after surgery, a shoe lift can be used. Only in extreme cases is surgery required for correction. The perceived difference in limb length for a patient after surgery is a common cause for lawsuits against the healthcare provider. Fracture Intraoperative fractures may occur. After surgery, bones with internal fixation devices in situ are at risk of periprosthetic fractures at the end of the implant, an area of relative mechanical stress. Post-operative femoral fractures are graded by the Vancouver classification. Vein thrombosis Venous thrombosis such as deep vein thrombosis and pulmonary embolism are relatively common following hip replacement surgery. Standard treatment with anticoagulants is for 7–10 days; however, treatment for 21+ days may be superior. Extended-duration anticoagulants (up to 35 days following surgery) may prevent VTE in people undergoing hip replacement surgery. Other research suggested that anticoagulants in otherwise healthy patients undergoing a so-called fast track protocol with hospital stays under five days, might only be necessary while in the hospital. Emerging evidence supports the use of aspirin for venous thromboembolism prophylaxis. Large randomised control trials suggested that aspirin is not inferior to low-molecular weight heparins and rivaroxaban. However, aspirin may not be appropriate in all cases, especially for patients who have additional risk factors for venous thromboembolisms or may have an inadequate response to aspirin. Some physicians and patients may consider having an ultrasonography for deep vein thrombosis after hip replacement. However, this kind of screening should only be done when indicated because to perform it routinely would be unnecessary health care. Intermittent pneumatic compression (IPC) devices are sometimes used for prevention of blood clots following total hip replacement. Osteolysis Many long-term problems with hip replacements are the result of osteolysis. This is the loss of bone caused by the body's reaction to polyethylene wear debris, fine bits of plastic that wear off the cup liner over time. An inflammatory process causes bone resorption that may lead to subsequent loosening of the hip implants and even fractures in the bone around the implants. Ceramic bearing surfaces may eliminate the generation of wear particles. Metal cup liners joined with metal heads (metal-on-metal hip arthroplasty) were developed for similar reasons. In the lab these show excellent wear characteristics and benefit from a different mode of lubrication. Highly cross-linked polyethylene plastic liners experience significantly reduced plastic wear debris. The newer ceramic and metal prostheses may not have long-term performance records. Ceramic piece breakage