Rehabilitation After Total Hip Replacement

Day 0: Walking on Your New Hip

In most cases, you will stand and begin walking on the day of your hip replacement.

Once your anaesthetic has worn off sufficiently and it is safe to stand, a physiotherapist will help you get out of bed.

You will usually begin with a walking frame or crutches. Most patients are allowed to place weight through their new hip straight away unless there is a specific reason to restrict weight-bearing.

Your first walk may only be a short distance.

The goals on day 0 are simple:

• stand safely
• begin walking
• learn how to use your walking aid
• begin simple exercises
• start rebuilding confidence in the operated leg

Modern hip replacement rehabilitation emphasises early mobilisation rather than prolonged bed rest.

Some pain is expected, but it should become progressively more manageable.

A hip replacement is major surgery and the tissues around the hip need time to recover.

Pain varies considerably between patients. It can also change as spinal anaesthesia, nerve blocks or local anaesthetic wear off.

A systematic review examining pain trajectories after total hip replacement analysed 71 trials involving almost 6,000 patients and found considerable variation in early postoperative pain between individuals.

Pain management therefore usually combines several approaches, which may include:

• paracetamol
• anti-inflammatory medication when appropriate
• local anaesthetic
• stronger pain medication when required
• ice
• movement and positioning

The aim is not necessarily to make the hip completely pain-free. It is to make you comfortable enough to sleep, walk and participate in rehabilitation.

Weeks 1–2: Swelling, Bruising and Ice

Bruising and swelling around the hip and thigh are normal during early recovery.

Swelling may extend down the thigh and sometimes into the lower leg.

Bruising can also become more obvious several days after surgery and may appear some distance away from the incision.

This does not necessarily mean something has gone wrong.

Ice can be useful for comfort and swelling. Apply a cold pack through a protective layer rather than directly against the skin.

Compression garments or stockings are sometimes used depending on your individual circumstances.

Movement is also important. Regular short walks are generally preferable to spending the entire day sitting or lying down.

A useful principle during early recovery is little and often: walk, exercise and rest repeatedly rather than trying to complete one long session.

Weeks 2–6: Walking and Physiotherapy

The main goals are a normal walking pattern, improving strength and increasing independence.

During this period, most patients progressively move from a frame or crutches to a walking stick and eventually independent walking.

Do not rush to discard your walking aid if doing so causes a significant limp.

Walking well with a stick is generally more useful than walking badly without one.

Physiotherapy may focus on:

• walking technique
• hip and leg strength
• balance
• getting in and out of chairs
• stairs
• everyday activities
• gradually increasing walking distance

There is no single rehabilitation program proven to be best for every hip replacement patient. A systematic review of rehabilitation following total hip replacement found broadly similar outcomes across a variety of rehabilitation programs.

Formal physiotherapy is also not essential for every uncomplicated patient. A randomised controlled trial comparing formal physiotherapy with a self-directed exercise program found similar functional outcomes in appropriately selected patients.

The important goal is progressive movement and strengthening, whether this occurs independently or with more formal physiotherapy support.

Weeks 6–12: Rebuilding Strength and Endurance

Feeling comfortable does not necessarily mean your hip has regained its full strength.

By six weeks, many patients are walking substantially better and performing everyday activities more easily.

However, weakness can persist even when pain has improved.

Exercise increasingly focuses on:

• hip abductor strength
• thigh and buttock strength
• balance
• walking endurance
• stairs
• functional activities

A systematic review and meta-analysis of exercise therapy after hip replacement found that exercise therapy improved both balance and gait.

Do not be concerned if endurance takes longer to return than pain relief. These are different parts of recovery.

What Is Normal After Hip Replacement?

Swelling, numbness, fatigue and occasional setbacks do not necessarily mean something is wrong.

Several experiences commonly concern patients.

Swelling and bruising: These can extend well beyond the incision and gradually settle over several weeks.

Numbness: Altered sensation around the incision is common because small skin nerves are affected during surgery. With an anterior approach, numbness or tingling over the outer thigh can also occur.

Muscle weakness: Your muscles may fatigue surprisingly quickly even when the arthritic hip pain has disappeared.

Uneven walking: A limp can persist while strength and movement recover.

Fatigue: Major surgery can leave you unusually tired for several weeks.

Good days and bad days: Increasing activity can temporarily produce more aching or swelling the following day.

Recovery is not perfectly linear. A difficult day does not necessarily mean you have damaged the hip replacement.

Do I Need Hip Precautions?

Hip precautions should be tailored to your operation and individual circumstances.

Patients are often concerned about bending, sleeping positions, crossing their legs or accidentally dislocating the new hip.

The precautions required depend partly on the surgical approach, stability of the hip and individual patient factors.The new hip can dislocate if it moves into a vulnerable position. Follow the precautions advised for your operation.

I use the Direct Anterior Approachfor most suitable primary hip replacements, and restrictions are tailored to the individual operation.

Follow the specific instructions you are given rather than restrictions you may hear from another patient whose operation may have been different.

Driving and Returning to Everyday Life

Return to activities should be based on safe function rather than simply reaching a particular date.

You should not drive while taking medication that impairs alertness or while you cannot confidently control the vehicle.

A systematic review and meta-analysis of driving after total hip replacement found substantial variation between studies, although brake reaction times generally returned towards or beyond preoperative values during the early postoperative period.

In practice, return to driving also depends on:

• which hip was replaced
• strength and reaction time
• pain
• ability to enter and exit the car
• ability to perform an emergency stop
• medication use
• insurance requirements

Work and recreational activities should similarly be reintroduced progressively.

Three Months to One Year: The Bigger Picture

Much of the improvement happens early, but recovery continues long after the incision has healed.

A large prospective study following 1,898 hip replacement patients found the greatest proportional improvement in patient-reported outcomes occurred during the first month, while measures of physical activity continued improving over subsequent months. Read the study of recovery trajectories after total hip replacement.

A broader systematic review of physical recovery following hip replacement similarly found substantial recovery over the first 6–8 months.

By this stage, rehabilitation is less about recovering from surgery and more about rebuilding:

• strength
• endurance
• balance
• confidence
• participation in normal life

Do not judge the final result of your hip replacement by how you feel at two or six weeks.

When Should I Seek Help?

Some symptoms are expected during recovery; others require assessment.

Contact our office, your GP or the hospital if you develop:

• increasing redness or warmth around the incision
• persistent wound leakage or pus
• fever or feeling significantly unwell
• pain that is becoming substantially worse after initially improving
• rapidly increasing swelling
• new significant calf pain or swelling
• sudden deterioration following a fall

Seek urgent medical attention for sudden shortness of breath, chest pain or coughing blood.

Sudden severe hip pain with an inability to move or bear weight through the leg, particularly if the leg appears shortened or abnormally rotated, also requires urgent assessment because this can indicate hip dislocation or fracture.

My Approach to Rehabilitation After Hip Replacement

The aim is confident, independent movement—not simply the fastest possible recovery.

For my patients having total hip replacement surgery in Brisbane, rehabilitation starts with standing and walking on the day of surgery.

Early recovery focuses on pain control, safe walking and independence. As the surgical discomfort settles, the emphasis progressively shifts towards strength, balance, endurance and returning to normal activities.

Patients recover at different rates. Large registry research has identified several different recovery trajectories following hip replacement rather than one universal pathway. Read the study of recovery trajectories after THR.

For patients having hip replacementwith me inBrisbane, I therefore prefer rehabilitation to be progressive and individualised.

The important question is not whether you are recovering at exactly the same speed as another patient, but whether your pain, walking, strength and function are moving in the right direction over time.

Hip Replacement Rehabilitation in Brisbane

Dr Alexey Borshch is a specialist orthopaedic surgeon in Brisbane with a particular clinical focus on surgery of the hip, knee and lower limb.

His practice as a Brisbane orthopedic surgeon focuses on the assessment and treatment of hip arthritis, along with performing hip replacement and revision hip replacement surgery.

Dr. Borshch completed his medical degree at the University of Queensland before undertaking specialist orthopaedic training in Queensland. He completed the Australian Orthopaedic Association training program and the Royal Australasian College of Surgeons Fellowship Examination in Orthopaedic Surgery. He obtained specialist registration in Orthopaedic Surgery in 2022 and is a Fellow of the Australian Orthopaedic Association.

Dr. Borshch offers consultations in Hamilton, Brisbane, and performs private orthopaedic surgery at Brisbane Private Hospital.