RSD after hip replacement surgery and what are other complications?

The risks of total hip replacement include blood clots in the lower extremities that can travel to the lungs (pulmonary embolism). Severe cases of pulmonary embolism are rare but can cause respiratory failure and shock. Other problems include difficulty with urination, local skin or joint infection, fracture of the bone during and after surgery, scarring and limitation of motion of the hip, and loosening of the prosthesis which eventually leads to prosthesis failure. Because total hip joint replacement requires anesthesia, the usual risks of anesthesia apply and include heart arrhythmias, liver toxicity, and pneumonia.

Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy is an abnormal pain reflex that can occur after surgery on the upper or lower extremities.  It is more common after total knee replacement than after total hip.  This process can result in a significantly protracted pain in the knee.  It is also commonly accompanied by significant stiffness in the knee.  The skin will change to a very thin frail appearing skin that can be of varying colors; from purple to reddish to pink.  In addition, it is frequently noted that there will be no hair growth in the area affected by a reflex sympathetic dystrophy.  The skin will be exquisitely sensitive and painful to even light touch.  There may be some remaining warmth within the leg. 

The diagnosis of this condition can be extremely difficult.  It is most commonly a diagnosis of exclusion.  A patient must be evaluated for the possibility of loosening of the components, infection, or other mechanical problem with the replacement prior to being diagnosed with reflex sympathetic dystrophy.  Occasionally, a three phase bone scan can be helpful in determining the diagnosis of a reflex sympathetic dystrophy. 

When a patient is diagnosed with a reflex sympathetic dystrophy it is important to note that additional surgery on the leg will most commonly result in worsening of the condition.  Occasionally, the condition can be benefited from a sympathetic blockade which is usually carried out by an interventional neuroradiologist.  In this procedure, a long-acting local anesthetic or nerve blocking agent is placed near the lower lumbar spine where the sympathetic nerves originate.  These nerves control the pain reflex and control blood flow through the skin of the lower extremities.  The injection may result in a blush of color in the area involved with the reflex sympathetic dystrophy, and frequently can result in significant relief of the pain of a reflex sympathetic dystrophy.  If the injection is successful, a more permanent blockage may be necessary to maintain long term relief for the patient.