Agreeing to undergo a total joint replacement surgery can be scary for some. While it is and should be considered a major surgical procedure, the functional outcomes are usually quite good for most people. A research study in 2020, showed that over 90% of patients, who had a total hip replacement surgery, showed significant improvements in both hip pain and function within one year after the procedure.
Over the years, I have treated hundreds of patients who have undergone total hip replacement surgeries. This has given me plenty of experience to develop the best and most important physical therapy exercises after hip replacement surgery in order to optimize postoperative recovery and function.
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Total Hip Replacement, medically known as a Total Hip Arthroplasty (THA), is a surgical procedure in the hip joint to remove damaged bone and cartilage and replace them with prosthetic components. This surgery is most commonly performed on individuals who have developed advanced stages of hip osteoarthritis (arthritis of the bones).
If you’re just in the initial stage of deciding whether or not to have a total hip replacement or if you’re trying to prepare your hip for an upcoming total hip replacement surgery, then you’ll definitely want to check out my article, “9 Must-Do Exercises Before a Hip Replacement Surgery.”
Once the decision to undergo surgery has been made, it is important to gain a strong understanding of both the physical and emotional demands that will be required within the first month after the surgery.
There will be sudden and significant changes to the body’s capacity to perform normal daily activities. Preparing for these sudden changes will promote a speedy recovery with less dramatic fluctuations. This includes learning which physical therapy exercises after a total hip replacement are the best to perform in order to promote an optimal outcome.
So let’s dive in!
Postoperative Pain Management
Disclaimer: Always follow your doctor’s/surgeon’s instructions when taking medications as the specifications of each patient case are different.
Just prior to the start of the surgery, the anesthesiologist and surgical team will commonly provide a nerve block injection with a local anesthetic. This injection will provide pain relief in the hip and leg for approximately 24-48 hours.
After surgery, the surgeon commonly provides a prescription for an opioid analgesic (Oxycodone, Tramadol, etc.) with instructions for the patient to begin taking this medication prior to the nerve block effectiveness wearing off. It is important to “stay ahead of the pain” as opioids tend to take several hours before they take effect. Don’t wait until the nerve block already wears off to begin taking the pain medication as it will already be too late!
It is common for patients to gradually taper off from taking opioids beginning around 7-14 days after surgery. They typically start by substituting the opioids with Tylenol or other non-opioid pain relief medications.
It is best practice to plan out the pain medication schedule to include one pill right before bed, which can allow for 3-4 hours of unobstructed sleep. However, eventually, the pain is likely to wake you up from your sleep. At this point, it helps to move the leg around and/or use a cold pack on the joint to reduce the pain and allow you to fall back asleep.
Leg Swelling Management
Swelling management isn’t as critical after a Total Hip Replacement as it is after a Total Knee Replacement. Swelling after a Total Hip Replacement is much more limited overall, though the use of a cryotherapy machine postoperatively is still highly recommended for pain management.
Using the cryotherapy machine 3-4x/day for 20-30 minutes during the first week after surgery is commonplace. Then, gradually reduce the frequency of icing down to 2x/day over the next couple of weeks.
I highly recommend using the Ossur Cold Rush Therapy Machine System with the hip pad for proper swelling management after a Total Hip Replacement.
- EFFECTIVE, SOOTHING AND LOCALIZED TREATMENT
- OFFERS POST-OPERATIVE PAIN AND SWELLING RELIEF
- STAY COOLER, LONGER!
- STRONG, SILENT AND LIGHTWEIGHT
- INCLUDES A KNEE PAD
- 6-MONTH MANUFACTURER WARRANTY
When Can I Start Exercising After My Hip Replacement Surgery?
Gentle exercises such as quad sets and heel slides can begin immediately after surgery. Most other exercises, including beginning formal physical therapy treatment sessions, should begin one week postoperatively after a Total Hip Replacement.
- Quad Sets
- Actively squeeze your quad muscles while trying to “squish” the towel roll that is placed under the knee.
- Perform: 10 sec holds x 10 reps (3-4x/day)
- Supine Heel Slides with Strap
- Use the strap to slide the foot towards you, which causes the hip to flex, pause, and then slide the foot out back to the starting position.
- Perform: 10 reps (3-4x/day)
- Ankle Pumps
- Risk of Deep Vein Thrombosis (DVT), which is essentially a blood clot, is heightened significantly after hip surgery. These most commonly occur in your lower legs because of stagnant blood pooling in the legs. To prevent DVTs, it is imperative that you stand and move around at least once per hour and perform ankle pumps several times throughout the day.
- Perform: 30 repetitions (5-6x/day)
My Doctor Did Not Prescribe Me Physical Therapy, Why Not?
I highly recommend going to formal physical therapy for those who have undergone a Total Hip Replacement. Seeing a physical therapist in person will provide you with a custom set of exercises and stretches that will target your greatest limitations and weaknesses.
However, there are some hip surgeons out there who only typically refer his/her patients to physical therapy after a Total Hip Replacement whenever the patient seems to be having difficulty recovering on their own. For instance, if a surgeon notices that the patient is still limping significantly and/or still has significant hip stiffness and pain during the 6-week post-op follow-up visit, they sometimes only then refer the patient to physical therapy.
I highly discourage this practice. Obviously, I am slightly biased by being a physical therapist, but I firmly believe that every post-op Total Hip Replacement patient should be seen for a physical therapy evaluation for us to determine whether the patient would benefit from therapeutic treatment.
My #1 Goal for all of my patients is to optimize their postoperative outcomes by MAXIMIZING their treatment sessions. There is absolutely no harm in referring postoperative patients to physical therapy for evaluation. If it is then determined that the patient has ample strength, mobility, and minimal ambulatory deviations, then yes, that patient is likely to succeed with/without skilled physical therapy.
As a patient, you certainly have every right to ask your surgeon to give you a referral to physical therapy after your surgery.
Ultimately, though, if my family member were to have a Total Hip Replacement, then I for sure would be getting that person in for formal physical therapy sessions.
How Long Will It Take to Recover After Hip Replacement?
It should take around 8 weeks after Total Hip Replacement surgery to return to full function. This is the amount of time that it typically takes patients to return to normal, independent daily activities and have a normal gait pattern (walking without a limp). There are a lot of additional factors that play into this timeframe including:
- How long have you been living with hip pain and/or other hip symptoms (i.e. stiffness, etc.)?
- Hip muscle strength
- Hip mobility
- How long have you been walking with a limp?
- How motivated are you to recover?
However, if you have been trying to hold off from having surgery for several months or years even, then it is likely going to take 4-6 months for a full recovery.
Exercises to Avoid After Hip Replacement Surgery
High-impact and rotational sports should be avoided for several months after surgery. Activities such as running and skiing are usually discouraged by surgeons after a Total Hip Replacement, however, there are no long-term research studies that have conclusively shown participation to have sped up the degradation of the implants.
Ultimately, it is up to you to decide whether or not to return to high-impact activities.
How important is it to you to participate in _____ activity?
How Soon Can I Play Golf After a Hip Replacement?
I advise that my patients can begin working on his/her short game (chipping and putting) around 4 weeks after a hip replacement surgery. This can gradually progress to club swinging and driving around 4-8 weeks and playing a full round of golf between 8-12 weeks postoperatively.
How to Prepare for a Total Hip Replacement Surgery
There are several considerations that one must consider before hip replacement surgery.
Declutter your home (remove any tripping hazards)
- Many of us have rugs, dog or children’s toys, clothing, etc. lying about in our homes. These objects become tripping and slipping hazards after joint replacement surgery when you’re medicated, weak, and not feeling well.
Make plans for assistance in the home for the first 1-2 weeks post-operatively
- For the first couple of weeks after surgery, you WILL NEED help around the home. This includes help with bathing (please use a shower chair), cooking, dressing, and other basics around the home. If you live alone, you can speak with your surgeon about going to an inpatient rehab facility during this period where you will receive daily physical therapy and nursing support.
Plan for alternative transportation for 4-6 weeks post-operatively
- You will not be permitted to drive while actively taking opioid pain medications. Also, if you have surgery on your right hip (the side used to press on the brake and gas pedal), plan for 4-6 weeks until the surgeon clears you to drive by yourself.
Purchase a walker and a single-point cane
- Most surgical centers require that you bring your own walker with you to surgery as they will not provide you with one. Most patients usually purchase a rolling walker (a walker with wheels on the front legs), however, if you are a fall risk and have difficulty with balance, I recommend that you purchase a regular non-wheeled walker as this type is much more stable. Go ahead and also purchase an adjustable single-point cane as you will quickly transition from the walker to the cane within 2 or 3 weeks after surgery.
9.6- ROLLING WITH WHEELS
- FOLDING WALKER
- QUALITY CONSTRUCTION
- 5″ WHEELS, VINYL CONTOURED HAND GRIP
- SAFE AND EASY OPERATION
9.5- NON-WHEELED
- FOLDING WALKER
- QUALITY CONSTRUCTION, YET LIGHTWEIGHT
- PREMIUM FEATURES
- SAFE & EASY TO USE
4.9- ERGONOMIC AND SMOOTH OFFSET HANDLE
- ANTI-CORROSION ALUMINUM CANE
- ADJUSTABLE HEIGHTS AND WEIGHT CAPACITY
- ANTI-SLIP RUBBER CANE BASE
Arrange sleeping and waking hours to be on the same floor of the home
- If possible, arrange so that you can sleep, eat, bathe, etc. all on the same floor as it will be very difficult for you to maneuver up and down the stairs for the first few weeks after hip surgery.
Install grab bar handles near the shower and toilet
- Installing grab bar handles in the bathroom will significantly help with getting into/out of the shower or up and down from the toilet, which can be very difficult after a hip joint replacement.
9.6- 2 PACK
- 16″ LONG EACH
- ANTI-RUST STAINLESS STEAL WITH CHROME FINISH
- NON-SLIP KNURLED SURFACE
- STYLISH END COVERS CONCEAL MOUNTING HARDWARE
Use a raised toilet seat
- A raised toilet seat can also help by temporarily elevating the height of the toilet seat making it much easier to both sit down and stand back up.
9- ADDITIONAL 5″ IN TOILET SEAT HEIGHT
- ADJUSTABLE WIDTH ARMS
- FOAM PADDED ARM RESTS
- UNIVERSAL FIT
- LIGHTWEIGHT & DURABLE
Use a shower chair in the tub/stand-up shower
- After surgery, you will not be able to stand independently while bathing due to hip pain and weakness. Use a shower chair to allow yourself to sit reducing the risk of falling.
9.3- SIT, SHOWER & RELAX
- DURABLE & SECURE – WEIGHT CAPACITY 350 LBS
- COMFORTABLE
- VERSATILE & EASY TO USE
- LIGHTWEIGHT & PORTABLE
Standard Hip Precautions
- Traditionally, hip precautions used to be observed in all patients who had undergone a posterolateral approach during the total hip replacement. The following standard hip precautions are to be followed until 6-weeks after surgery:
- No crossing of the legs (no hip adduction and/or internal rotation)
- No hip flexion beyond 90 degrees (be careful when tying your shoes)
- No crossing of the legs (no hip adduction and/or internal rotation)
- However, newer surgical approaches have been developed where the standard hip precautions are no longer required, so be sure that you clearly understand your surgeon’s instructions post-operatively. You can also ask your physical therapist if you’re not sure.
- Traditionally, hip precautions used to be observed in all patients who had undergone a posterolateral approach during the total hip replacement. The following standard hip precautions are to be followed until 6-weeks after surgery:
Schedule your first physical therapy appointment for after the surgery
- Now is the time to go ahead and schedule your first post-operative physical therapy appointment. You can ask your surgeon, but traditionally your first appointment should be scheduled for when you are 1 week post-op from a hip replacement surgery.
The 8 BEST Exercises After Hip Replacement Surgery!
Recumbent Bicycle (Stationary Bike)
- Perform: 10-15 mins, building up to 30 mins eventually with mild resistance (1x/day)
Supine Hip External Rotator Stretch
- Use both hands to gently pull your knee towards the opposite shoulder.
- You should feel a stretch in the buttock area.
- Perform: 30 sec holds x 3 reps (1x/day)
Hip Flexor "Thomas Stretch" - Modified
- Lie on the edge of a bed or couch with the inside knee bent and the outside leg gently hanging off the edge.
- Try to place the toes against the floor to hold the downward knee in a bent position.
- Only want to feel a GENTLE stretch on the thigh of the downward leg.
- Do NOT perform this stretch if you have had a surgical anterior approach without guidance from your physical therapist or surgeon.
- Perform: 30 sec holds x 2-3 reps (1x/day)
Dual Leg Bridging
- Bend both knees equally to a position that the injured knee can tolerate.
- Engage your glute muscles by squeezing your buttocks.
- Lift your hips towards the ceiling. Pause, then lower.
- Perform: 2-3 sets x 10 reps (1x/day)
Supine Marching
- Tighten your abdominals while pressing your low back flat against the surface.
- Slowly lift one bent leg towards your chest, then lower. Alternate marching side to side.
- Perform: 2-3 sets x 10 reps (1x/day)
Straight Leg Raise
- Engage your core by contracting your abdominal muscles.
- Lift the injured leg towards the ceiling while striving to keep the knee completely straight. Pause. Then lower.
- Perform: 2-3 sets x 5-10 reps (1x/day) ** Increase Reps Slowly and Gradually Over Time **
Hip Adduction Isometrics
- Place a firm pillow or towel roll between your knees.
- Squeeze the object between the knees and hold for 5 seconds, then relax.
- Perform: 2 sets of 5 sec holds x 10 reps (1x/day)
Sit-to-Stand from Chair
- Perform a 1/2 depth squat (mini-squat) by sitting your hips back as if you were going to sit down on a chair.
- Do not allow your knees to go in front of your toes.
- Modification: For poor balance, hold onto the edge of a dining room table or kitchen countertop.
- Perform: 2-3 sets x 10 reps (1x/day)
