Hip Replacement Rehabilitation Guide

Understanding Your Hip Replacement

Total hip arthroplasty (THA) is one of orthopedics' most successful procedures. The damaged hip joint—worn from arthritis, fracture, or other conditions—is replaced with metal and plastic components. The femoral head (ball) is replaced with a metal or ceramic ball on a stem that sits in your thigh bone. The socket (acetabulum) is resurfaced with a metal cup lined with plastic or ceramic.

Think of your hip as a ball-and-socket joint. When the surfaces are worn and rough, every movement grinds and causes pain. Hip replacement creates new, smooth articulating surfaces that glide instead of grind. But surgery is just step one. The muscles around your hip have been cut, stretched, or weakened. The ligaments have been disrupted. Your brain has learned protective movement patterns that limit function. Rehabilitation rebuilds strength, restores mobility, and retrains normal movement patterns.

Unlike knee replacement where motion is the early priority, hip replacement emphasizes stability. The new hip is at risk for dislocation until tissues heal and scar tissue forms to stabilize the joint. This creates unique challenges—preventing dislocation while regaining mobility. The balance requires following precautions precisely while progressively challenging the hip.

Recovery Timeline Overview

Understanding what to expect at each stage helps you stay on track:

Hip Precautions: What They Mean and Why

If you had a posterior approach, hip precautions are critical for preventing dislocation while tissues heal.

Week 0-2: Protection Phase

The goals are simple but critical: wound healing, pain control, and early mobility with precautions.

Daily Milestones

Essential Exercises (Weeks 0-2)

Ankle Pumps (DVT prevention):

• Move foot up and down vigorously
• Pump ankle like pressing gas pedal
• 20 reps every hour while awake
• Prevents blood clots

Gluteal Sets:

• Squeeze buttocks together tightly
• Hold 5 seconds, relax
• 10-15 reps, 3 times daily
• Activates hip stabilizers

Quad Sets:

• Sit or lie with leg extended
• Push knee down into surface, tightening thigh
• Hold 5 seconds, relax
• 10-15 reps, 3 times daily

Standing Hip Abduction (holding support):

• Stand holding counter or walker
• Move surgical leg outward sideways
• Keep knee straight, body still
• Don't lean—only leg moves
• 10 reps, 2 times daily

Clamshells (if precautions allow):

• Lie on non-surgical side with knees bent
• Keep feet touching, lift surgical knee
• Opens like clamshell
• Don't rock backward—only hip moves
• 10-15 reps, 2 times daily

Week 2-6: Mobility Phase

This is where most people see dramatic improvement. Focus shifts from protection to progression.

Mobility Progression

Key Exercises (Weeks 2-6)

Standing Hip Extension:

• Stand holding counter for support
• Move surgical leg backward slowly
• Keep knee straight, don't arch back
• Feel glute squeeze
• 10-15 reps, 2 times daily

Standing Hip Abduction (progressed):

• Stand holding counter
• Move surgical leg outward sideways
• Add light ankle weight as able
• 2 sets of 15 reps, 2 times daily

Mini Squats (if precautions allow):

• Stand holding counter for support
• Squat slightly, bending hips and knees 20-30 degrees
• Keep surgical leg aligned—don't let knee cave inward
• Avoid deep bending (＞90°)
• 2 sets of 10-15 reps, 2 times daily

Single Leg Balance:

• Stand near wall or counter for safety
• Balance on surgical leg, progress to 30+ seconds
• Improves stability and confidence
• 2 sets of 5 reps, 2 times daily

Bridge (if precautions allow):

• Lie on back, knees bent, feet flat
• Lift hips toward ceiling
• Squeeze glutes at top
• Keep surgical leg within safe range
• 2 sets of 10-15 reps, 2 times daily

Week 6-12: Strengthening Phase

Now that mobility is established and precautions may be relaxing, focus shifts to strength and endurance.

Driving and Return to Work

Driving:

• Right hip surgery: 4-6 weeks before driving
• Left hip surgery: 2-3 weeks (automatic transmission)
• Requirements: Off narcotic medications, adequate reaction time, sufficient strength to brake firmly
• Test in empty parking lot before driving on roads

Return to work:

• Desk job: 4-6 weeks
• Light duty: 6-8 weeks
• Heavy labor: 3-4 months or permanent restrictions
• Discuss timing with your surgeon—individual factors matter

Expected Outcomes

By 3 months, most people achieve:

• Walk 1/4 mile or more without assistance
• Climb stairs normally (reciprocal pattern)
• Perform most daily activities independently
• Minimal pain with normal activities
• Hip motion within functional range

Full recovery continues for 6-12 months as strength, endurance, and confidence continue to improve.

Long-Term Protection and Activity

Your hip replacement will last longer with some considerations:

Recommended activities (low impact):

• Walking
• Swimming
• Cycling
• Golf (with cart initially, progress to walking)
• Dancing (ballroom, not high-impact)
• Hiking on flat terrain

Activities to avoid or limit:

• High-impact activities: running, jumping sports
• Heavy lifting: ＞50-75 lbs repeatedly
• Deep squatting: respect implant limits
• High-risk falls: contact sports, rock climbing
• Extreme ranges: discuss with surgeon

Maintenance:

• Continue exercises 2-3 times weekly
• Maintain healthy weight (each extra pound adds ~3 lbs to hip)
• Report infections before dental/surgical procedures (antibiotics may be needed)
• Regular follow-up X-rays to monitor implant

Warning Signs: When to Seek Help

Common Questions

References