A hematoma is a collection of blood outside of blood vessels, often pooling in soft tissues. While minor bruising is common after surgery, a hematoma is a more significant accumulation. These collections can form after major procedures like hip surgery, appearing as a swollen, discolored area that may feel like a lump.
Surgical Procedure Contributions
Hip replacement surgery involves navigating muscle, connective tissue, and bone to access the hip joint. This requires cutting small blood vessels, leading to bleeding within the surgical site. Surgeons control blood loss, but microscopic vessels can continue to ooze after the wound is closed.
Stopping bleeding from every tiny vessel is challenging. Capillaries and small venules can continue releasing blood, contributing to gradual accumulation post-operatively. This ongoing leakage can form a noticeable hematoma.
Bone tissue, especially the femur and pelvis in hip replacement, is highly vascular. When bone surfaces are cut or reamed for implant placement, blood releases from the bone marrow and porous structure. This bleeding can significantly contribute to the total blood volume collected within the surgical cavity.
More extensive or complex hip surgeries, like revision procedures, require greater tissue manipulation and longer operative times. This increased disruption of tissues and blood vessels can lead to persistent bleeding and hematoma formation.
Patient Health and Predispositions
A patient’s health and pre-existing medical conditions influence hematoma susceptibility after hip surgery. Uncontrolled high blood pressure can increase internal pressure within blood vessels, making them prone to leakage or dislodging clots. Maintaining stable blood pressure during and after surgery minimizes bleeding risk.
Certain medical conditions impair the body’s ability to form blood clots. These include inherited bleeding disorders (e.g., hemophilia, von Willebrand disease) or acquired clotting factor deficiencies. The blood does not coagulate effectively, leading to prolonged or excessive bleeding and hematoma formation.
Liver or kidney conditions can increase bleeding risk. The liver produces proteins necessary for blood clotting, while kidneys clear certain medications and maintain fluid balance. Dysfunction in either organ can compromise clotting or affect medication metabolism that influences bleeding.
Advanced age can be a factor. Older patients may have more fragile blood vessels susceptible to damage. Clotting efficiency can decrease with age, and older individuals often take multiple medications affecting bleeding tendencies, increasing hematoma predisposition.
Patients with obesity may face increased challenges during surgery. Extensive fatty tissue can make surgical access and dissection more difficult, requiring broader tissue manipulation. This can lead to diffuse bleeding that is harder for the surgical team to control during the procedure.
Medications and Post-Operative Care
Medications play a role in hematoma risk after hip surgery. Anticoagulant medications, or blood thinners, are prescribed after hip replacement to prevent complications like DVT or PE. While these drugs (e.g., warfarin, rivaroxaban, apixaban) prevent blood clots, they reduce the blood’s ability to clot, increasing bleeding and hematoma formation.
Antiplatelet medications (e.g., aspirin, clopidogrel, NSAIDs) impact clotting. These drugs inhibit platelets, essential for forming the initial plug at a bleeding site. If a patient takes these medications without proper management around surgery, their risk of increased blood loss and hematoma formation rises.
Beyond prescription medications, many over-the-counter remedies and herbal supplements can thin blood. Fish oil, ginkgo biloba, garlic supplements, or high doses of vitamin E can interfere with platelet aggregation or affect clotting factors. Patients must inform their surgical team about all such products for guidance before surgery.
The post-operative period is when initial clots form to seal damaged vessels. Too much movement, weight-bearing, or strenuous activity after hip surgery can disrupt fragile clots or strain healing tissues. This disruption can cause previously controlled blood vessels to re-bleed, leading to a new or expanding hematoma. Adhering to surgeon’s post-operative instructions minimizes complication risk.