Rehabilitation after hip replacement: a week-by-week guide

What changes after a hip replacement

A total hip replacement substitutes the worn joint surfaces with artificial components. The femoral head, eroded by arthritis, is removed and replaced with a ceramic or metal ball fixed onto a stem inserted into the femur. The acetabulum (the pelvic socket) is lined with a metal cup containing a polyethylene or ceramic liner. The two pieces articulate to reproduce the natural movement of the hip.

The procedure lasts 60 to 90 minutes on average. Current surgical techniques, especially the anterior approach, preserve more muscle and shorten recovery. But regardless of technique, rehabilitation is the determining factor of the outcome. A good surgeon implants the prosthesis. Your rehabilitation work decides what you will be able to do with it.

Post-operative precautions

Precautions depend on the surgical approach. Your surgeon will give you specific instructions. The following guidelines are general and must be adapted to your case.

Posterior approach (the most common)

The three prohibited movements during the first 6 weeks are hip flexion beyond 90 degrees (do not bend the thigh past horizontal), internal rotation (do not turn the foot inward), and adduction (do not cross the legs). These combined movements risk dislocating the prosthesis. In practice: use a raised toilet seat, do not bend down to pick up objects from the floor, do not cross your legs sitting or lying, do not sit on low chairs.

Anterior approach

Restrictions are less demanding. Excessive hip extension and forced external rotation are the movements to avoid. Flexion beyond 90 degrees is often permitted earlier. Dislocation risks are generally lower with this approach. Your surgeon will specify the limitations and their duration.

Complication prevention

Deep vein thrombosis is a risk after any hip surgery. Wear the prescribed compression stockings. Take the anticoagulant medication as directed. Move your feet and ankles regularly, even in bed. Walk as soon as possible after the operation.

Week 1: first steps

You will get up the same day or the day after surgery. The hospital physiotherapist will guide you through the first transfers (bed to chair, chair to toilet) and the first steps with a walker or crutches.

Bed exercises

Ankle pumps. Lying down, pull your feet toward you then push them away, as if pressing a pedal. 20 repetitions every hour. This exercise activates the calf muscle pump and reduces the risk of blood clots.

Isometric quadriceps contraction. Lying down, push the back of the knee into the mattress by tightening the thigh muscle. The knee locks straight. Hold for 5 seconds. Release. 10 repetitions, 3 times per day. The quadriceps inhibits very quickly after surgery. This isometric contraction wakes it up.

Isometric gluteal contraction. Lying down, squeeze your buttocks as if holding a coin between them. Hold for 5 seconds. Release. 10 repetitions, 3 times per day.

Heel slide. Lying on your back, slide the heel of the operated side toward the buttock by bending the knee and hip. Go as far as pain allows, respecting the 90-degree flexion limit if your surgeon prescribed it. Return the leg to a straight position. 10 repetitions, 2 times per day.

Walking

Walk with the walker or two crutches. Take small steps. The walking pattern is: crutches forward, operated leg, then healthy leg. Bear some of your weight through the crutches to unload the hip. Distance target for the first week: the necessary trips within the hospital room and corridor.

Weeks 2 and 3: at home

Most patients go home between post-operative day 2 and day 5. Rehabilitation continues at home, ideally with physiotherapy sessions 3 times per week.

Exercises

Side-lying abduction. Lying on the healthy side, a pillow between the knees. Raise the operated leg toward the ceiling, knee straight. Lift 20 to 30 cm. Lower slowly. 3 sets of 10. This movement strengthens the gluteus medius, the muscle most engaged during walking to stabilize the pelvis.

Standing hip extension. Standing, hands resting on the back of a chair. Move the operated leg backward, knee straight, without arching the back. Hold for 3 seconds. Return. 3 sets of 10. This movement strengthens the gluteus maximus.

Standing hip flexion. Same position. Raise the knee on the operated side toward the ceiling. Do not exceed 90 degrees if precautions require it. 3 sets of 10.

Mini-squat with support. Hands on the back of a chair. Feet hip-width apart. Bend the knees 20 to 30 degrees. Push back up. 3 sets of 10. This movement reintroduces bilateral weight bearing and engages the quadriceps and glutes together.

Walking

Increase walking distance each day. Aim for 10 to 15 minutes of continuous walking by the end of week 3. Use both crutches as long as a limp persists. Focus on walking quality: even steps, stable pelvis, eyes straight ahead.

Ice and swelling management

Apply ice to the operated hip for 15 minutes, 3 times per day. Ice reduces swelling and relieves pain. Always place a cloth between the ice and your skin.

Weeks 4 to 6: progressive strengthening

Post-operative pain is decreasing. Mobility is improving. Now is the time to increase exercise intensity.

Exercises

Glute bridge. On your back, knees bent, feet flat. Lift the pelvis. Hold for 5 seconds. Lower. 3 sets of 12. When it becomes easy, progress to the single-leg bridge (one foot on the floor, the other knee toward the chest).

Step-up. Facing a 15 cm step. Step up with the operated leg. Control the descent. 3 sets of 10. Increase the step height as the exercise becomes easy (20 cm, then 25 cm).

Lateral walk with resistance band. A band around the ankles. Take lateral steps, 10 in each direction. Keep knees slightly bent and back straight. 3 sets. This exercise targets the gluteus medius in the frontal plane, which directly improves pelvic stability during walking.

Reverse lunge. Standing, step back with the healthy leg. Bend both knees. Push back to return. 3 sets of 8 per leg. This movement loads the operated hip functionally while improving balance.

Transitioning from crutches

Around week 4 to 6, most patients transition from two crutches to one, held on the opposite side of the operated hip. The crutch stays until walking is smooth and limp-free. For some, that takes 4 weeks. For others, 8. There is no fixed timeline. Walking quality dictates progression.

Weeks 6 to 12: independence and functionality

Dislocation precautions are typically lifted by the surgeon around week 6. Hip range of motion can be used more freely. The goal now is to return to normal daily life and prepare for leisure activities.

Exercises

Full squat. Feet apart, lower as deep as possible while keeping the back straight. 3 sets of 12. Add weight progressively (dumbbell, weighted backpack).

Single-leg deadlift. Standing on the operated leg. Lean your torso forward while extending the free leg behind you. Lower until the torso is parallel to the floor. Rise back up. 3 sets of 8. This exercise combines gluteus maximus strengthening, hamstring work, and balance training.

Standing abduction with band. Band around the ankles. Move the operated leg out to the side. Control the return. 3 sets of 15. Increase band resistance when the exercise is mastered.

Stationary bike. If you have access to a stationary bike, start with 10 minutes at light resistance. Add 2 minutes per session. Aim for 20 to 30 minutes by the end of this period. The bike is an excellent exercise for the hip: it improves flexion mobility, strengthens the quadriceps, and builds cardiovascular endurance without impact.

Extended walking

Aim for 30 minutes of daily walking without a crutch. Vary terrain once flat ground is comfortable. Add gentle slopes. Outdoor walking on natural terrain challenges balance and proprioception more completely than indoor walking.

After 12 weeks: returning to activities

Most patients resume driving between week 4 and 6 (right side operated) or as early as week 2 (left side operated, automatic transmission). Check with your surgeon and your insurer.

Return to work depends on the type of activity. A desk job is possible by week 4 to 6. Physical work may require 3 to 6 months.

Sporting activities

Swimming is permitted once the wound has closed (around week 3 to 4). Start with freestyle or backstroke. Breaststroke, with its external hip rotation movement, can resume around week 8.

Road cycling can resume around week 8 to 12, depending on your comfort. Start on flat terrain. Avoid falls (they are dangerous with a prosthesis).

Light hiking resumes around week 12. Start with flat trails of 30 to 45 minutes. Increase duration and elevation gain progressively.

Golf resumes around week 12 to 16. The swing engages hip rotation significantly. Start with short shots (putting, chipping) before progressing to the drive.

Running is a debated topic. Some surgeons allow it after 6 months if the patient has good muscle capacity and alignment. Others advise against it due to accelerated prosthesis wear. Discuss this specifically with your surgeon.

Warning signs after hip replacement

Seek emergency care if: the hip dislocates (sudden pain, inability to move the leg, leg shortened and rotated), intense pain appears with fever (infection risk), or if the calf swells and becomes painful (clot risk).

See your doctor within days if: the wound becomes red, weepy, or warm, pain increases instead of decreasing, or a clicking sound appears in the hip.

Factors that influence recovery

Physical condition before the operation matters. Patients who maintained physical activity and good muscle tone before surgery recover faster. If your operation is planned, start strengthening exercises 4 to 6 weeks before the date.

Body weight influences the longevity of the prosthesis and the speed of recovery. Every excess kilogram adds extra load on the artificial components. A healthy weight reduces the risk of complications and long-term revision surgery.

Smoking slows bone healing and increases infection risk. If you smoke, quitting at least 4 weeks before surgery significantly improves outcomes.

Motivation and exercise consistency are the most determining factors. The prosthesis gives you a new hip. Rehabilitation decides what that hip will let you do.

A matter of time, not talent

Rehabilitation after hip replacement is not complicated. The exercises are simple. The progressions are logical. But it takes time and consistency. The first days are uncomfortable. The first weeks are tiring. Around the second month, most patients notice a clear change: the arthritic pain that poisoned their daily life is gone, and mobility returns week by week.

At 6 months, 90% of patients report satisfaction with the result. At one year, the majority have resumed the activities that matter to them. Hip replacement is one of the most successful procedures in modern orthopedic surgery. Follow the program and trust the process.