What can go wrong?

The modern operating room is a very safe environment and complications of surgery are rare. It is important however that you understand the risks that do exist around your surgery. Risks of surgery will be discussed with you before your operation as part of your consent process.  Do please ask if you have any specific concerns or need any risks clarifying for you.

General risks that may occur at or after Orthopaedic surgery include:

• Infection - this is very rare with keyhole techniques (much less than 1%), and still uncommon with open surgery: most open operations carry about a 1% chance of infection.  Shoulder replacement surgery carries an approximately 2-3% risk of infection.  Every effort is made to minimise the risks of infection.  If you get an infection, you may just need antibiotics, but sometimes further surgery, or even revision of a joint replacement or fixation is required. 
• Bleeding that requires treatment is rare after open surgery and extremely rare after keyhole surgery.  If you do suffer bleeding, you may require a blood transfusion to replace the lost blood and, occasionally, further surgery is required to stop the bleeding or repair damaged blood vessels.  Life threatening bleeding is extremely rare.  however, certain operations (e.g. collar bone surgeries) are close to major blood vessels, so their risk of such bleeding is higher.  
• Nerve injury (causing motor and/or sensory loss of function) is uncommon.  A nerve may occasionally get compressed or stretched during an operation as retractors are used to access tissues.  If this is the case there may be a temporary loss of function in that nerve's supply (this might be felt as numbness in an area of your skin or weakness in some muscles). Recovery would be expected over time and usually further surgery is not required.  It is very unusual for a major nerve to get cut during  surgery and great care is taken to avoid such injuries. If a nerve does get cut, then recovery is unlikely and further surgery may be indicated to repair the damaged nerve.  Certain operations place particular nerves at more risk, as they run very close to, or in the way of the operative target.  In this case, your surgeon will mention these nerves and the risks and implications of injury.
• Mal-union  and Non-union.  If you are having surgery to fix a broken bone (fracture), the goal is to restore the position of your bone(s) and to get your fracture to heal.  Occasionally however a fracture heals with incorrect alignment despite fixation (malunion).  Sometimes the bones do not heal together, and this is called a non-union.  If this happens and you remain symptomatic from the problem, then you may require revision surgery. 
• Tendon or ligamentous injury is rare during surgery. If such an injury were to happen your surgeon might be able to repair the injury at the time.  This might alter your post-operative rehabilitation plan to protect the repair.  If the injury was not evident during the operation, you might require further surgery to repair it later on.
• Stiffness will affect about 1 in 40 patients after keyhole shoulder surgery and can also affect patients after any operation.  Some people develop an abnormal inflammatory response in their shoulder capsule after an operation (even keyhole surgery).  This is called a 'secondary frozen shoulder'.  If you develop this, you may require further treatment in the form of targeted injection or even further keyhole surgery to free up your joint. You would also require physiotherapy to try to optimise your function. The elbow is also a joint prone to developing stiffness. Prolonged immobilisation of your elbow (e.g. plaster cast across the elbow for more than a couple of weeks) is therefore generally avoided.  If you develop stiffness that does not resolve with therapy, you may require further surgery (might be keyhole or open surgery) to restore range of motion to your joint. 
• Chronic pain syndromes (sometimes called complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy) are rare, but they can occur after any injury or surgery to your upper limb.  A good way to minimise the risk  is to begin early motion of your operated or injured limb and to avoid isolating it from your activities of daily living. You will therefore normally be given simple exercises and advice to help you start to use your arm, even in a restricted fashion, as soon after surgery as possible.  Patients with post-operative complex regional pain typically experience swelling, hot and cold sensations, stiffness and pain in their affected hand or limb.  Thankfully this problem can usually be improved with medications and therapy.  This normally involves the help of a pain specialist and physiotherapists. Very occasionally this remains an intrusive condition.   
• Wound problems are very rare after keyhole surgery and rare after open surgery.  If your wound gets a superficial infection you may require antibiotics. If your wound doesn't heal or pulls apart, then you may require further surgery to address this.  You will be given advice on protecting your surgical wounds until they heal (dressings, keeping wounds clean and dry etc).  Your surgeon will review your wound healing at your post-operative clinic visit. 
• Blood clots such as deep venous thrombosis (DVT - blood clots in deep veins) and pulmonary embolus (PE - blood clots or fat globules  that have travelled in your bloodstream to your lungs) are very rare after upper limb surgery.  You therefore do not routinely require any blood-thinning treatment for most upper limb surgeries.  You may well however be asked to wear compression stockings and you will have calf-compression pumps applied to your legs during your surgery if appropriate.  If you have had a shoulder replacement, you will be given blood-thinning injections after surgery until you are discharged home from hospital.   
• Anaesthetic risks are very low in modern surgical practice.  Your anaesthetist will assess you before your operation and they will highlight the risks of the anaesthetic procedure.  For many upper limb surgeries, they will offer a nerve block.  This is a technique where they bathe the nerves that come out of your neck with local anaesthetic.  The effect is that your arm goes numb and limp for between 10 and 24 hours.  This reduces the pain response in your body during surgery and when you wake up.  It is generally a good option to take up this offer.  The risk of permanent nerve injury from nerve blocks is very low and your anaesthetist will explain these risks to you. 
• Stroke, pneumonia, cardiac events (heart attack or heart failure) kidney injury and death are all very rare after planned surgery.  However, any surgery places an extra demand on your body's organs.  For most of us, this stress is well within our capacity to cope and we suffer no problems. However, for frail patients or those with significant pre-existing medical problems, the same stress may overwhelm the body's coping mechanisms.  In that case, patients may suffer complications such as stroke, heart problems, kidney injury and breathing difficulties.  These problems may require specific medical treatment and their recovery can vary.  While extremely rare, patients may succumb to their post-operative problems and die. If you are frail or have significant medical problems, these risks will be highlighted so that you can make an informed decision about whether to proceed with your operation.  If all non-operative options have failed to help you, and you wish to have an operation to improve your pain and quality of life, then you will need to be seen by a Consultant Anaesthetist to make sure that risks are minimised and again that the risks are highlighted to you.  You may require a post-operative high-dependency unit admission and you would expect a prolonged hospital stay. 

With most planned surgical procedures, these risks are all very small. If you have health problems, these can increase the risk of surgery, so it is important that you tell us of all your health issues. Tobacco use, diabetes and immune system disorders may impair healing and increase your risk of infection.  Where relevant, this will be emphasized to you.