Post-operative follow-up: With regard to post-operative evaluation, arrangements will have been made for you to be seen again by me in the clinic at around six weeks from surgery.
At that stage, six weeks after your surgery, I would expect the scar to be beautifully healed. I would be happy for you to start to gently massage the scar, in the line of the incision, with Bio Oil, E45 cream or Nivea cream. This will smooth the scar and can help to desensitise the area.
I would expect you to be able to progress with your weightbearing and we will discuss this with you.
I would expect, as detailed above, for those who have had a hybrid hip replacement with a cemented stem, to be fully weightbearing at that stage. Those who have had an uncemented hip replacement or hip resurfacing should now be able to put weight fully through that leg.
We will then push on with mobilisation and weightbearing off crutches as tolerated.
I would expect patients to be able to bend their leg up to 90 degrees and to have good movements with pushing the hip behind them and out to the side. Often that lateral movement remains a little bit uncomfortable. It is important, however, that the hip abductor muscles are worked on at that stage to reduce any limp though I would expect that to be pretty well settled by the time we see you at six weeks.
Often we will arrange x-rays at six weeks so that we have a definitive view of the hip replacement. It is more comfortable for the x-rays to be carried out at that time and we will often perform an x-ray from the front and indeed from the side to check component position and alignment.
Beyond that, I would expect a physiotherapy review to ensure that your movements are good and to push on with your rehabilitation.
Further review: Dependent on progress, we are then likely to arrange to see you at between three and four months from surgery, again to ensure that all has progressed well.
With an uncemented hip replacement, or indeed following hip resurfacing, we will typically request an x-ray at around that time to ensure that the components are sound, solidly secure and integrating against host bone. (Patients with a hybrid or cemented hip replacement are unlikely to require an x-ray review at that stage.)
From there we would typically arrange to review patients for a final check at around a year following surgery. A final x-ray will be performed at that stage, again to ensure that the components are sound. By then we would expect patients to have rehabilitated soundly. I would expect patients to be mobilising very satisfactorily without pain and indeed to have returned to the vast majority of the activities that their arthritic hip had prevented them from enjoying.
Of course, if there are any concerns with this over time, we will have had an opportunity to have discussed this with you in the out-patient clinic.
Longer term follow-up and review: With regard to more long term follow-up, this is a very topical area. Historically, concerns with regard to hip replacements and failure, as detailed elsewhere in the website, have largely involved wear of the previously-used polyethylene. This, as detailed, can result in bone damage. This damage can occur without the patient being aware of any issue. As a consequence of this, over the years, some revision surgery has been challenging, particularly when that bone loss has progressed without symptoms.
For that reason, it is my advice that patients do have their hips ‘checked out’ over time, very much as we would with an MoT on the car.
My current practice and advice is that patients should have a further check x-ray at around seven or eight years from surgery to ensure that all is well. Again, I think it would be sensible to have further x-rays at twelve, fifteen and then every two or three years just to ensure that all is well though, as I have said elsewhere on this website, we would expect sound longevity in the hip replacements we are implanting at this stage ,with longevity to twenty, twenty-five and perhaps even thirty years.
As ever, it is very important with any symptoms of pain, restricted mobility, any abnormal sensation of movement or any other concern with your hip, that you are in contact so that we can review things and request up to-date x-rays. As above, however, I would want to reassure patients that it is very likely that their hip will continue to function nicely in the long term following surgery.
Follow up after a metal-on-metal hip resurfacing: One difference to this follow-up regime remains for patients who have had metal-metal hip resurfacing.
In line with MHRA guidance, I review hip resurfacing patients at a year after their surgery at which stage we will check blood metal ion levels. It is my own practice to repeat that review at two years to ensure that all is well, to ensure that the hip is functioning nicely, that the x-ray is good and, again, that there is no concern with blood metal ion levels. Consistent with MHRA guidelines, my practice is to review metal-metal hip resurfacing patients at five years and ten years and subsequently routinely beyond that, to ensure that blood metal ion levels remain sound. At any stage with a hip resurfacing with any symptoms, abnormal mobility, pain, soft tissue discomfort, weakness or a limp you should be in contact so that we can review things with you and arrange investigations as required.