Hip Replacement Exercises: Complete Recovery & Rehabilitation Guide
📊 Quick Facts About Hip Replacement Recovery
💡 Key Takeaways for Successful Hip Replacement Recovery
- Start early: Begin gentle exercises within 24 hours of surgery to prevent blood clots and maintain muscle tone
- Consistency is crucial: Perform exercises 3-4 times daily in the early weeks, prioritizing regular short sessions over occasional long ones
- Follow hip precautions: Avoid bending beyond 90 degrees, crossing legs, and internal rotation for 6-12 weeks (varies by surgical approach)
- Progress gradually: Move from bed exercises to standing exercises to walking as your strength improves
- Use proper technique: Quality of movement matters more than quantity - slow, controlled movements are safer and more effective
- Listen to your body: Mild discomfort is normal, but stop if you experience sharp pain and consult your healthcare team
- Walking is medicine: Short, frequent walks are one of the best exercises for hip replacement recovery
Why Are Exercises Important After Hip Replacement?
Regular exercise after hip replacement surgery is essential for restoring hip mobility, rebuilding muscle strength, preventing blood clots, reducing scar tissue formation, and achieving the best possible functional outcome. Studies show that patients who follow structured rehabilitation programs recover faster and report higher satisfaction with their new hip.
Hip replacement surgery, medically known as total hip arthroplasty (THA), involves replacing a damaged hip joint with an artificial prosthesis made of metal, ceramic, and plastic components. While modern surgical techniques have made this procedure highly successful, the surgery itself is only the beginning of your recovery journey. The rehabilitation exercises you perform in the weeks and months following surgery play a crucial role in determining your ultimate outcome.
During surgery, the muscles, tendons, and other soft tissues around your hip joint are manipulated and sometimes cut to access the joint. This trauma, combined with the period of reduced activity before surgery, leads to muscle weakness and joint stiffness. Without proper rehabilitation, these issues can persist and limit your ability to walk, climb stairs, and perform daily activities comfortably.
Research published in the Cochrane Database of Systematic Reviews demonstrates that structured exercise programs after hip replacement lead to significantly better outcomes in terms of physical function, pain reduction, and quality of life. Patients who engage in regular rehabilitation exercises typically regain independence faster and are more likely to return to their pre-surgery activity levels or even exceed them.
Benefits of Post-Operative Exercise
The benefits of rehabilitation exercises extend far beyond simply strengthening the muscles around your new hip. A comprehensive exercise program addresses multiple aspects of recovery simultaneously, creating a synergistic effect that accelerates healing and improves outcomes.
- Restores range of motion: Gentle stretching and movement exercises help maintain and improve flexibility in the hip joint, preventing stiffness that can limit function
- Rebuilds muscle strength: Targeted strengthening exercises restore the power of muscles that support and move the hip, including the quadriceps, gluteals, and hip abductors
- Prevents blood clots: Movement promotes blood circulation in the legs, significantly reducing the risk of deep vein thrombosis (DVT), a potentially serious complication
- Reduces swelling: Exercise helps pump fluid back toward the heart, decreasing post-operative edema and associated discomfort
- Promotes bone healing: Weight-bearing exercises stimulate bone growth around the prosthesis, improving long-term implant stability
- Improves balance and coordination: Progressive exercises help retrain proprioception (body awareness) and reduce fall risk
- Enhances psychological wellbeing: Active participation in recovery provides a sense of control and accomplishment, reducing anxiety and depression
A 2024 meta-analysis of 42 randomized controlled trials found that patients who participated in structured physiotherapy programs after hip replacement showed 30% greater improvement in functional outcomes compared to those receiving minimal intervention. The benefits were most pronounced in patients who started exercises early and maintained consistency throughout the recovery period.
What Should I Know Before Starting Exercises?
Before starting hip replacement exercises, you must understand your specific hip precautions (which vary by surgical approach), obtain clearance from your surgeon, learn proper positioning and techniques, and recognize warning signs that indicate you should stop and seek medical attention.
While exercise is beneficial and essential for recovery, it must be performed safely and appropriately. The specific exercises recommended and any restrictions you must follow depend largely on the surgical approach your orthopedic surgeon used during your procedure. Understanding these factors is crucial for a safe and effective rehabilitation.
The two main surgical approaches for hip replacement are the posterior approach and the anterior approach, though several other variations exist. Each approach involves different muscle and tissue handling, which affects which movements you should avoid during the early healing phase. Your surgeon and physiotherapist will provide specific guidance based on your individual surgery.
Understanding Hip Precautions
Hip precautions are specific movement restrictions designed to prevent dislocation of your new hip joint during the early healing period when the surrounding tissues are still recovering. The capsule and muscles that help hold the hip in place need time to heal and regain strength. Violating these precautions can result in the ball of the prosthesis coming out of the socket, requiring medical intervention to relocate it.
| Surgical Approach | Typical Precautions | Duration | Additional Notes |
|---|---|---|---|
| Posterior (Most Common) | No bending hip beyond 90°, no crossing legs, no internal rotation | 6-12 weeks | Use raised toilet seat, hip chair |
| Anterior | No extreme hip extension, no external rotation with extension | 4-6 weeks | Generally fewer restrictions |
| Lateral | Variable - surgeon-specific guidance | 6-8 weeks | Focus on abductor protection |
| Minimally Invasive | Often fewer restrictions; surgeon-specific | 2-6 weeks | Faster return to normal movement |
The precautions listed above are general guidelines. Your surgeon may have modified or added to these based on your specific surgery, bone quality, and other factors. Always follow the specific instructions given to you by your surgical team. If you are unsure about any movement or exercise, ask your physiotherapist before proceeding.
General Safety Guidelines
Regardless of your surgical approach, certain safety principles apply to all hip replacement patients performing rehabilitation exercises. Following these guidelines will help you exercise effectively while minimizing the risk of complications or setbacks.
- Get clearance: Ensure your surgeon has approved you to begin the exercises in your program
- Work with a physiotherapist: A trained professional can teach proper technique and progress your program appropriately
- Use prescribed walking aids: Do not discontinue crutches or walker until instructed by your healthcare team
- Exercise on a stable surface: Use a firm bed or floor mat to prevent slipping
- Maintain slow, controlled movements: Avoid jerky or ballistic motions that could strain healing tissues
- Never exercise through sharp pain: Mild discomfort is normal, but sharp or sudden pain is a warning sign
- Stay hydrated: Adequate fluid intake supports healing and helps prevent constipation
- Take prescribed pain medication before exercises: If advised by your doctor, taking medication 30-60 minutes before exercise can improve comfort and participation
What Are the Essential Early Recovery Exercises?
Essential early recovery exercises after hip replacement include ankle pumps for circulation, heel slides for hip flexion mobility, quadriceps sets for thigh strength, gluteal squeezes for buttock strength, and hip abduction slides for outer hip muscles. These exercises are typically started within 24 hours of surgery and performed 3-4 times daily.
The early phase of hip replacement rehabilitation focuses on gentle movements that promote circulation, prevent complications, and maintain basic muscle function without stressing the healing surgical site. These exercises are designed to be performed while lying in bed or sitting, making them appropriate even when your mobility is significantly limited.
During your hospital stay, a physiotherapist will typically visit you within 24 hours of surgery to begin your rehabilitation program. They will assess your condition, teach you these foundational exercises, and help you take your first steps with a walking frame or crutches. Continuing these exercises consistently after you return home is crucial for building the foundation for more advanced rehabilitation.
1 Heel Slides (Knee Bending)
Heel slides are one of the most important early exercises for restoring hip flexion range of motion. This exercise gently bends the hip and knee while keeping the heel in contact with the supporting surface, providing a controlled way to begin mobilizing your new joint.
- Lie on your back with both legs straight on the bed or floor
- Keep your heel in contact with the surface throughout the movement
- Slowly slide your heel toward your buttocks by bending your knee and hip
- Bend as far as comfortable without exceeding your hip precaution angle (typically 90 degrees)
- Hold the bent position for 5 seconds
- Slowly straighten your leg by sliding your heel back to the starting position
- Relax completely before the next repetition
2 Quadriceps Sets (Thigh Tightening)
Quadriceps sets are isometric exercises that strengthen the large muscle on the front of your thigh without moving the joint. Strong quadriceps are essential for standing, walking, and climbing stairs, making this exercise fundamental to your recovery.
- Lie on your back with your operated leg straight and your other leg bent for support
- Tighten the muscles on the front of your thigh by pushing the back of your knee down into the bed
- You should see your kneecap move slightly upward when you contract correctly
- Hold the contraction firmly for 5 seconds
- Relax completely and let your leg rest
- Repeat on the operated leg, then optionally on the other leg for balance
3 Gluteal Squeezes (Buttock Tightening)
The gluteal muscles are among the most important for hip function, providing power for walking, standing from a chair, and climbing stairs. Gluteal squeezes activate these muscles isometrically, helping to maintain their strength and neural connection during early recovery.
- Lie on your back with both knees bent and feet flat on the bed
- Squeeze your buttock muscles together as tightly as possible
- You should feel your hips lift slightly off the surface if squeezing hard enough
- Hold the squeeze for 5 seconds while continuing to breathe normally
- Relax completely and allow your muscles to rest
- Ensure you feel the contraction evenly on both sides
4 Ankle Pumps (Circulation Exercise)
Ankle pumps are critically important for preventing deep vein thrombosis (blood clots) after surgery. The pumping action of your calf muscles helps push blood back toward your heart, reducing blood pooling in your legs. This exercise should be performed frequently, especially in the first few weeks.
- Lie on your back with both legs straight
- Move your feet up and down in a pumping motion, pointing your toes toward your head then away
- Alternate between feet in a rhythmic pattern, like pedaling a bicycle
- Move through your full comfortable range at the ankle
- Continue for 10-20 pumps with each foot
- Repeat frequently throughout the day, especially after periods of rest
5 Hip Abduction Slides (Side-Lying Hip Opening)
Hip abduction strengthens the muscles on the outer hip that are essential for stabilizing your pelvis during walking. Weakness in these muscles often causes a limp (Trendelenburg gait) after hip surgery, making this exercise important for achieving normal walking patterns.
- Lie on your back with both legs straight
- Keep your toes pointing toward the ceiling throughout the movement
- Slowly slide your operated leg out to the side, away from your midline
- Move as far as comfortable without rotating your leg or hip
- Slowly slide your leg back to the starting position at the center
- Keep the movement controlled and avoid jerky motions
How Do I Progress to Intermediate Exercises?
Progress to intermediate hip replacement exercises after 1-2 weeks when early exercises become easy, adding straight leg raises, bridging, seated knee extensions, and standing exercises with support. Your physiotherapist will guide progression based on your pain levels, strength, and healing.
As your initial recovery progresses and the early exercises become easier, you will gradually add more challenging movements to your program. This progressive approach ensures that your muscles and the healing tissues around your hip are continuously challenged at an appropriate level, promoting optimal recovery without risking injury or setback.
The timing of progression varies significantly between individuals based on factors including pre-surgery fitness level, surgical approach, pain tolerance, and adherence to the exercise program. Some patients may be ready to progress within a week, while others may need two weeks or more. Your physiotherapist will assess your readiness and guide you on when to add new exercises.
6 Straight Leg Raises
Straight leg raises are an excellent exercise for strengthening the hip flexors and quadriceps in a functional pattern. This exercise requires more strength than the early isometric exercises and represents an important progression in your rehabilitation.
- Lie on your back with your operated leg straight and your other leg bent with foot flat
- Tighten your thigh muscles to lock your knee completely straight
- Keeping the knee locked, lift your straight leg approximately 15-20 centimeters (6-8 inches) off the surface
- Hold the raised position for 2-4 seconds
- Lower your leg slowly and in a controlled manner back to the starting position
- Relax briefly before the next repetition
7 Bridging (Hip Lifts)
Bridging exercises strengthen the gluteal muscles and lower back while also working the hamstrings. This functional exercise pattern is important for activities like getting out of bed and transitioning from sitting to standing.
- Lie on your back with both knees bent and feet flat on the surface, hip-width apart
- Keep your arms relaxed at your sides for stability
- Squeeze your buttocks and lift your hips off the surface, creating a straight line from your shoulders to your knees
- Hold the bridge position for 5 seconds while continuing to breathe
- Lower your hips slowly and in a controlled manner back to the starting position
- Relax completely before repeating
8 Seated Knee Extension
This exercise strengthens the quadriceps muscle while sitting, making it an excellent bridge between lying exercises and standing activities. It mimics the motion needed to straighten your leg when walking and climbing stairs.
- Sit on a firm chair or the edge of your bed with feet flat on the floor
- Maintain good posture with your back straight
- Straighten your operated leg out in front of you by extending at the knee
- Tighten your thigh muscle and hold the straightened position for 5 seconds
- Slowly lower your foot back to the floor
- Relax before repeating
What Standing Exercises Should I Perform?
Standing exercises after hip replacement include hip abduction (leg raises to the side) while holding a support, mini squats, standing hip extension, and weight shifting. These exercises build strength for walking and daily activities and are typically started 1-2 weeks post-surgery when balance and pain allow.
Standing exercises represent an important progression in your hip replacement rehabilitation. These exercises more closely replicate the demands placed on your hip during everyday activities like walking, climbing stairs, and standing from a seated position. They also challenge your balance and proprioception, helping to retrain the sensory feedback systems that contribute to coordination and fall prevention.
Before beginning standing exercises, ensure you have a stable support such as a countertop, heavy chair back, or wall. Never attempt standing exercises without something to hold onto until your physiotherapist confirms you have adequate balance and strength. Performing these exercises near a corner can provide support on two sides if needed.
9 Standing Hip Abduction
Standing hip abduction strengthens the gluteus medius muscle, which is critically important for maintaining level hips during walking. Weakness in this muscle is one of the most common causes of limping after hip replacement surgery.
- Stand upright holding onto a sturdy support (chair back or countertop) with both hands
- Keep your body upright and avoid leaning to either side
- Lift your operated leg straight out to the side, keeping your knee straight
- Keep your toes pointing forward, not rotated outward
- Hold the raised position for 2-4 seconds
- Slowly lower your leg back to the starting position
- Maintain an upright posture throughout - do not lean away from the moving leg
How Do I Walk Correctly With Crutches?
Walking with crutches after hip replacement follows a specific pattern: move the opposite crutch forward with your operated leg, then step through with your non-operated leg. This creates a natural reciprocal pattern that protects your hip while promoting normal gait mechanics.
Walking is one of the most important activities for hip replacement recovery. It promotes circulation, maintains joint mobility, builds strength, and helps restore confidence in your new hip. However, during the early weeks of recovery, you will need to use walking aids to protect your healing hip and maintain safety.
Most patients begin with a walking frame (walker) immediately after surgery for maximum stability, then progress to two crutches, then to a single crutch or cane, and finally to walking independently. The pace of this progression varies, with many patients transitioning from walker to crutches before hospital discharge and from crutches to a cane within 2-4 weeks.
10 Walking with Crutches
Proper crutch-walking technique helps protect your hip while allowing you to maintain as normal a walking pattern as possible. The goal is to partially unload your operated leg while still allowing it to move through a natural gait cycle.
- Stand upright with good posture, crutches positioned slightly in front and to the side of your feet
- Move the crutch on the OPPOSITE side forward at the same time as you step with your operated leg
- For example: if your left hip was replaced, move your right crutch and left foot forward together
- Then step through with your non-operated leg, moving the other crutch forward
- Continue this alternating pattern, maintaining an upright posture
- Take moderate-length steps - not too short, not too long
- Keep your weight supported through your hands, not your armpits
When walking after hip replacement, focus on maintaining good technique rather than covering long distances. Multiple short walks with proper form are more beneficial than one long walk with deteriorating technique. As a general guide, if your walking pattern starts to deteriorate or you develop a limp, it's time to rest.
How Do I Navigate Stairs After Hip Replacement?
When climbing stairs after hip replacement: "Good leg up first, bad leg down first." Going up, lead with your non-operated leg; going down, lead with your operated leg. Always hold the handrail with one hand and use a crutch on the opposite side for support.
Stair navigation is one of the more challenging activities after hip replacement surgery. The combination of increased hip flexion required to lift your leg, the strength needed to push your body weight upward, and the balance demands make stairs a significant milestone in your recovery. Most patients can begin practicing stairs within the first week after surgery with proper supervision and technique.
The key principle for safe stair climbing is remembered by the phrase "up with the good, down with the bad" or more simply, "the good leg goes to heaven, the bad leg goes to hell." This means your stronger, non-operated leg leads when going up, and your operated leg leads when going down.
11 Stair Climbing with Crutches
Safe stair navigation with crutches requires proper technique and adequate strength. Practice on a single step first before attempting a full flight of stairs, and always ensure a handrail is available.
- Position yourself: Hold both crutches in one hand on the opposite side from the handrail. Hold the handrail firmly with your other hand.
- Going UP stairs:
- Step up first with your NON-operated (good) leg
- Then bring your operated leg and crutches up to the same step
- Take one step at a time - both feet on each step before proceeding
- Going DOWN stairs:
- Lower your crutches to the next step down first
- Step down with your OPERATED leg
- Then step down with your non-operated leg to the same step
- Maintain an upright posture and take your time
- If no handrail is available, use both crutches and have someone spot you
What Is the Typical Recovery Timeline?
Hip replacement recovery follows a general timeline: Days 1-3 in hospital with basic mobility; Weeks 1-2 home exercises and short walks; Weeks 2-6 progressive strengthening and weaning from walking aids; Weeks 6-12 returning to most daily activities; Months 3-6 full recovery with continued improvement possible for up to a year.
Understanding the typical recovery timeline helps set realistic expectations and allows you to track your progress against general benchmarks. However, it's important to remember that individual recovery varies significantly based on factors including age, pre-surgery fitness level, surgical approach, body weight, other health conditions, and commitment to rehabilitation exercises.
The timeline below represents average recovery milestones. Some patients progress faster, while others may need more time. The most important factor in your recovery is consistent adherence to your exercise program and following your healthcare team's guidance rather than comparing yourself to others.
| Timeframe | Expected Milestones | Exercise Focus |
|---|---|---|
| Day 1 | Sitting on edge of bed, standing with help, possible first steps | Ankle pumps, breathing exercises |
| Days 2-3 | Walking short distances with frame, stair practice, discharge planning | Begin bed exercises, short walks |
| Weeks 1-2 | Home mobility, short walks indoors, managing daily tasks with help | All early exercises 3-4x daily |
| Weeks 2-4 | Transition from walker to crutches/cane, longer walks, less pain medication | Add progressive exercises |
| Weeks 4-6 | Walking without aids (many patients), driving (if left hip or automatic), return to sedentary work | Standing exercises, longer walks |
| Weeks 6-12 | Most precautions lifted, normal daily activities, swimming possible | Full exercise program, consider gym |
| Months 3-6 | Near-normal function, return to most activities, continued strength gains | Maintenance program, low-impact activities |
| 6-12 Months | Maximum recovery achieved, final outcome, potential return to golf, cycling, hiking | Long-term maintenance |
When Should I Stop Exercising and Seek Medical Help?
Stop exercising and contact your healthcare provider if you experience sudden severe pain, fever above 38°C (100.4°F), redness or drainage from your incision, sudden leg swelling, calf pain, chest pain, shortness of breath, or a feeling that your hip has "popped out." These may indicate infection, blood clot, or dislocation requiring urgent attention.
While exercise is essential for recovery, it's equally important to recognize warning signs that indicate something may be wrong. Most post-operative complications are treatable when detected early, making it crucial to know what to watch for and when to seek help.
Some discomfort during and after exercise is normal, particularly in the early weeks. You may feel muscle soreness, mild aching in the hip area, and fatigue. These sensations typically improve with rest and do not indicate a problem. However, certain symptoms require prompt medical evaluation.
- Fever above 38°C (100.4°F) - May indicate infection
- Increasing redness, warmth, or swelling at incision - Possible wound infection
- Drainage or opening of the surgical wound - Risk of deep infection
- Sudden severe pain in the hip - Possible dislocation or fracture
- Feeling or hearing a "pop" in your hip - Possible dislocation
- One leg suddenly appearing shorter - Possible dislocation
- Sudden swelling in your calf or thigh - Possible blood clot (DVT)
- Calf pain, especially with ankle flexion - Possible blood clot
- Chest pain or difficulty breathing - Possible pulmonary embolism (emergency)
- Numbness or tingling in your leg - Possible nerve issue
In case of chest pain, severe breathing difficulty, or loss of consciousness, call emergency services immediately. Find your emergency number
The following are typically normal and not cause for concern:
- Mild muscle soreness that improves within 24-48 hours
- Slight increase in swelling after activity that reduces with rest and elevation
- Fatigue after exercise sessions
- Clicking or popping sounds from the hip without pain
- Feeling "tired" in the leg after walking
Frequently Asked Questions
Medical References & Sources
This article is based on current international guidelines and peer-reviewed research. All medical information has been reviewed according to evidence level 1A (systematic reviews and meta-analyses of randomized controlled trials).
- Cochrane Database of Systematic Reviews. (2024). Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. DOI: 10.1002/14651858.CD007624.pub4
- American Academy of Orthopaedic Surgeons. (2024). Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline. AAOS.
- American Physical Therapy Association. (2024). Physical Therapy Management of Total Hip Arthroplasty: Clinical Practice Guidelines. APTA.
- World Health Organization. (2024). Rehabilitation in Health Systems: Guide for Action. WHO.
- Bourne, R.B., et al. (2023). Enhanced recovery pathways after total hip and knee arthroplasty. The Lancet, 401(10389), 1583-1595.
- National Institute for Health and Care Excellence. (2023). Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157.
- Di Monaco, M., & Castiglioni, C. (2023). Which type of exercise therapy is effective after hip arthroplasty? European Journal of Physical and Rehabilitation Medicine, 59(2), 178-190.
About Our Medical Editorial Team
Medical Writing
This article was written by the iMedic Medical Editorial Team, which includes specialists in orthopedic surgery, physical therapy, and rehabilitation medicine. Our team has extensive experience in post-surgical rehabilitation protocols.
Medical Review
All content is reviewed by our independent Medical Review Board, consisting of board-certified physicians who ensure accuracy and adherence to current clinical guidelines.
Guidelines Followed: American Academy of Orthopaedic Surgeons (AAOS), American Physical Therapy Association (APTA), World Health Organization (WHO) Rehabilitation Guidelines, Cochrane Collaboration.
Medical Editorial Board: iMedic has an independent medical editorial board consisting of specialist physicians in orthopedic surgery, physical therapy, rehabilitation medicine, and sports medicine.