Total Joint Replacement – Consent Form

RISKS & POSSIBLE COMPLICATIONS OF TOTAL KNEE/HIP ARTHROPLASTY: You are scheduled for __________ total knee/hip arthroplasty (joint replacement surgery on ________________. There are significant risks and complications associated with this operation. I have outlined them in the following paragraphs for your understanding. I encourage you to read them and ask any questions you may have. I will be glad to answer them to your satisfaction. 1. There is the risk of infection with any surgical procedure. The risk of infection with total joint replacement is significant due to the use of artificial materials to replace the joint. You will be given intravenous antibiotics prior to, as well as following the surgery to prevent infection. Should there be an infection in your joint replacement after surgery, it may require a long term treatment with intravenous antibiotics as well as surgical drainage and, in some cases, removal of all the metal and plastic material from the joint with subsequent reinsertion of a new joint at a later time or other forms of treatment as needed. There is the risk of infection to the joint in the future with minor surgical procedures such as dental work. You must receive prophylactic antibiotics prior to such procedures. 2. There are risks of injury to the nerves and blood vessels surrounding the joint especially in cases of revision surgery. Injury to the sciatic nerve or one of its main branches can result in foot drop. This is usually corrected with a temporary or sometimes a permanent food drop brace. 3. Blood clots can occur in the veins of your legs. These clots can break off and lodge themselves in the heart or lungs and, in extreme cases, could cause death. To prevent these blood clots, you will be given blood thinner medication, which will start on the day of surgery and will continue after surgery. 4. There is the risk of lengthening or shortening of the leg with the insertion of the total joint components. Such discrepancies can usually be corrected with the insertion of a shoe lift. Occasionally, in extreme cases, severe leg length discrepancy may require a revision surgery. 5. The components used to replace the diseased joint are made out of metal (such as stainless steel or titanium) or plastic. These components are fixed to the bone with or without “cement.” There is the risk of wearing out or loosening of the metal components in the bone with the use of the joint over a prolonged period of time. This may require replacement of the worn out or loose components in the future. 6. There is the risk of postoperative stiffness of the joint. This may require manipulation of the joint under anesthesia. 7. There are risks associated with blood transfusions. Some of these are minor reactions; other could be serious such as hepatitis or AIDS. I have discussed with you the choice of autologous blood (your own blood donated prior to the surgery), directed donor blood (blood donated for you by a family member), and the use of bank blood (blood available from the blood bank). 8. In the unusual cases, there is the risk of fracturing the bones in which the total joint components are placed. In that case, the fracture is usually treated at the same time the surgery for the joint replacement is being done. 9. In some cases, a total hip may dislocate at anytime after surgery and require a closed or occasionally an open reduction. Recurrent dislocation may require a revision surgery. The physical therapist will teach you “Hip precautions”. You must follow them for the rest of your life to avoid postoperative dislocations. 10. There are risks of common medical complications associated with major surgery and/or anesthesia such as heart attack, stroke, etc. These complications may be serious and, in rare occasions, even fatal. I advise you to discuss them in detail with you anesthesiologist before surgery. Date: __________________________ Physician: _______________________ ___________________________ Print Patients Name ___________________________ Signature ___________________________ Witness

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