The decision as to whether or not to go ahead with surgery is based on balancing the potential improvements against what is involved in the recovery and the risks of the operation. This is different for every person and every episode of care.
There are always things that can go wrong with surgery. Some are minor inconveniences, others very serious but rare. Rest assured that Mr Callahan goes to the utmost lengths to reduce the risks of surgery as much as possible, but things still happen.
Some complications that are a risk with any type of orthopaedic surgery include:
- General medical issues such as heart attacks, strokes or other organ failure. Even death.
- Excessive bleeding during or after the operation, which might require blood transfusion.
- There can be problems getting wounds to heal especially in the foot and especially if there is excessive swelling, the patient smokes, has diabetes, or is on immunosuppressive medications for inflammatory arthritis.
- Damage to nerves. This may be temporary due to stretching or permanent. It could lead to numbness, pins and needles, or even nerve pain in an area. If nerves to a muscle are injured there may be weakness of the muscle supplied.
- CRPS (Complex Regional Pain Syndrome) is an odd condition that sometimes occurs after surgery or injury. The nervous system becomes hypersensitive and continues to be active after the tissue injury has healed. It can result in nerve pain, swelling, hot and cold feelings, and changes in the colour of the limb. It is difficult to manage, requiring a combination of medications, physiotherapy and psychology often over an extended period.
- Infection occurs in a wide spectrum of severity. It is not uncommon to have a slight infection in the skin after surgery that requires antibiotics. Severe deep infections however are rare, but potentially limb or life threatening.
- The case of infection where there are metallic materials in the body is a special one. The infective bacteria are able to adhere to the metal and coat themselves with a protective layer which prevents the body’s immune system from clearing the infection. As such it can be very hard to eliminate the infection. Multiple operations may be required, or the metal may need to be removed to completely cure the infection.
- Immobilisation and swelling can cause pooling of blood in the limbs which then clots in the veins. This is known as deep venous thrombosis or “DVT”. This can result in further severe swelling, pain and long term damage to the venous system. The particular concern is if pieces of clot break off and lodge in the lungs (pulmonary embolism). This problem is very serious and can even result in death.
Each particular surgery has specific risks which are discussed in the relevant pages. Some common issues in orthopaedics are:
- Persistent pain in the area after surgery despite all other aspects being “successful”.
- Fractures of the bones during or after the surgery.
- Non-union or failure of a fracture or fusion to knit together. This would require follow-up surgery to stimulate healing.
- Malunion or healing in the wrong position.
- Stiffness or instability or weakness in a joint which has had surgery.
- Wearing out, prominence, or failure of prosthetic implants.
- Alterations in biomechanics that result in problems elsewhere in the limb.