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How long post op before referred
back/leg pain should go away?
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Dr.
Shimmin: Within 2-3 weeks after the surgery, patients are usually aware that their arthritic
pain is significantly resolved. Of course during that time they will still be
experiencing some post-operative pain but this usually gets better on a daily
basis. Sometimes hip replacements of any type can lead to an improvement in degenerate
lumbar spine pain. This can take some months before it is apparent and it is
certainly by no means guaranteed that this will be a beneficial side effect of
any form of hip replacement surgery.
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What effect
does taking bisophosphonates have on bone ingrowth?
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Dr.
Shimmin:
At this point in time little clinical information is available to ascertain whether
these are of any significant value in promoting bone in-growth to orthopaedic
implants.
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Is there much
difference in xrays at 1mo, 6 mos, 1yr, etc.?
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Dr.
Shimmin: In a routine situation a post operative x-ray will be taken. No significant changes
will be noticed in the first 6 months. At six months some of the bone in-growth
into the acetabular component may be visible In the first three years after implantation
there maybe some remodeling visible in the femoral neck which then tends to stabilize.
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What are the
long term post op recommended restrictions?
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Dr.
Shimmin:
My recommendations for patients with hip resurfacing is that they avoid unnecessary
impact activities or regular jogging. It is possible that because these activities
increase the joint reaction forces and hence theoretically does increase the
wear debris generated from the bearing surface.
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How long does
it take bone to grow into the prosthesis?
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Dr.
Shimmin:
It takes about 8 weeks for cementless implants to in-grow to the patients bone.
This does vary from implant to implant and does depend upon the exposed in-growth
surface. During this period of in-growth it is important that patients follow
the specified post-operative protocol suggested by their treating surgeons. At
this stage there is no medical therapy that is proven to increase the rate of
which bone in-growth occurs.
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How can follow
up and xrays be done after an overseas surgery?
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Dr.
Shimmin:
In my practice post-operative visits occur at 1 month, 3 months, and then annually
thereafter. New x-rays are taken on an annual basis. This is by no means standard
and many surgeons will have different post-operative review protocols.
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If part of the
implant fails, can a revision be done that just replaces it without going to
a THR? If the femoral component fails, can the original acetabular part still
be available?
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Dr.
Schmalzried: Acetabular side failure in the first 10 years following HR is rare. Revision
of the acetabular side with retention of the femoral side is possible. Femoral
side failure is the main cause for reoperation in the first 10 years following
HR. Usually the acetabular component can be retained, given that it is well positioned
and well fixed.
See Ball,
S.T. et al. 2007.
Dr.
Shimmin:
If the femoral component fails such as with avascular necrosis, fracture or loosening
and the acetabular component is well fixed then one option is to retain the acetabular
component and just replace the femoral component with a stemmed implant with
a large modular head. If the acetabular component fails then often the best treatment
is to revise the whole implant, ie both the femur and the acetabular component.
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