Surgical risks in orthopedic surgery

The complications described here are representative of the majority of complications encountered and described in medical literature. This list is not exhaustive and does not include the more exceptional complications or those related to specific types of operation.

Post-operation bleeding

This occurs quasi-systematically, leading to traces of blood on dressings and ecchymoses (bruising) on the skin for 1 to 3 weeks.

It can sometimes cause haematoma which can be observed in swelling and tenderness. Further surgery may be required to evacuate the haematoma and verify its causes. In cases where bleeding is severe, transfusion may be necessary.

Infection

Most of the time, the contamination of a wound, cut or draining orifice is without serious consequences.

In the vast majority of cases, the germs responsible originate from the patient himself, in spite of the precautions observed before, during and after the procedure.

Where osteo-articular infection occurs, one or more further operations may prove to be necessary, as well as a prolonged course of antibiotics.

After surgery care is then longer and more complicated than was planned and functional after effects may persist. If surgery requires a prosthesis to be fitted, any infection would probably require it to be removed.

Sensitivity-related problems

This is almost systematic around the operated zone, but there is progressive recovery over a few months. Insensitive or less sensitive zones may persist, notably near the scar. Smoking limits the recovery of sensitivity.

Algodystrophy

Algodystrophy is a common complication, which is frequently observed with certain pathologies such as wrist fractures (around 20% of cases, whatever the treatment used.).

The term refers to a sort of inflammation triggered by an injury which is often minimal, or even minor surgery.

For the moment it remains impossible to predict which patients will be subject to this complication.

The signs of this affection include often severe pains (which seem disproportionate), stiffness of the joints, swelling in the hand and fingers, hot/cold sensations and a reduction in strength. Sometimes these signs are limited to one part of the hand, sometimes the shoulder may also be affected. Tests are rarely necessary to confirm diagnosis. One noticeable sign is a localised decalcification in the bones of the hand on X-ray.

Once diagnosis is fixed, treatments vary depending on the pain and discomfort during movement.

The treatment allows us progressively to diminish the clinical symptoms, however, development of the condition remains unstable over several months or even one to two years.

In spite of optimum treatment, it is not always possible to prevent after-effects.

Such after-effects may include residual pain, stiffness in the fingers and/or wrist and sometimes even in the shoulder. The mechanism triggering this affection is still not fully understood and we are obliged to limit ourselves to the treatment of the consequences without acting on the cause.

Working in complete cooperation with the patient throughout such a long treatment remains a crucial element.

Joint stiffness

The loss of joint mobility, in its varying degrees, is always possible after upper limb surgery. It is unpredictable and may be due to algodystrophy, to an inappropriate physical therapy programme, to the initial pathology or to the type of ligament healing individual to the patient.

Lesions related to the vessels, nerves or tendons

Given the enormous number of vessels, nerves and tendons circulating between the shoulder and the hand, a lesion of these elements is always a possibility during surgery, even though it is a very rare occurrence. Such lesions are repaired immediately during the procedure and the consequences are thus limited. However, they may at first go unnoticed and, in such a case, further surgery is necessary with functional after effects remaining a possibility.

Serious risks

Good safety precautions limit serious risks, but do not eliminate them entirely. Some risks, which thankfully remain exceptional, may be unpredictable and jeopardise the vital or functional prognosis (emboli, paralysis, septicaemia…). The anaesthetic involves its own set of complications which the anaesthetist will explain to you during consultation.

Scars

There is no way of erasing the scars. It is perfectly normal for the scar to thicken and redden over the first few months. This is related to the inflammatory reaction which is part of any scarring process and which will improve with time.

Two years are necessary for the scar to stabilise and its permanent visual aspect varies depending on its anatomic position and especially depending on the individual patient himself. In some cases the scar remains red and/or swollen and this is known as a hypertrophic or even cheloid scar (more frequent with black skin), and it may occur without warning and require particular treatment.

The position and length of the scar will be discussed during consultation, and will depend on the type of surgery and your morphology; conditions are then adapted to the specific case during the procedure.

Healing

This concerns cutaneous scars and deep tissue procedures. Healing occurs generally between 2 to 4 weeks. It may be delayed by tobacco, and patients are advised to refrain from smoking six weeks before and six weeks after the operation. The most serious complication is cutaneous necrosis which refers to the varying degrees of loss of the cutaneous zone in the operated area and which can leave a serious alteration in terms of the aesthetic result. Further surgery after an appropriate waiting period may prove necessary in such cases.