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This one's a bit late..sorry 😟
Completely distracted by our son's birthday party..
A LOT of fun was had by all.. hope you'll forgive the delay :)


After writing about the difference a check up can make in Newsletter #46..

I’m inspired to check in on how Amanda's doing..
Her story will prompt a deep dive into what causes hip pain..


Let's Recap

I introduced Amanda’s 'less clear cut story’ in Newsletter #29..

..walked through her ‘x-ray films and scans’ in Newsletter #30..

..covered ‘where injections do play a role’ in #31 and..

..described how we came to a ‘decision’ together in #32.

 
Amanda had a hip replacement age 59. 

Before her operation she had more tests than usual..
BUT hers was typical of the pathway taken to pin down the source of pain.

With all the tests results in, we could discuss how much pain was coming from her hip joint and how much from elsewhere.

In particular, from her back..
 

3 years on, how's she doing..?

Well, not particularly well.

Her pain & function outcome score (or PROM score) ranges between 60 and 80% good.

AND she's retired earlier than she wanted from work.

I would normally follow up a patient with a hip replacement at 1, 7 and every subsequent 3 years (in line with national guidelines).


BUT I've seen Amanda in clinic 4x  since her surgery. 

Her groin pain (from her hip joint) has almost completely gone. That's GOOD.

BUT she still gets pain on the outside of her hip. That's BAD.

AND her back pain has flared up on a couple of occasions.
Which can be REALLY BAD (at times).


That pain in her back and buttock is very much from her back. 
 
The pain on the outside of her hip is coming from the muscle
..age related change, inflammation or perhaps a small tear.

We took a look at a similar problem in the 'check up' issue..
..take a look here in Newsletter #46.

And this post got some traction on X (formerly Twitter) for what to do about it..

..that's more or less what I talked through with Amanda.


So, what's the take home?

Well, overall, Amanda tells me that she is better off:

• She can walk her dog 
• Do most things that she wants
• BUT she is far from 100% happy. 

I do NOT think  there's anything wrong with Amanda’s hip replacement.
Her case and x-ray films have been reviewed by colleagues..

AND I've offered Amanda a second opinion.
(as is standard in these tricky cases).
 

She agrees the new hip is okay. 

AND she's unlikely to need or choose revision hip surgery any time soon.
That's the right decision for her. No doubt about it.

BUT the conclusion is that the complexity in Amanda's case is NOT currently captured by our healthcare system.

And that can distort what we tell our patients about joint replacement..
Our healthcare system only counts numbers..

• Revision or not. 
• Death or not. 

Amanda is very much alive, and her hip has NOT been revised.
So to our current system Amanda's case counts as a SUCCESS.
 
That's important because that information can influence the decisions other people make about hip replacement.


Measuring pain and function gives us a more complete picture.
Outcome scores (or PROMs) provide us with some nuance.
Amanda is only 60 to 80% good.

I’ll return to the importance of good measurement again.
Like good regulation it can appear boring.
File it, perhaps, under 'boring' but..

'Vitally important'.

And good measurement will play a major role in solving this problem..

In the meantime, I hope that Amanda’s case sheds some light..
It certainly prompts a deep dive into what causes hip pain..
 
That's coming up soon..
I'm thinking a short series of autumn newsletters.

After a small diversion next week..
I've got something on my mind!

Behind the scenes..

Meanwhile behind the scenes..
I've been learning about growing a subscriber list.
The advice for every good newsletter is to create a good lead magnet.

What is that, I hear you ask?
A piece of content that will really help people.

Content that really solves a problem.
A nudge in return for people joining the newsletter list.
The recommendation is to write a short, impactful, one-page explainer.

Well, that's made me think..
And taking that advice on board,
I’ve overdone it and written an 8-pager..!

I've thought about what really makes a difference to me.
And it's one key schematic that helps me to do more with less pain.

It's the key schematic that I keep returning to..
The key schematic idea that helps me 😀
The key idea that I helps my patients. 

And explaining it can’t be rushed.
Apparently, it can't be done in less than 8-pages!

As a subscriber to the Lifetime Hip Newsletter I thought you might be interested?

So, here it is FREE to you (click on the link)

Friends, partners and family can subscribe for FREE at www.danhwilliams.com/#subscribe

AND now they will also get a copy of that key schematic
..to help them do more with less hip + knee pain.  

And anyone can try out past Newsletters at the same link.

Good luck!