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In most hospitals, you will be invited to a preparation day a few weeks before the operation. Necessary preliminary examinations will be carried out and you will receive information about the planned treatment from the surgeon, physiotherapist, nurse and anesthesiologist.

When the operation date has been determined, contact the municipal physiotherapist/occupational therapist with regard to aids after the operation.

• Useful aids
• toilet raiser
• shower stool

stocking applicator, grabber and long shoehorn

Remember to bring crutches with you upon admission. It may also be useful to bring clothes that are easy to move in and shoes that are easy to put on and fit well on the foot.

Anesthesia

The operation is usually performed under spinal anesthesia/back anesthesia, but can also be performed under general anesthesia. By appointment with the anesthesiologist, you can, in addition to spinal anesthesia, receive sleeping medication during the procedure.

Hip prosthesis

Well-documented hip prostheses are used. The artificial joint consists of a plastic liner (or ceramic) which is attached to the hip socket (pelvis) and a metal stem with a hip ball which is attached to the thigh bone. The prosthesis components can be attached to the bone with or without the use of bone cement.

Preparations at home

To prevent infection in the surgical wound, you must remove rings, jewelry, piercings, nail polish and makeup, and take a thorough body wash the evening before the operation. You will receive instructions about this on the preparation day.

Fasting and medications

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In hip operations, anesthesia is in most cases given in the back, a so-called spinal anesthesia, and you will then be awake. Sometimes anesthesia is chosen instead in consultation with the anesthesiologist, and you will then be unconscious during the procedure.

An anesthesiologist will sit with you throughout the operation. He or she is your contact person and ensures that you are doing well. You should not feel pain, but you will notice some movement in your body while the orthopedic surgeon replaces the joint. You will also be able to hear knocking sounds and other sounds from the surgeon's work.

You can listen to music during the operation if you wish. Bring the music you want to listen to. If you prefer to sleep a little, you can get relaxing medication.

The operation is performed under strict hygienic conditions. Hip operations are now performed either on the side or on the back. The orthopedic surgeon opens the hip joint with an incision at the hip. The head of the femur is removed after the femoral neck has been cut. This part is replaced by a prosthesis made of stainless steel or titanium alloy. The hip socket is replaced with a plastic or titanium socket.

Prostheses come in several sizes and the orthopedic surgeon chooses the one that best suits you. The cement-free components are hammered into place. The prosthesis then grows into the bone over weeks or months. Some prostheses are attached with bone cement that is mixed and dries within a few minutes.

After the head of the femur has been mounted, the hip prosthesis is placed in the joint. The surgeon checks the leg length and that the hip is stable with normal movements so that it does not later "dislocate".

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A typical hospital stay is 1–3 days with daily training and activity. You will receive instructions in exercises and crutch walking from a physiotherapist while you are at the hospital. Self-effort is crucial for a successful result.

Activity

• It is important to get back on your feet quickly. As early as 3–5 hours after the operation, you can, with help, get out of bed. From the first day after the operation, you should walk with 2 crutches or other suitable aids.
• You can generally load the operated hip.
• You can get in and out of bed on both the operated and non-operated side.

You can lie on the non-operated side after the operation with a pillow between your legs. You can also lie on your stomach. You can lie on the operated side as long as it is not painful.

Pain

It is common to experience pain in the days and weeks after the operation. It is not dangerous to use the hip even if it is a little painful. You will receive pain-relieving tablets that dampen the pain to an acceptable level. The medications are gradually reduced as the pain subsides. Most people get a pain-free and well-functioning hip, but it may take time (in some cases up to 1 year) before the pain is completely gone and the movement is optimal.

Precautions

• Restrictions after hip prosthesis surgery vary somewhat between hospitals and also depend on which surgical method has been used. Common restrictions may be:
• Avoid bending forward with your knees pointing inward and your foot placed out to the side for 3 months, "calf-bent position".

• Avoid sitting with your legs crossed, and crossing the operated leg past the midline for the first 3 months.
• You can pick up things from the floor by stretching the operated leg behind you when you bend down (see pictures below).

You can bend forward and let your knees fall to the side, "frog position", when you do not notice any tension/discomfort in the operated hip.

After discharge

Swelling and discoloration of the leg on the operated side is common due to increased fluid and blood accumulation. This can be seen all the way down to the ankles. It will gradually disappear on its own. To reduce swelling, you can lie with your leg elevated and your upper body low. Light activity and circulation-promoting exercises can also help reduce swelling.

Wound care

The skin is closed either with a resorbable thread that does not need to be removed, or with thread/staples that must be removed after 2–3 weeks. Bandages are changed as needed. You will receive information about how to handle both the stitches and the bandage before discharge. It is recommended to avoid bathing in swimming pools/bathtubs/saltwater for the first 3 weeks.

Training/crutches

It is important to be active and exercise daily after discharge from the hospital.

Most people can manage the training on their own. The crutches can be discontinued when you can walk normally without limping. Deviations may occur in individual cases. You will receive information and training on this during your stay.

Activities

Walking and other light activities are recommended. Sexual intercourse can be resumed as far as pain allows.

Sick leave/prescriptions

Usually, sick leave is required for 2–8 weeks, depending on the type of job.

You will receive a prescription for pain-relieving medication. After further consultation, some will also receive a prescription for blood thinners.

Driving

• You should wait until you have discontinued the use of crutches and your leg feels strong enough to handle driving. You should also not drive if you are taking pain medication with a red warning triangle. The Road Traffic Act applies.

Getting in and out of the car as a passenger: Position the seat far back and tilt the backrest well backward.

Follow-up appointment

You will receive information about your follow-up arrangement upon discharge.

Possible complications

The most common complications associated with hip prosthesis surgery are infection and dislocation of the hip (dislocation). Both occur in about 1% of patients. It is important to contact the department quickly if you experience sudden severe pain or signs of infection (See more under “Warning sign”). Nerve damage can also occur, but this is rare and often temporary.

Blood clots are prevented with rapid mobilization and blood-thinning injections, or sometimes also with compression stockings. It is also recommended to avoid long flights for the first 6 weeks after the operation. Sometimes a leg length difference occurs, most often when the operated leg becomes longer. Then it may be necessary to use an insole in the opposite shoe.

Information from physiotherapist

1. Exercises for the hip after prosthesis surgery.

2. Tighten your buttock muscles and press both knees down into the ground. Hold for a few seconds. Release.

3. Bend your knee and hip and pull your heel along the ground. Then straighten the leg again.

4. Bend your ankles. Bring the legs apart and then slowly back together. Do not lift the legs from the ground.

5. Lying hip lift: Lie on your back with bent knees. Squeeze your buttock muscles together and lift your pelvis and lower back off the ground. Slowly lower again.

6. Standing heel raise with support: Stand behind a chair and support yourself with your hands on the chair back. Lift yourself up on your toes with both legs and slowly lower yourself again.

7. Support yourself in a chair or similar. Put the operated leg slightly behind the other - toes on the ground. Stretch out by bringing the heel towards the ground. Feel that you are using your thigh muscles and buttock muscles when you stretch out.

8. Support yourself against a chair, against a wall or similar. Bring the operated leg out to the side and then bring it back in a controlled manner. It may be good not to have shoes on the operated leg when doing this exercise.

9. Support yourself with both hands on a chair back or similar. Stand with your feet shoulder-width apart. Bend in the hips and knees with equal weight on both legs.

10. Stair climbing up with crutches: Up with the healthy leg first, then the operated leg and crutches.