over the counter, you should do so only under a doctor's supervision. When neither NSAIDs nor analgesics are sufficient to relieve pain, doctors sometimes recommend combining the two. Again, this should be done only under a doctor's supervision.
In some cases, a stronger analgesic medication such as Tramadol or a product containing both acetaminophen and a narcotic analgesic such as codeine may be necessary to control pain.
Topical analgesic products such as Capsaicin and methylsalicylate may provide additional relief. Some people find that the nutritional supplement combination of glucosamine and chondroitin helps ease pain. People taking nutritional supplements, herbs, and other complementary and alternative medicines should inform their doctors to avoid harmful drug interactions.
In a small number of cases, doctors may prescribe corticosteroid medications, such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteroids reduce joint inflammation and are frequently used to treat rheumatic diseases such as rheumatoid arthritis. The downside of corticosteroids is that they can cause further damage to the bones in the joint. Also, they carry the risk of side-effects such as increased appetite, weight gain, and lower resistance to infections. A doctor must prescribe and monitor corticosteroid treatment. Because corticosteroids alter the bodys natural hormone production, which is essential for the body to function, you should not stop taking them suddenly, and you should follow the doctors instructions for discontinuing treatment.
Sometimes, corticosteroids are injected into the hip joint. A joint lubricant such as Hyaluronan may also be injected into the hip joint to relieve pain.
If exercise and medication do not relieve pain and improve joint function, the doctor may suggest a less complex corrective surgery before proceeding to hip replacement. One common alternative to hip replacement is an Osteotomy. This procedure involves cutting and realigning bone, to shift the weight from a damaged and painful bone surface to a healthier one. Recovery from an Osteotomy takes 6 to 12 months. Afterward, the function of the hip joint may continue to worsen and additional treatment may be needed. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure.
What does hip replacement surgery involve?
The hip joint is located where the upper end of the femur, or thigh bone, meets the pelvis, or hip bone. A ball at the end of the femur, called the femoral head, fits in a socket (the acetabulum) in the pelvis to allow a wide range of motion.
During a traditional hip replacement, which lasts from 1 to 2 hours, the surgeon makes a 6- to 8-inch incision over the side of the hip through the muscles and removes the diseased bone tissue and cartilage from the hip joint, while leaving the healthy parts of the joint intact. Then the surgeon replaces the head of the femur and acetabulum with new, artificial parts. The new hip is made of materials that allow a natural gliding motion of the joint.
In recent years, some surgeons have begun performing what is called a minimally invasive, or mini-incision, hip replacement, which requires smaller incisions and a shorter recovery time than traditional hip replacement. Candidates for this type of surgery are usually age 50 or younger, of normal weight based on body mass index, and healthier than candidates for traditional surgery. Joint resurfacing is also being used.
Regardless of whether you have traditional or minimally invasive surgery, the parts used to replace the joint are the same and come in two general varieties: cemented and incremented.
Cemented parts are fastened to existing, healthy bone with a special glue or cement. Hip replacement using these parts is referred to as a cemented procedure. Uncemented Incremented parts rely on a process called biologic fixation, which holds them in place. This means that the parts are made with a porous surface that allows your own bone to grow into the pores and hold the new parts in place. Sometimes a doctor will use a cemented femur part and uncemented acetabular part. This combination is referred to as a hybrid replacement.
Is a cemented or uncemented prosthesis better?
The answer to this question is different for different people. Because each person's condition is unique, you and your doctor must weigh out the advantages and disadvantages.
Cemented replacements are more frequently used for older, less active people and people with weak bones, such as those who have osteoporosis, while uncemented replacements are more frequently used for younger, more active people.
Studies show that cemented and uncemented prostheses have comparable rates of success. Studies also indicate that if you need an additional hip replacement, or revision, the rates of success for cemented and uncemented prostheses are comparable. However, more long-term data are available in the United States for hip replacements with cemented prostheses, because doctors have been using them here since the late 1960s, whereas uncemented prostheses were not introduced until the late 1970s.
The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, a person with uncemented replacements must limit activities for up to 3 months to protect the hip joint. Also, it is more common for someone with an uncemented prosthesis to experience thigh pain in the months following the surgery, while the bone is growing into the prosthesis.
How to prepare for surgery and recovery
People can do many things before and after they have surgery to make everyday tasks easier and to help speed their recovery.
Before Surgery
Learn what to expect. Request information written for patients from the doctor, or contact one of the organizations listed near the end of this booklet.
Arrange for someone to help you around the house for a week or two after coming home from the hospital.
Arrange for transportation to and from the hospital.
Set up a recovery station at home. Place the television remote control, radio, telephone, medicine, tissues, wastebasket, and pitcher and glass next to the spot where you will spend the most time while you recover.
Place items you use every day at arm level to avoid reaching up or bending down.
Stock up on kitchen supplies and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily.
After Surgery
Follow the doctors instructions.
Work with a physical therapist or other health-care professional to rehabilitate your hip.
Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.
Use a long-handled reacher to turn on lights or grab things that are beyond arms length. Hospital personnel may provide one of these or suggest where to buy one.
What can be expected immediately after surgery?
You will be allowed only limited movement immediately after hip replacement surgery. When you are in bed, pillows or a special device are usually used to brace the hip in the correct position. You may receive fluids through an intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid, and a type of tube called a catheter may be used to drain urine until you are able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.
The day after surgery or sometimes on the day of surgery, therapists will teach you exercises to improve recovery. A respiratory therapist may ask you to breathe deeply, cough, or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.
As early as 1 to 2 days after surgery, you may be able to sit on the edge of the bed, stand, and even walk with assistance.
While you are still in the hospital, a physical therapist may teach you exercises such as contracting and relaxing certain muscles, which can strengthen the hip. Because the new, artificial hip has a more limited range of movement than a natural, healthy hip, the physical therapist also will teach you the proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to your new hip.
How long are recovery and rehabilitation?
Usually, people do not spend more than 3 to 5 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, your overall health, and the success of your rehabilitation.
What are possible complications of hip replacement surgery?
According to the American Academy of Orthopedics Surgeons, more than 235,000 total hip replacements are performed each year in the United States and more than 90 percent of these do not require revision.
New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.
The most common problem that may arise soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest.
The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation. Less common complications of hip replacement surgery include infection, blood clots, and heterotypic bone formation (bone growth beyond the normal edges of bone). Studies are also looking at the use of bisphosphonates, ciprofloxacin, pentoxifylline, and other medications to prevent this bone resorption around the implants.
When is revision surgery necessary?
Hip replacement is one of the most successful orthopedics surgeries performed. Studies have shown that more than 90 percent of people who have hip replacement surgery will never need to replace an artificial joint. However, because more people are having hip replacements at a younger age, and wearing away of the joint surface becomes a problem after 15 to 20 years, replacement of an artificial joint, which is also known as revision surgery, is becoming more common. It is more difficult than first-time hip replacement surgery, and the outcome is generally not as good, so it is important to explore all available options before having additional surgery.
Doctors consider revision surgery for two reasons: if medication and lifestyle changes do not relieve pain and disability, or if x-rays of the hip show damage to the bone around the artificial hip that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces, or joint loosening shows up on an x ray. Other possible reasons for revision surgery include fracture, dislocation of the artificial parts, and infection.
What types of exercise are most suitable for someone with a Total Hip Replacement?
Proper exercise can reduce stiffness and increase flexibility and muscle strength. People who have an artificial hip should talk to their doctor or physical therapist about developing an appropriate exercise program. Most of these programs begin with safe range-of-motion activities and muscle-strengthening exercises. The doctor or therapist will decide when you can move on to more demanding activities. Many doctors recommend avoiding high-impact activities, such as basketball, jogging, and tennis. These activities can damage the new hip or cause loosening of its parts. Some recommended exercises are walking, stationary bicycling, swimming and cross-country skiing. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.
What hip replacement research is being done?
To increase the chance of surgical success and decrease the risk of complications and prosthesis failure, researchers are working to develop new surgical techniques, more stress-resistant materials, and improved prosthesis designs. They are also studying ways to reduce the bodys inflammatory response to the artificial joint components. Researchers are also studying gender and ethnic discrepancies in those who have the procedure and characteristics that make some people more likely to have successful surgery.
Total Knee Replacement Surgery
A painful knee can severely affect your ability to lead a full active life. Over the last 25 years, major advancements in artificial knee replacement have greatly improved the outcome of surgery. Artificial knee replacement surgery is becoming more and more common as the population of the world begins to age.
Causes For Knee Joint Replacement
There are many conditions that result in degeneration of the knee joint. Osteoarthritis is the most common cause for patients who have knee replacement surgery. Osteoarthritis is commonly referred to as "wear and tear arthritis". Osteoarthritis can occur with no previous injury to the knee joint - the knee simply "wears out". Some people may have a genetic tendency that increases their chances of developing osteoarthritis.
The major problem in osteoarthritis is that the cartilage (the articular cartilage) on the surface of the bone inside the joint wears away. Once the slick protective surface of the articular cartilage is worn away, the results is bone rubbing against bone. Bone rubbing against bone is painful.
Fractures of the knee, torn cartilage, and torn ligaments can cause the knee joint to function abnormally. This abnormal function can lead to excessive wear and tear of the joint many years after the injury - just like an out-of-balance tire can wear out too soon.
Symptoms
The symptoms of a degenerative knee joint usually begin as pain while bearing weight on the affected knee, such as when walking. You may start to limp. The knee may become swollen with fluid. The range of motion of the affected knee can be effected. The knee will bend less than normal and may lose its ability to completely straighten out. Bone spurs will usually develop and can be seen on xray. Finally, as the condition worsens, you may feel pain may almost all of the time. Pain may even keep you awake at night.
Diagnosis
The diagnosis of a degenerative knee joint starts with a complete history and physical examination by your surgeon. Xrays are required to determine the how bad your knee joint has become. Xrays may help suggest a cause for the degeneration in your knee. Other tests may be required if your surgeon thinks that other conditions may be adding to the degenerative process. Blood tests can rule out systemic arthritis, such as rheumatoid arthritis, or an infection in the knee.
Medical Treatment
Not all degenerative knee conditions require a knee replacement as a first treatment. Your doctor may suggest several alternative treatments to put off replacing the knee as long as possible. Using a cane may help relieve some of your pain and allow you to walk more comfortably. Anti-inflammatory medicinces may reduce the inflammation from the arthritis and reduce pain.
Surgery
Most degenerative problems will eventually require replacement of the painful knee with an artificial knee joint, called a prosthesis. The decision to proceed with surgery should be made by you, your family, and your doctor and only after you feel that you understand as much as possible about the surgery and recovery process.
Once the decision to have surgery is made, there are several things that may need to be done. Your orthopedic surgeon may suggest a complete physical examination by your medical or family doctor. This is to ensure that you are in the best possible condition to undergo the operation. You may also need to spend time with the physical therapist who will be managing your rehabilitation after the surgery. The therapist will begin the teaching process before the surgery to ensure that you are ready for the rehabilitation afterwards.
One purpose of the pre-operative visit with the physicial therapists is to record baseline information. This includes measurements of your current pain levels, what you are able to do, how much swelling you have in the knee, and the amount of movement and strength of each knee.
A second purpose of the pre-operative visit is to prepare you for surgery. Youll begin practicing some of the exercises you will use right after surgery. You will also be trained in how to use a walker or crutches. Whether or not your surgeon used a cemented or noncemented type knee prosthesis will determine how much weight you will be able to place on your foot while walking. Finally, an assessment will be made of any special needs you will have once you return home.
Finally, you may be asked to donate blood before the operation. Blood can be donated 3 to 5 weeks before surgery. Your body will make new blood to replace the donated blood. If you need to have a blood transfusion at the time of surgery, you will receive your own blood.
The Artificial Knee Joint, called a prosthesis
There are two main types of artificial knee replacements:
Cemented Prosthesis
Uncemented Prosthesis
Both types are widely used. In many cases, a combination of the two types are used. The kneecap, or patellar, portion of the prosthesis is usually cemented into place. The choice to use a cemented or uncemented prosthesis is usually made by the surgeon based on your age and lifestyle, and your surgeon's experience.
Each prosthesis has four parts:
The tibial component replaces the end of the tibia. The tibia is commonly called the shinbone.
The femoral component replaces the end of the femur, the groove where the kneecap slides. The femur is commonly called the thighbone. It is the largest bone in the body.
The patellar component replaces the surface on bottom of the patella. The "top" of the kneecap is the part you can feel through your skin. The "bottom" is the on the other side, and slides up and down in the femoral groove whenever you bend or straighten your leg.
The femoral component is made of metal. The tibial component is usually made of two parts - a metal tray that is fitted directly onto the bone, and a plastic spacer that provides a bearing surface. The plastic used is very tough and very slick - so slick and tough that you could ice skate on a sheet of the plastic without much damage to the plastic.
A cemented prosthesis is held in place using an epoxy type cement that attaches the metal to the bone. An uncemented prosthesis has a fine mesh of holes on the surface that allows the bone to grow into the mesh and attaches the prosthesis to the bone.
Rehabilitation
While you are in the hospital:
Range of Motion exercises
Walking
Exercises for strength and flexibility
The physical therapist will schedule your first visit soon after surgery. Therapy will focus on the range of motion in the knee. Gentle movement will be used to help you begin bending and straightening of the knee. If your surgeon recommends a continuous passive motion (CPM) machine, it will be adjusted for your knee. Next, youll go over your exercise regimen. When you are stabilized, your therapist will assist you up for a short walk using crutches or a walker. Physicial therapy will continue once or twice a day. You will be on your way home when you can safely:
get into and out of bed,
walk up to 75 feet with crutches or a walker,
go up and down a flight of stairs, and
get to the bathroom.
It is also important that you have good contraction of the upper thigh muscle, called the quadriceps, and that the range of motion of your knee is improved.
After you leave the hospital:
Once your are at home, the physicial therapist will likely come to your home for treatment. This is to ensure you are safe in and around your home. Your therpist will probably see you for at least one safety check visit and to go over your exercise program again. You may need as many as three visits at home before beginning outpatient physical therapy.
As you progress:
Once you beging outpatient physical therapy, several key areas will be addressed. Your therapist may choose one or more treatments, such as heat, ice, or electrical stimulation, to help reduce any persistent swelling or pain. Continue to use your walker or crutches. If you had a cemented prosthesis, you can increase the amount of weight you place on your sore leg until you feel uncomfortable. If you had a noncemented prosthesis, place only your toes down until your doctor or therapist allows you to increase the amount of weight you can bear.
Range of motion exercises will help you regain full bending and straightening of your knee. Your exercise program will include strengthening, balance, endurance, and functional activities. Your strengthening program will focus on key muscle groups in the buttocks and hips, thigh, and calf muscles. When you are allowed full weight bearing, several balance exercises will be used to further stabilize your knee. Endurance can be achieved by riding a stationary bike, swimming laps, and using an upper body ergometer (upper cycle). Finally, you will be taugh a special group of exercises that simulate your day-to-day activities, like going up and down steps, squatting, raising up on your toes, and bending down. Later, specific exercises may be chosen to simulate the physical demands of your work or hobby.
Complications Of Total Knee Replacement:
As with all major surgical procedures, complications can occur. The most common complications following knee replacement are:
Thrombophlebitis
Infection in the joint
Stiffness of the joint
Loosening of the joint
This is not intended to be a complete list of the possible complications, but these are the most common.
Thrombophlebitis:
Thrombophlebitis, sometimes called Deep Venous Thrombosis (DVT), can occur after any operation. It is more likely to occur following surgery on the hip, pelvis, or knee. DVT occurs when the blood in the large veins of the leg forms blood clots within the veins. This may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart they can travel to the lung. Once in the lung they get lodged in the capillaries of the lung and cut off the blood supply to a portion of the lung. This is called a pulmonary embolism. Pulmonary means "lung". An embolism is a fragment of something traveling through the vascular system. Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving around as soon as possible!
Some of the commonly used preventative measures include:
Pressure stockings to keep the blood in the legs moving.
Medications that thin the blood and prevent blood clots from forming.
Infection:
Infection can be a very serious complication following an artificial joint. The chance of getting an infection following total hip replacement is probably around 1 in 100 total hip replacements. Some infections may show up very early - before you leave the hospital. Others may not show up for months, or even years, after the operation.
Also, an infection can spread into the artificial joint from other infected areas. Your surgeon may want to make sure that you take antibiotics when you have dental work, or surgical procedures on your bladder or colon to reduce the risk of spreading germs to your new joint.
Stiffness:
In some cases, the ability to bend the knee does not return to normal after an artificial knee replacement. Many orthopedic surgeons are now using a machine known as a CPM machine (Constant Passive Motion) immediately after surgery to try and increase the range of motion following artificial knee replacement. Other orthopedic surgeons rely on physical therapy beginning immediately after the surgery to regain the motion. It is not clear which is the best approach. Both approaches have benefits and risks, and the choice is usually made by the surgeon based on his experience and preferences.
To be able to use the leg effectively to rise from a chair, the knee must bend at least to 90 degrees. A desirable range of motion should be greater than 110 degrees. Balancing of the ligaments and soft tissues (during surgery) is the most important determining factor in regaining an adequate range of motion following knee replacement, but sometimes increasing scarring after surgery can lead to an increasingly stiff knee. If this occurs, your surgeon may recommend taking you back to the operating room, placing you under anesthesia once again, and forcefully manipulating the knee to regain motion. Basically, this allows the surgeon to breakup and stretch the scar tissue without you feeling it. The goal is to increase the motion in the knee without injuring the joint
Loosening:
The major reason that artificial joints eventually fail continues to be loosening of the joint where the metal or cement meets the bone. There have been great advances in extending the life of an artificial joint. Still, most joints will eventually loosen and require a revision. Hopefully, you can expect 12-15 years of service from your artificial knee. In some cases the knee will loosen earlier than that. Just like your diseased knee, a loose joint causes pain. Once the pain becomes unbearable, another operation will probably be required to replace the knee.
Spinal Surgery for Fractured Vertebrae:
In older people with soft or brittle bones (osteoporosis), the bones of the spine (vertebrae) sometimes fracture or collapse. This causes pain and a "hunchback" appearance that get worse as time goes on. Certain forms of cancer also weaken the vertebrae and cause the same problems. A relatively new treatment for these conditions is a type of spinal surgery called "kyphoplasty" (ki'-fo-plass-tee).
What is the surgical procedure?
Kyphoplasty requires only two small incisions in the back. You can usually go home the same day. You may receive a general anaesthetic. This means that you will be completely unaware of what's going on. Or you may have an intravenous local anaesthetic. This numbs only the area of the surgery. Your surgeon or the anesthesiologist will discuss which is best for your case.
The surgery is performed on your back. You will lie face down on the operating table. The surgeon will make two small cuts, insert tubes through the openings, and then push tiny balloons through the tubes into the fractured vertebrae. The surgeon uses an X-ray machine to track the progress of the balloons.
When the balloons are in place, they are gently inflated. This pushes the bones back toward their normal height and shape. Pushing the vertebrae up leaves cavities within the bones. After removing the balloons, the surgeon use bone cement to fill the cavities. The tubes are removed as soon as the cement has hardened. This takes about 15 minutes. The incisions are so small that the surgeon will close them with a single stitch.
After kyphoplasty, you will not have any restrictions on what you can do. Your physician will encourage you to resume all your normal activities as soon as possible.
What results can I expect after kyphoplasty?
Early results on other patients have shown that kyphoplasty is a safe and effective method of reconstructing and stabilizing collapsed vertebrae in the spine resulting from osteoporosis or cancerous tumors. Most patients have excellent pain relief and straighter backs. This may result in added height. More than 95 percent of patients rate their treatment as successful and report that they are able to return to all their pre-fracture activities. Most patients do not need physical therapy or any other form of rehabilitation. They should take bone-strengthening medication during treatment.
A few patients complain of persistent pain after kyphoplasty. Sometimes the area is painful because the tissues have been irritated by the procedure. If this is the case, the pain should get better within two weeks. Other patients may have underlying degenerative arthritis in the spine. With these patients, the usual treatment is medication and an ongoing exercise program. If you have persistent pain after kyphoplasty, talk to your doctor about what can be done to relieve it.
For the best results, kyphoplasty should be performed as soon as possible after spinal bone collapse or fracture. The results are less predictable in older fractures but in certain circumstances may still be beneficial.
If you have severe osteoporosis, spinal bones that were not treated could collapse or fracture at other levels of the spine. If this happens, you can have another kyphoplasty to treat these bones. However, kyphoplasty tends to help prevent further fractures by keeping the spine aligned in its proper upright position.
What are the risks with kyphoplasty?
The use of anesthetics carries some risks in all surgeries. The risks depend on your overall health.
There is a slight possibility that bone cement will leak outside the vertebrae. This happens in less than 10 percent of patients. In most cases, it does not cause any problems. Very rarely, the cement may irritate or damage the spinal cord or nerves. This can cause pain and/or altered sensation. The risk of paralysis as a result of leaking cement is estimated to be less than one case in 10,000 cases. Though it is seldom required, surgery could be necessary to remove any cement that has leaked.
There is also an extremely small chance that cement could travel to the lungs and an even smaller chance that the cement block could cause infection at the time of surgery or even years after surgery. These complications would be treated with medications and/or surgery.
Who should not have kyphoplasty?
Kyphoplasty is recommended for older patients with vertebral collapse or fracture due to osteoporosis or tumor only. It is not suitable for:
Patients with young, healthy bone:
Young patients whose fractures or collapse of the vertebrae are due to high energy accidents or injury
Patients with spinal curvature, such as scoliosis or kyphosis, due to causes other than osteoporosis
Patients with spinal stenosis or herniated discs with nerve or spinal cord compression and loss of neurological function
