Complications revisited. The debit side of total hip replacement

Experience with 501 cases of Charnley total hip replacement, performed over a 6 yr period, analyzed in detail for complications, presents only 1.2% failures after a minimum follow up period of 6 mth and maximum of over 5 yr. Salvage or secondary cases have had a higher incidence of superficial and deep infections, dislocation and subluxation. Routine use of topical antibiotics in spray form may be a factor in a low overall incidence of deep infection (0.8%) including no deep infections in over 400 primary cases. Trochanter removal has advantages which outweigh the frequency of delayed union and nonunion of less than 5%. Prophylaxis for thromboembolic disease, using dextran 70, has been used in more than 400 cases, under 3 different regimens, with 1 death from pulmonary embolism in over 400 cases. The overall death rate of 1.1% was due to a variety of causes which are listed, as well as 6 cases considered technical failures.