Hip surgery – Getting a new hip joint

A hip operation means that the femoral head, femoral neck and arthroplasty are replaced with two artificial parts of metal and plastic. The most common reasons why you need a hip replacement are osteoarthritis or a broken neck.

You may be helped by a hip replacement surgery if you have a leg fracture or if you have osteoarthritis which causes you hip pain and difficulty moving, while training and painkillers are no longer enough. The goal is that you will have less pain so that you can move better.

Preparations

You can prepare yourself at home by doing the following:

  • You can place things you use more easily on a daily basis.
  • You can remove loose rugs to reduce the risk of tripping.
  • You can shop for food, cook and freeze.

You can also contact an occupational therapist to try out aids you may need. It can be, for example, pantyhose, grip pliers, toilet seat raise, pillow and pillows to raise the bed. You may also need aids to avoid bending more than 90 degrees in the hip, which can cause the prosthesis to jump out of joint after surgery.

You will also need walking aids. Contact a physical therapist in the municipality to try out crutches or a walker. The physiotherapist can also help you with walking instructions. During winter time you need ice studs mounted on the crutches.

Examples of tools that you can get yourself are a long shoe horn, elastic laces, a long-handled bath brush and a so-called slip mat.

It’s good to find out what’s ahead of the surgery.

You must not eat and drink before the operation

The night before an operation you should not eat, drink, smoke or sniff, but it is good to find out what applies where you are to be operated.

You should shower your entire body and wash yourself with a special soap twice, both the day before the surgery and on the morning of the surgery. You can buy the soap at a pharmacy. Put on clean clothes after the shower and sleep in clean sheets. You should not wear body jewelry, loose jewelry or watch you after you start washing with the soap. You must also not use cosmetics or nail polish.

Good to be in good shape before surgery

It is a great strain for the body to get a new hip joint. Therefore, it is good if you try to improve your fitness and build up the strength of the leg muscles before surgery. Training also improves the immune system. A strong immune system is important to reduce the risk of infection. Through the training you will be easier to get up and move the first time after the surgery. In addition, the risk of complications such as blood clots and pneumonia is reduced. It is good to get help from a physical therapist with how to set up your workout to get the best results.

You can also think about trying to eat well, both to increase the body’s resistance and to build muscle strength. You may need to lose weight if you are overweight. It facilitates surgery and healing. A dietician can provide advice and support.

It is an advantage to feel good mentally to get good results from the operation. Many of the suggestions above to get in good shape before surgery also have a positive effect on mental health. It may be good to talk to a doctor if these tips do not help and you are depressed, for example. You may need treatment with medicines before surgery.

Good to quit smoking and not drink alcohol

The benefits of quitting smoking before surgery are many. The wounds heal faster and the blood circulation and fitness improves so you can recover faster. At the same time, the risk of complications is significantly reduced. You should stop smoking altogether, but if it is not possible, it is good if you can refrain from smoking six weeks before the operation and even the first weeks afterwards. Your doctor can tell you what support is available when you need help to quit smoking.

You should also avoid drinking alcohol six weeks before an operation to reduce the risk of complications.

Sometimes training can be enough

In osteoarthritis, you can often reduce your hips from the hip if you do physical therapy, relieve the joint with, for example, stick or lose weight. Regular exercise can allow you to maintain and improve the ability to walk, leg strength and mobility, and thus possibly postpone or avoid surgery.

In many places, for example, there are special arthritis schools where you can get information and help with training. There are also digital arthritis schools.

Preparatory visit

The procedures for preparing for a hip replacement surgery may differ slightly between different orthopedic clinics. It is common for you to come to the hospital two weeks before surgery for an enrollment visit. You can meet an orthopedic surgeon, an anesthetist, a nurse, a physical therapist and possibly a occupational therapist. The purpose of the visit is that you will be informed about how the operation will go to and how the stay in the hospital will be. The preparatory visit also aims to go through how you feel and what is important to prepare for the operation.

The orthopedist explains how the operation will go and answers questions. The doctor does a regular body examination and examines the hip to be treated. You also usually get to talk to an anesthetist who decides what form of anesthesia to use.

You are given blood and urine tests so that the doctor can check the blood value, blood sugar, salt balance and that the kidneys and urinary tract are functioning properly. The doctor also usually checks the blood pressure. You can fill out a form about your health condition and hip problems.

Tell your doctor about medication

It is important that you tell your doctor what medication you are taking and if you are hypersensitive to any medication. There may be several reasons for adjusting medication prior to surgery. Some medicines may or may not be combined with surgery. It is therefore important that you list all the medicines you use, also called herbal remedies.

The surgery is carried out in a hospital with surgery department and orthopedic clinic. You can usually come to the hospital the same morning as the operation is planned, but in some hospitals you may instead come in the afternoon or the night before. Once again, the healthcare staff goes through routines so that you do not have a fever, any wounds or an ongoing infection. You are then allowed to speak to the orthopedic surgeon.

You may change into hospital clothes and lie down in a bed before driving into the operating ward. The nurse attaches a venous catheter so you can get fluid and medication directly into the bloodstream. You are given painkillers before surgery, against the pain that comes after surgery, and antibiotics in the blood to prevent infections. It is increasingly common for the surgery to be done in so-called day surgery, that is, you come in the morning and go home the same day.

Then the operation goes on

You either get anesthesia or you are anesthetized. The most common thing is that you get back anesthesia and something soothing. Some may find it unpleasant to listen to the sounds in the operating room. Then you can get a sleep aid that allows you to sleep through the entire operation, without being anesthetized by anesthesia. Other people prefer to be awake and listen to music or radio in the headphones that are in the operating room.

During the operation, you lie on the side in a position to help you lie still. The area to be operated is washed with bactericidal alcohol solution and covered in sterile cloths. The orthopedist then makes a cut through the skin, underlying soft parts and muscles into the hip joint itself. The hinge head is lifted out of the hinge bowl and the parts to be replaced are removed.

Then the orthopedic leveles to the articulation bowl so that the artificial hip bowl can be attached there. Then the orthopedic attaches the prosthesis to the joint, either with cement or by tapping it. Sometimes the prosthesis may need to be fixed with a few screws into the pelvis. The orthopedist then attaches the shaft on which the new hip ball should sit on the femur, with or without cement.

When the shaft is in place, the new hip ball is put on and the joint is put back in the correct position. The surgery ends with muscles, connective tissue, subcutaneous fat and skin being sewn again. It usually takes one to two hours.

There are two methods

There are two different operating methods. One means cementing the new parts. The second means that no cement is used without the bone being allowed to grow firmly against the prosthesis. The latter method is more often used on younger people, as they often need multiple operations. If a second operation needs to be done, it becomes easier if the joint prosthesis is not cemented.

In USA, it is most common to get a prosthesis that is fixed with cement. It is a safe and good method that is suitable for most people. It is the orthopedist who decides which method to use. The choice of method is governed by, for example, age, the quality of the bone and the shape of the joint and the upper leg.

You may come to an emergency ward after surgery. There, the health care provider checks, for example, breathing and blood pressure, before being allowed to return to the ward.

You don’t feel anything during the operation itself, but afterwards it usually hurts in the operating area. Therefore, you get painkillers. Healthcare professionals will often ask you how you are feeling and if it hurts. The goal is to do as little pain as possible so that you can be up and moving without feeling too much discomfort. It is important to avoid complications such as blood clots. At the same time, you should not use more medicines than you need, as this can lead to side effects such as constipation, nausea and dizziness.

You also receive medicines that protect against blood clots. It can either be given as a syringe in the subcutaneous fat on the stomach or as a tablet. This treatment usually lasts for four weeks after surgery.

It is individual how long you need to stay in the hospital and you often get to discuss this with your doctor before the surgery. You usually do not have to stay long after the surgery, but it can vary depending on how old you are, how healthy you were before the surgery and how much help you can get at home. Often it is only a few days.

For most people, the prosthetic joint works without complications for the rest of their lives. Most suffer less pain, go better and become more mobile early after surgery.

Advice and precautions

You may start training to walk and use the hip joint the same day or at the latest the day after surgery. You can expect the pain and pain that existed before the surgery to disappear or decrease sharply already after a few days. However, it is common for some stiffness to remain for some time.

You need to train a lot after the surgery to regain muscle strength and practice good walking technique. Initially, you may use crutches or other walking aids, but you often manage without them after three months. You can continue with aids, especially outdoors, if the hips from the hip have been going on for so long that your strength and balance have become noticeably worse.

You can lie on the side you prefer right after the surgery. But you should avoid crossing your legs when you sit for at least three months after the surgery.

It is good with daily physical activity to exercise the muscles and walking technique. You should avoid bending or twisting the hip in the outer positions for at least three months after an operation, as it increases the risk of the hip going out of joint. After three months, there are often no limits to what activities you can do, but ask your doctor. Activities such as walking, swimming, golf, tennis, cross-country skiing, horse riding and dancing are excellent. Downhill skiing can work well if you are a used skier, but there is a risk that your hip will jump out of joint if you fall. You should avoid extremely heavy or long-lasting loads on the prosthetic joint.

You can decide for yourself when it is good to have sex, discuss with your physiotherapist or doctor. You can start driving when you regain good control and strength in the leg. It is your own responsibility to determine when you are road-safe.

Follow-up

Follow-up after surgery varies greatly between different hospitals. It is common to return visits after three to four months. The doctor or physiotherapist then checks how the rehabilitation is going. Follow-up can also be done by receiving a telephone call from a nurse. Sometimes you have to fill out questionnaires.

Most will be fine

Most people who get a new hip joint can expect to be able to live the rest of their lives without having to have a hip again. But there is always a risk of complications. Complications are usually divided into those who may come in connection with the operation and those who may come later.

Possible complications after surgery

It is relatively uncommon to have complications following a hip joint surgery. You should be aware of any pain in the hip joint after surgery. Then you may have got an infection. The risk of infection varies and depends on several things, such as your condition prior to surgery and the cause of the operation, but also the type of surgery performed. Ask your doctor.

You may get an infection in the operating wound that turns out to be a redness that hurts the wound edges. You may have a fever at the same time as your skin feels warm. The symptoms may vary.

You can also get a deep infection around the prosthesis. It causes you pain and fever. You should contact the orthopedic clinic immediately if you suspect such an infection. It is a troublesome condition that requires long treatment. You are given antibiotics before and in conjunction with the surgery to prevent a bacterial infection.

The newly operated hip joint can jump out of joint. This may happen if you touch your leg outside the safety margins that you have had to carefully go through both before and after the operation. If the hip jumps out of joint it can be corrected again, under anesthesia. This can usually be done without the need to open the operating wound.

You may also get a blood clot even if you have received a medicine that prevents blood clot after surgery. An important way to reduce the risk of blood clots in the legs is to quickly get on the legs after surgery. Blood clots appear as swelling and mute in the leg, sometimes along with fever. A serious complication that may occur is that the blood clot reaches the lungs, causing shortness of breath. In case of such suspicion you should seek medical advice as soon as possible.

Possible complications after some time

Complications may also occur several years after surgery. There is always a small risk that the prosthesis will jump out of joint. The younger and more active you are, the greater the risk of the prosthetic parts loosening from the anchorage to the bone. Ten years after surgery, fewer than five in 100 need to undergo an operation where all or part of the prosthesis needs to be replaced. You should seek a doctor if you get sore when you move and strain your hip. This may be because the new joint is not stuck properly, or that a prosthetic part may have become worn or broken. You may also have an infection in the area around the joint. Then you have to be re-operated to replace the old prosthesis with a new one.

Some dental treatments involve a risk of bacteria entering the bloodstream and being transported to the newly operated joint. You can get antibiotics in conjunction with dental treatment so that the joint does not run the risk of being infected. This happens, for example, if you are newly operated or if there is a risk of infection due to old age, smoking, obesity and other diseases. It can also occur due to deficiencies in the immune system or anemia.

You should always tell your dentist if you have a joint prosthesis. The dentist will determine if you need antibiotics.

Why is the treatment done?

In the hip, the hip ball leads to the pelvis in the pelvis and they slide towards each other. You may get sore and stiff if the cartilage in the joint is sick or damaged. The most common cause is osteoarthritis. You may need to get a new hip joint if you are having a lot of trouble and the exercise you have done is not having enough effect. Then the femoral head, femoral neck and arthroplasty are replaced with artificial parts, a so-called hip joint prosthesis. The prosthesis usually consists of plastic and metal. The goal of the operation is to reduce the pain from the hip so that you can move better.

Common causes

There are several reasons why you may need surgery. The most common reason is that you have osteoarthritis. Then the cartilage is broken in the hip faster than it builds up, which can cause the joint to function poorly and cause you pain.

The reason why you get osteoarthritis is not completely clear, but most people believe that osteoarthritis is due to mechanical properties and overload. This may in turn be due to, for example, injury or congenital hip disease, such as hip dysplasia or hip joint dislocation in childhood.

There are also other childhood diseases of the hip that can cause hip arthritis later in life. Perthes disease is one such example. You are also more likely to get osteoarthritis if you weigh too much and have weak muscles.

Another less common reason you may need surgery is that you have a rheumatic joint disease, such as rheumatoid arthritis, psoriatic arthritis, or bone necrosis. Bennekros means that the blood supply to the hip ball is not working and that the skeleton in the area stops being rebuilt. Bennekros may be due to cortisone treatment, that you consume too much alcohol or that you have suffered a severe injury to the hip joint and femur.

A bone fracture, so-called hip fracture, is another common reason you may need surgery. You may need a full or half hip prosthesis, depending on what the fracture looks like. If you get a semi-prosthesis, the femoral neck and articulated head are replaced with artificial parts, but not the articulated bowl. The doctor can also fasten the leg using screws or nails if the leg ends of the fracture are in good position close to each other. Then you may need to have a hip joint if the fracture does not heal properly and you will have trouble.

When is an operation inappropriate?

You cannot be operated on if you have an infection in your body, if you have leg ulcers or if you have a fever. The risk then increases for problems with wound healing, infection in the surgical area and other complications. You should also not be operated on if you have had a heart attack during the past six months.

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