Peroperative Complications of the Total Endoprosthesis

Abstract

Under normally loading, the total endoprosthesis is able to achieve good results, but it is a wishful thinking to believe that it can also cope with maximum loading in special situations. Therefore, we do not consider the total endoprosthesis an ideal solution, but a possible alternative when treating a coxarthrosis surgically. This is explained by the fact that complications can considerably worsen the results obtained with the total endoprosthesis. Although the early and late complications are mainly responsible for the bad results, the chances of the prosthesis and thus of the patient can be determined already during the operation. The factors that may give rise to intraoperative complications comprise the patient himself, the operation, the anaesthesia, and above all the surgical personnel (Table 1). The complications can only be influenced by an appropriate indication, suitable pre-operative preparation, and impeccable surgical technique. Therefore the operation demands thorough training and experience in joint surgery, a good armamentarium of instruments and devices, and last but not least a biological intelligence, without which good results cannot be achieved even with a subtle operative technique. Although alloarthroplasty can today be considered a routine operation, technical difficulties will occur under certain conditions, which may lead to numerous complications. We may even maintain that the causes of the complications which arise during the postoperative phase can be more or less ascribed to incidents during the operation. The contamination of the wound with bacteria has to be regarded — strictly speaking — as a peroperative complication whose consequences will become evident only at later date.