Follow-Up After Joint Replacement Surgery

What Happens at a Follow-Up Appointment?

doctor visit
  Thomas Barwick / Getty Images 

After undergoing joint replacement surgery, such as hip replacement surgery or knee replacement surgery, there will be a number of follow-up appointments with your orthopedic surgeon to ensure that your recovery is proceeding as anticipated. While most people are interested in the actual surgical procedure, the vast majority of your appointments with your surgeon will be during this postoperative recovery process.

These follow up appointments may continue for years, or even decades, depending on your surgeon's preference. Follow-up appointments are a critical time of evaluation that can help ensure the recovery is proceeding as expected and can help detect any potential problems or complications that may require intervention.

Frequency of Follow-Up

Orthopedic surgeons will differ in how often they see their patients for follow-up appointments. In addition, depending on a particular patient's recovery, they may see the patient more or less frequently. 

Short-term Follow-Up After Joint Replacement

My usual schedule to see patients after hip replacement or knee replacement surgery is as follows:

  • Two weeks post-surgery
  • Six weeks post-surgery
  • Three months post-surgery
  • One year post-surgery

I am very quick to offer a follow-up at the 6 month post-surgery time as well, but not all patients need that additional follow-up appointment. As stated, there is often variability with this particular schedule with some surgeons seeing their patients more or less frequently based on their experience and preference. 

Long-Term Follow Up After Joint Replacement

There is especially great variability about how frequently surgeons will reassess their patients in long-term follow-up (more than a year after surgery). A one-year follow-up appointment is quite consistent, but there is significant variability thereafter.

These visits are often called surveillance visits, and the x-rays obtained are called surveillance x-rays. There is no clear consensus about how often patients should have an x-ray of their joint, or even if these "surveillance" x-rays are necessary and helpful.

Some surgeons will obtain x-rays every year, some every other year, or at some interval that approximates that, but there is little evidence that the surveillance x-rays do much to change the management of people who have undergone joint replacement. More important than having a scheduled surveillance x-ray, people who notice new symptoms such as new pain, buckling, or other problems with joint replacement, should request to have a follow-up appointment with their surgeon.

It is unusual to obtain studies other than a regular x-ray for routine surveillance of a joint replacement implant. Typically other studies such as CAT scans, bone scans, MRIs, or laboratory tests are only obtained if there is a concern regarding a specific problem.

There have been situations where implants known to cause certain complications, such as recalled metal on metal hip replacements, may have recommendations for specific tests to be performed at routine intervals to assess the performance of the implant. In the setting of a normal joint replacement without specific complication, these types of tests are not necessary.

What to Expect

Follow-up appointments after joint replacement surgery will address some of the following issues and possible concerns. Not every one of these issues is as much of a concern at every appointment. Early in the postoperative recovery, your surgeon will be focused more specifically on concerns such as infection and blood clot, whereas later in recovery they may be focused on mobility and strengthening. Long-term follow-up is generally much more focused on implant survival.

Incision
Incision healing is the foremost concern during the early postoperative recovery timeline. It is not unusual for some bleeding to occur at the incision site for the first few days following surgery. But in general, the incision should be completely dry within 3-4 days. Drainage after that point is not normal, and you should discuss this with your surgeon.
In situations where there is concern about ongoing drainage, your surgeon may recommend interventions including additional surgery, antibiotic treatment, or other options. In addition to inspecting the incision, your doctor may need to remove sutures or staples. Typically sutures or staples that require removal will be taken out approximately two weeks following the surgical procedures.

Mobility
Ensuring that people who have joint replacement surgery return to their functional activities is of critical importance. For that reason, most surgeons have milestones that they want to see their patients achieve. A typical progression following lower extremity joint replacement is to use a walker or crutches for a few weeks, followed by a transition to a cane, followed by independent activity. Some people who rely on these ambulatory supports for balance may not progress as quickly.

Strength
Regaining strength following joint replacement surgery is critical to the restoration of normal functional activities. Regaining strength is not only important in the muscles surrounding the joint, but also within the entire extremity to ensure recovery of normal function. For example, after knee replacement, it is not uncommon for patients to require strengthening of their core musculature in order to restore normal walking and lower extremity function. Restoration of strength is especially critical in the time period from about six weeks to three months postoperatively.

Gait
Your replacement surgeon will likely want to see how you are walking, and what types of devices you find necessary for walking. As part of an assessment, they will evaluate your gait and look for any specific abnormalities or limps. It is typical to have an abnormal (antalgic) gait following lower extremity surgery, but over time this should resolve, especially with appropriate physical therapy. Persistent gait abnormalities may need further investigation.

X-Rays
X-rays are commonly obtained at the postoperative visits, although they are not typically needed at every visit. Usually, your doctor will obtain an x-ray shortly after the surgery. Some surgeons obtain these x-rays while patients are still in the hospital, others may check an x-ray at the first postoperative visit. Typically these x-rays are obtained to ensure that implant alignment looks good. In addition, these images may serve as a baseline to see if anything changes down the road. X-rays taken later in recovery can help to assess fixation of the implants (how tightly they are held within the bone) as well as potential loosening or wearing out of the implants.

Other Tests
Sometimes other tests are necessary either to assess the performance of a joint replacement implant or for other reasons. For example, people taking certain blood-thinning medications may need routine follow-up blood tests. Other laboratory studies are seldom needed unless there is suspicion of a complication such as infection. Other imaging tests are generally performed when there is a concern about a problem such as loosening or wearing out of the implants.

Complications

There are a number of complications that can occur after joint replacement surgery, both in the early postoperative time, as well as over the long-term.  Some of these complications may be simple to manage, others may require more serious intervention.

No matter what, it is almost always better to identify a complication early on, rather than letting it linger. For that reason, if you suspect that there is a problem with your joint replacement, you should notify your physician immediately. Doing so may help make a potentially serious problem much easier to manage.

Some of the signs you should see your doctor include:

  • Worsening redness around the incision
  • Drainage from the site of the incision
  • Worsening swelling in the extremities
  • A new injury to the extremity or surgical region
  • Difficulty bearing weight on the extremity
  • Deformity of the joint

These are just some of the signs that you can look out for. Let your surgeon know if you experience any of these findings. Sometimes a simple treatment early on can prevent a more serious complication. For that reason, it is important that patients let their physician know of any concerns, and that we address those as quickly as possible. It may be as simple as reassuring the patient that these findings are not unusual, but it may save a major intervention.

A Word From Verywell

Most people do not think about the postoperative recovery timeline prior to having surgery. But it is actually the most frequent time for visits to your surgeon. Understanding this timeline for the rehabilitation process can help ensure a smooth transition through your recovery.

In addition, understanding the signs to watch for to identify potential problems with a joint replacement can help address problems before they become more serious. It is important to know that physicians have significant variability in the specific time course in which they see people following joint replacement surgery. Some surgeons may continue to keep an eye on the implants for the life of the patient while others may ask their patients only to follow-up if they have a problem or concern. The most important thing for patients to understand the signs of a problem, and to let their surgeon know if they see any issue developing.