EMERGENCIES IN TOTAL HIP REPLACEMENT
Summary. Over the last three decades total hip replacement became one of the most common surgical procedures in orthopaedic surgery. According to the number of large joint endoprosthesis, hip replacement is on the first place. Lately, the number of revisional and special tumoral endoprosthesis is increasing, with more severe complications. Dislocation is a leading early complication of total hip arthroplasty. Dislocations after primary total hip arthroplasties occur at an overall incidence of 1–3%, and at 15–20% in revision and tumoral procedures. Closed reduction and eventually immobilization is the method of treatment. If closed reposition in not possible, revision surgery must be performed. Periprosthetic fractures are, as every other fracture, indication for a surgical treatment. Depending on the type of fracture the method of treatment is either open reduction and internal fixation or removal of the primary and implantation of revision endoprosthesis. Deep infection following total joint replacement remains one of the most serious complications, often needing surgical treatment. Treatment consists of incision and debridement. If there is a fever, increased erythrocyte sedimentation and CRP with signs of sepsis, endoprosthesis must be removed. A haematoma appearance after surgical procedure is an emergency which needs a surgical treatment – haematoma evacuation in order to prevent further complication, on the first place infection. Fractured endoprosthesis is one of the most severe complication in the total hip replacement, and need to be surgically treated as soon as possible with endoprosthesis replacement. Aseptic loosening can also be considered as a relative emergency in surgical treatment of total hip replacement. Longer waiting for reoperation can cause losing valuable bone mass needed for revisional endoprosthesis implantation and fixation. Although emergencies in hip replacement are not very common, they must be recognized and eventually surgically treated as soon as possible.