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After a hip replacement exercises
A hip replacement swaps a worn hip joint for an artificial ball and socket. It reliably relieves pain and improves walking, and most people recover faster than they expect - often faster than after a knee replacement. The rehabilitation focuses on rebuilding the hip and buttock muscles, which weaken over years of arthritis and again after surgery, and on restoring a normal walking pattern.
Depending on the surgical approach you may be given hip precautions: movements to avoid for the first six to twelve weeks to protect against dislocation, such as bending the hip past 90 degrees, crossing the legs, or turning the leg inwards. Some approaches need no precautions at all. Follow the specific advice from your surgical team, which always takes priority over general guidance.
The typical picture in the early weeks is a hip that is sore around the wound and along the outside of the thigh, tires quickly, and is stiff first thing in the morning. A limp is common at first and usually reflects weak buttock muscles rather than anything wrong with the joint, and it improves as strength returns. Some puffy swelling in the thigh, and sometimes down at the ankle, is normal for several weeks when it is soft, painless and eases overnight or with the leg up. Calf pain or tightness, a warm or red calf on one side, or sudden breathlessness are not part of normal recovery and need urgent medical attention to rule out a clot.
Most people are walking with a stick or unaided within two to six weeks, back to most daily activities by around three months, and still gaining strength and stamina at a year. This programme moves from gentle early activation and standing work, through progressive strengthening, into walking distance and daily function. Contact your surgical team if the hip becomes hot, increasingly painful, or gives way.
Who this programme is for
People recovering from a total hip replacement who have been cleared to exercise by their surgical team, and who are observing any hip precautions they were given. It suits the first weeks at home through to rebuilding walking distance months later. It complements hospital physiotherapy rather than replacing it.
Get checked by a clinician first if
- Sudden severe hip or groin pain, the leg looking shorter or turned out, and inability to weight-bear - possible dislocation, seek urgent assessment
- Calf pain, swelling, warmth or redness, or sudden breathlessness or chest pain - seek urgent help to rule out a clot
- Wound that opens, leaks, or becomes increasingly red, hot and painful, with or without a fever
- New numbness, foot drop, or the foot feeling cold or looking pale
- The pain followed a significant accident, fall or direct blow and you have not been checked over
- You feel unwell with the pain - a fever, night sweats, or losing weight without trying
- The area is hot, very swollen and red, especially if you also feel feverish
- Pain that is severe, steadily getting worse, or keeps you awake every night and does not ease with a change of position
The staged programme
Stage 1
First days and weeks
The early phase. Ankle pumps for circulation, gentle hip and buttock activation within any precautions, and supported standing to load the leg and start retraining balance and a normal step.
Stage 2
Build strength
From around 4 to 6 weeks. Progress sit-to-stand, bridging and standing hip strengthening, working towards even weight through both legs and away from a limp.
Stage 3
Return to activity
From around 3 months, once precautions are lifted. Rebuild walking distance, stairs, and the strength for hobbies and daily life, continuing for 6 to 12 months.
How long recovery takes
Most people walk with one stick or unaided within 2 to 4 weeks, stop using walking aids around 4 to 6 weeks, return to driving around 6 weeks, and feel largely back to normal daily life by 3 months. Muscle strength and stamina keep improving for up to a year.
Knowing when to progress
In the first 6 to 12 weeks, keep every exercise within your hip precautions. Aim to take even weight through the new hip from early on, as favouring it prolongs the limp. Progress strengthening load gradually and keep it going beyond the point you feel recovered - residual buttock weakness is common and fixable.
Common questions
What are hip precautions and how long do they last?
They are temporary limits - typically no bending the hip past 90 degrees, no crossing the legs, and no turning the operated leg inwards - to protect against dislocation while the tissues heal. They usually apply for 6 to 12 weeks. Some newer surgical approaches use few or no precautions; follow your team's advice.
Why do I still have a limp after the pain has gone?
Years of arthritis weaken the buttock muscles that keep the pelvis level when you walk. The limp usually improves with dedicated hip abductor strengthening over 2 to 3 months.
When can I sleep on my side?
Often from around 6 weeks, usually on the non-operated side first with a pillow between your knees to keep the leg from crossing the midline. Check with your surgical team.
What activities are allowed long term?
Walking, swimming, cycling, golf, bowls, dancing and hiking are all encouraged. High-impact activities like running and jumping are usually discouraged to reduce wear. Your surgeon can advise for your implant.
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