Risks and Complications of Surgery
As when you board an airplane you are warned about things that can go wrong, unfortunately there are likewise inherent risks involved in any surgery. Some of these are described below as a guide for your information. Please discuss these and any particular concerns you may have with me before any surgery.
This is inevitable with surgery. With keyhole procedures the scars are under 1cm, non keyhole procedures will have longer scars. This will be described to you prior to surgery.
All surgery is painful to a degree. We will try to reduce the pain by the use of nerve blocks, local anaesthetic injections and painkillers but we cannot make it all go away.
Whenever skin is broken there is a risk of infection. We clean the surgical area prior to surgery and may use antibiotics in some procedures. The reported risk is less than 1% and should it happen can often be treated with a course of antibiotics. Very rarely deep infections can occur, and this may need further procedures and prolonged treatment (see joint replacement).
Rare with a reported incidence of less than 1%.
A risk in any surgery as the nerves are often next to where we operate. Injuries though are rare, reported to be under 1%.
Rare in upper limb surgery, less than 1% reported rate. Most surgery will be day case surgery.
Joints do not like being injured as they get stiff. Surgery is a form of injury, and it may be on an already injured and stiff joint. With rehabilitation most people get back a functional range of movement though it may take up to a year. About 10% of patients may need some additional help getting there, either with injections or potentially further surgery to free things up.
Chronic Regional Pain Syndrome (CRPS)
This is an ill understood problem of persisting pain and stiffness that can occur after shoulder and elbow injuries, but is more common in the hand and the wrist- a reported incidence of 5-40% in some complex surgical procedures. For the majority this resolves with time and rehabilitation, but you may need specialist regional onward referral if it doesn’t improve.
Incomplete resolution of the problem
While we try to get patients as well as we can, it is likely that if you have needed surgery your arm will not be perfect and you will notice a difference compared to the other side, particularly at extremes of activity. For most patients they are pain free at rest and can do most things most of the time. On balance the improvement is roughly 85-90%, enough to return to their daily activities, sports and hobbies.
Procedure Specific Complications
Rotator Cuff Repair
As the quality of the tendon tissue may be poor there is reported to be up to a 20% to 40% retear rate after cuff repairs. Fortunately even if the tendon retears the pain relief is maintained in most people and they are glad they had the surgery done.
The risk of recurrent dislocation is reported to be 5-10%. This partly reflects the return to activity that caused the dislocation in the first place
The risk of infection in joint replacement is about 1%. Should this occur you may need prolonged courses of antibiotics. Dislocations can occur, particularly after reverse shoulder replacements (reported 2%) and all artificial joint replacements will wear out with time. Most should last 8-15 years. When it wears out, and for infections and dislocations further revision surgery may be required.
Tennis/Golfers Elbow release
After surgery most people are better but it can take some six to nine months to settle down. Recovery from a keyhole procedure is quicker but still takes time. About 30% of people may have persistent symptoms.
Carpal Tunnel Release
The scar on the hand can be tender for several months, noticeably when it is loaded such as pushing down on a chair or lifting a heavy kettle, before it settles down.
In this disease the abnormal tissue wraps itself round the nerves and blood vessels to the finger. Therefore, there is a risk of injury to these that may leave some numbness in the finger. The biggest issue is to appreciate that although we can remove what we can see, we cannot take away all the tissue so the Dupuytrens disease will come back.
Mucous cyst removal
Removing the cyst does not treat the underlying joint producing the fluid to there is a risk of recurrence in about 10%.
Although the pain is better after the surgery the thumb will feel weaker until the muscles rebalance and strengthen. This may take six to nine months to improve.