Hip replacement surgery may be appropriate for osteoarthritis of the hip, hip fractures, congenital injuries or other changes in the hip. The damaged and often painful joint is replaced with a prosthesis. A hip replacement is considered after other non-surgical treatments have been tried and have not had a sufficient effect.
When the cartilage in the hip wears down, the hip loses its natural gliding surface. This can cause stiffness, reduced mobility and a tendency for the joint to give way. You experience pain both when bearing weight and, eventually, at rest and at night. Sometimes, exercise and pain-relieving tablets do not provide adequate pain relief. In that case, it may be appropriate to replace the hip socket and femoral head with an artificial hip joint, that is, a prosthesis.
When you become ill or have a health problem, there are often several different options for both examinations and treatment.Here you will find tools that can help you make a decision.
You can also find generalinformation about osteoarthritisat helsenorge.no.
At most hospitals, you will be called in for a preoperative assessment day a few weeks before the operation. Necessary preliminary examinations are carried out, and you receive information about the planned treatment from a surgeon, physiotherapist, nurse and anaesthesiologist. You will also receive information about any assistive devices you may need.
Remember to bring crutches when you are admitted. It may also be a good idea to bring clothes that are easy to move in and shoes that are easy to put on and fit securely.
The operation is usually performed under spinal anaesthesia, but can also be done under general anaesthesia. In consultation with the anaesthesiologist, you may be given a sedative during the procedure in addition to the spinal anaesthetic.
Well-documented hip prostheses are used. The artificial joint consists of a plastic liner (or ceramic) fitted in the hip socket (pelvis) and a metal stem with a femoral head fitted in the thigh bone. The prosthetic components can be fixed to the bone with or without bone cement.
To prevent infection in the surgical wound, you must remove rings, jewellery, piercings, nail polish and makeup, and wash your body thoroughly the evening before the operation. You will receive instructions about this on the preoperative assessment day.
On the day of the operation, you must arrive fasting. This means you must not eat, drink, smoke, use snuff or have lozenges/candy after midnight. You may only take any medications that the anaesthesiologist has told you in advance to take. This will be clarified on the preoperative assessment day before the operation.
In most hip operations, the anaesthetic is administered in the back, a so-called spinal anaesthetic, and you may be awake. Sometimes, in consultation with the anaesthesiologist, general anaesthesia is chosen instead, in which case you will be unconscious during the procedure.
An anaesthesia nurse will stay with you throughout the operation. They are your point of contact and will make sure you are comfortable. You should not feel pain, but you may notice some movement in your body while the orthopaedic surgeon replaces the joint. You may also hear banging and other sounds from the surgeon’s work.
You can listen to music during the operation if you wish. Bring the music you would like to listen to. If you would rather sleep for a while, you can be given relaxing medication.
The operation is performed under strict hygienic conditions. Hip operations are performed either with the patient lying on their side or on their back. The surgeon opens the hip joint with an incision near the hip. The femoral head is removed after the femoral neck is cut. This part is replaced with a prosthesis made of stainless steel or titanium alloy. The hip socket is replaced with a plastic or titanium cup.
The prostheses come in several sizes, and the orthopaedic surgeon chooses the one that is best suited to you. The cementless components are tapped into place. The prosthesis then grows firmly into the bone over the course of weeks or months. Some prostheses are fixed with bone cement, which is mixed and dries within a few minutes.
Once the femoral head has been fitted, the hip prosthesis is placed in the joint. The surgeon checks the leg length and ensures that the hip is stable during normal movements, so that it does not later “dislocate”.
Hip replacement surgery takes varying amounts of time, but usually around 90 minutes.
The usual hospital stay is 1–3 days, with daily exercise and activity. While in hospital, a physiotherapist will instruct you in exercises and how to walk with crutches. Your own efforts are essential for a successful outcome.
It is important to get back on your feet quickly. As early as 3–5 hours after surgery, you may be able to get out of bed with help. From the first day after surgery, you should walk using 2 crutches or other suitable aids.
Pain in the days and weeks after surgery is common. It is not dangerous to use your hip even if it is a little painful. You will be given pain-relieving tablets to keep the pain at an acceptable level. Your medication will be gradually reduced as the pain subsides. Most people have a pain-free, well-functioning hip, but it can take time (up to 1 year for some people) for the pain to disappear completely and movement to become optimal.
Restrictions after hip replacement surgery vary somewhat between hospitals and also depend on the surgical method used. Common restrictions may include:
Swelling and discolouration of the leg on the operated side are common due to increased fluid and blood accumulation. This may extend 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 exercises that promote circulation can also help reduce swelling.
The skin is closed either with dissolvable thread that does not need to be removed, or with thread/staples that must be removed after 2–3 weeks. Change the dressing as needed. You will be given information before discharge about how to care for both the stitches and the dressing. It is recommended that you avoid swimming in a pool, bathing in a tub or swimming in salt water for the first 3 weeks.
Daily activity and exercise are important after you leave the hospital.
Most people will be able to do the exercises on their own. You can stop using the crutches when you can walk normally without limping. Exceptions may apply in individual cases. You will receive information and practise this during your stay.
Walking and other light activities are recommended. You can resume sexual activity as far as your pain allows.
You will usually need 2–8 weeks of sick leave, depending on your type of work.
You will be given a prescription for pain-relieving medication. By prior agreement, some people will also be given a prescription for blood thinners.
You should wait to drive until you have stopped using crutches and your leg feels strong enough to drive. You must also not drive if you are taking pain-relieving medication with a red warning triangle on the packaging. The Road Traffic Act applies.
You will be given information about your follow-up plan when you are discharged.
The most common complications associated with hip replacement surgery are infection and dislocation of the hip. Both occur in approximately 1% of patients. It is important to contact the department promptly if you experience sudden severe pain or signs of infection (see more under “Warning signs”). Nerve damage can also occur, but it is rare and most often temporary, either fully or partially.
Blood clots are prevented through early mobilisation and blood-thinning injections, sometimes also with compression stockings. It is also recommended that you avoid long flights for the first 6 weeks after surgery. Sometimes a difference in leg length occurs, most often because the operated leg becomes longer. In that case, you may need to use an insole in the opposite shoe.
Exercises for the hip after replacement surgery.
Tighten your buttock muscles and press both knees down into the surface. Hold for a few seconds. Relax.
Bend your knee and hip and slide your heel along the surface. Then straighten your leg again.
Pull your ankles up. Move your legs apart and then slowly bring them back together. Do not lift your legs off the surface.
Glute bridge: Lie on your back with your knees bent. Squeeze your buttock muscles and lift your pelvis and lower back off the surface. Slowly lower back down.
Standing heel raises with support: Stand behind a chair and hold the back of it for support. Rise onto your toes on both feet, then slowly lower yourself back down.
Support yourself on a chair or similar. Place the operated leg slightly behind the other, with your toes on the floor. Straighten your leg by moving your heel towards the floor. Feel your thigh and buttock muscles working as you straighten your leg.
Support yourself against a chair, a wall or similar. Move the operated leg out to the side, then lower it back down in a controlled manner. It may be helpful to remove your shoe from the operated leg for this exercise.
Support yourself with both hands on the back of a chair or similar. Stand with your feet shoulder-width apart. Bend your hips and knees, distributing your weight evenly across both legs.
Going up stairs with crutches: Step up first with the uninjured leg, then the operated leg and crutches.
Going down stairs with crutches: Place the crutches one step down, then follow with the operated leg. The uninjured leg goes last. The crutches always move with the operated leg.
Waiting time: 30 - 86 weeks
Contact the Orthopaedic Department
Sykehusveien 1
Sykehusveien 1, 4838 Arendal
Waiting time: 12–28 weeks
Egsveien 100, building 10
Egsveien 100, building 10, 4615 Kristiansand
Waiting time: 8–32 weeks
Contact the Department of Surgical Specialties, Flekkefjord
Engvald Hansens vei 6
Engvald Hansens vei 6, 4400 Flekkefjord
